6.1. RFB 25-26-03 Attachment F1 - Statement of Experience (Word).docx
DOCX document 42 KB Posted
- Solicitation number
- RFB 25-26-03
- Issued by
- Santa Clara County, San Francisco City, California
About this file
This document is a Statement of Experience form for a Request for Bid (RFB 25-26-03) issued by the City of Santa Clara for Heat Recovery Steam Generator (HRSG) Cleaning Services in support of Silicon Valley Power (SVP). The procurement seeks qualified contractors to provide cleaning services for heat recovery steam generators, with the bid opportunity posted on the BidNet Direct e-Procurement system. Bidders are required to complete a comprehensive form detailing their business background, experience, safety records, licensing, and key personnel qualifications.
The form requires detailed disclosure of business information, including years in operation, experience with utilities and power plants, potential legal or financial issues, safety performance metrics such as Total Recordable Incident Rate (TRIR) and Experience Modification Rate (EMR), and professional licenses. Bidders must provide a three-year history of safety performance, with explanations required for incident rates exceeding specific thresholds. The document emphasizes transparency, requiring bidders to disclose any past contract failures, litigation, bankruptcy declarations, or pending business sales that might impact their ability to perform the contracted services. By signing the form, bidders certify the accuracy of their submitted information, with the understanding that false statements could result in contract voiding.
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Text version
RFB - 25-26-03
Attachment F1 – Statement of Experience Heat Recovery Steam Generator (HRSG) Cleaning Services
SECTION A
Business Name
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Address
City, State, Zip
Federal Tax ID
Business License # Please submit copy with bid, if applicable.
Business Type- select from the dropdown list.
Choose an item.
Explain if Other was selected from list above:
State of Incorporation, if applicable
SECTION B
Number of years in business under present business name.
Number of years under prior business name, if applicable.
SECTION C
Number of years of experience providing required, equivalent, or related projects/services.
Number of years’ experience with utilities or power plants.
SECTION D
Has the business failed to complete or refused to complete a contract?
Yes ☐
No ☐
If yes, please explain.
SECTION E
Business is authorized to conduct business in the State of California?
SECTION F
Has the business been involved in any litigation?
Explain any litigation related to services/work similar to the services being requested?
SECTION G
Has the business filed any written declaration for bankruptcy protection, a potential merger or acquisition, office closure, pending lawsuits, financial loss that might affect the business’ ability to perform contracted work/services?
If yes, please explain
Bidder shall disclose if they are currently in negotiations to be sold or plan to sell the business during the term of any resulting Agreement.
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SECTION H
License Provisions – Has the business changed names or license numbers in the past five (5) years?
If yes, please explain.
SECTION I
List the names and titles of key personnel assigned to this effort.
Name Title
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SECTION J
List all required business and professional licenses that may pertain to the requirements of any awarded contract.
Please submit any copies with bid, if applicable.
License Number Type Expiration
SECTION K
Provide Total Recordable Incident Rate (TRIR) rates and submit Occupational Safety and Health Administration (OSHA) Form 300 logs for the last three (3) years.
If a TRIR rate is greater than two (2) provide explanation for the rate and any actions that have been taken to mitigate/ improve the rate.
SECTION L
Provide Experience Modification Rate (EMR) rates for the last three (3) years.
If an EMR rate is greater than one (1) provide explanation for the rate and any actions that have been taken to mitigate/ improve the rate.
By signing this Statement of Experience, you are certifying that all information provided on this form and contained within your proposal are true, and you acknowledge that if the proposal contains any false statements, the City of Santa Clara may declare any contract or agreement made as a result of the proposal to be void.
Signature: Date:
Print Authorized Name: Title:
RFB – 25-26-03
File details come from the government source that posted it. Updated .