6-EJCDC Qualifications Statement.pdf

EJCDC C-451, Qualifications Statement.

Copyright© 2018 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved.

THIS FORM HAS BEEN SUBSTANTIALLY EDITED BY OWNER

QUALIFICATIONS STATEMENT

ARTICLE 1—GENERAL INFORMATION

1.01 Provide contact information for the Business:

Legal Name of Business:

Corporate Office

Name: Phone number:

Title: Email address:

Business address of corporate office:

Local Office

Name: Phone number:

Title: Email address:

Business address of local office:

1.02 Provide information on the Business’s organizational structure:

Form of Business: ☐ Sole Proprietorship ☐ Partnership ☐ Corporation

☐ Limited Liability Company ☐ Joint Venture comprised of the following companies:

1.

2.

3.

Provide a separate Qualification Statement for each Joint Venturer.

Date Business was formed: State in which Business was formed:

Is this Business authorized to operate in the Project location? ☐ Yes ☐ No ☐ Pending

1.03 Identify all businesses that own Business in whole or in part (25% or greater), or that are wholly or partly (25% or greater) owned by Business:

Name of business: Affiliation:

Address:

Name of business: Affiliation:

Address:

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Name of business: Affiliation:

Address:

1.04 Provide information regarding the Business’s officers, partners, and limits of authority.

Name: Title:

Authorized to sign contracts: ☐ Yes ☐ No Limit of Authority: $

Name: Title:

Authorized to sign contracts: ☐ Yes ☐ No Limit of Authority: $

Name: Title:

Authorized to sign contracts: ☐ Yes ☐ No Limit of Authority: $

Name: Title:

ARTICLE 2—LICENSING

2.01 Provide information regarding licensure for Business:

Name of License:

Licensing Agency:

License No: Expiration Date:

Name of License:

Licensing Agency:

License No: Expiration Date:

ARTICLE 3—DIVERSE BUSINESS CERTIFICATIONS

3.01 Provide information regarding Business’s Diverse Business Certification, if any. Provide evidence of current certification.

Certification Certifying Agency Certification Date

☐ Disadvantaged Business Enterprise

☐ Minority Business Enterprise

☐ Woman-Owned Business Enterprise

☐ Small Business Enterprise

☐ Disabled Business Enterprise

☐ Veteran-Owned Business Enterprise

☐ Service-Disabled Veteran-Owned Business ☐ HUBZone Business (Historically Underutilized) Business

Copyright© 2018 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved.

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☐ Other

☐ None

ARTICLE 4—SAFETY

4.01 Provide information regarding Business’s safety organization and safety performance.

Name of Business’s Safety Officer:

Safety Certifications

Certification Name Issuing Agency Expiration

4.02 Provide Worker’s Compensation Insurance Experience Modification Rate (EMR), Total Recordable Frequency Rate (TRFR) for incidents, and Total Number of Recorded Manhours (MH) for the last 3 years and the EMR, TRFR, and MH history for the last 3 years of any proposed Subcontractors that will provide Work valued at 10% or more of the Contract Price. Provide documentation of the EMR history for Business and Subcontractors.

Year

Company EMR TRFR MH EMR TRFR MH EMR TRFR MH

ARTICLE 5—FINANCIAL

5.01 Provide information regarding the Business’s financial stability. Provide the most recent audited financial statement, and if such audited financial statement is not current, also provide the most current financial statement.

Financial Institution:

Business address:

Date of Business’s most recent financial statement: ☐ Attached Date of Business’s most recent audited financial statement: ☐ Attached Financial indicators from the most recent financial statement

Contractor’s Current Ratio (Current Assets ÷ Current Liabilities)

Contractor’s Quick Ratio ((Cash and Cash Equivalents + Accounts Receivable + Short Term Investments) ÷ Current Liabilities)

Copyright© 2018 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved.

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ARTICLE 6—SURETY INFORMATION

6.01 Provide information regarding the surety company that will issue required bonds on behalf of the Business, including but not limited to performance and payment bonds.

Surety Name:

Surety is a corporation organized and existing under the laws of the state of:

Is surety authorized to provide surety bonds in the State of Georgia? ☐ Yes ☐ No

Is surety listed in “Companies Holding Certificates of Authority as Acceptable Sureties on Federal Bonds and as Acceptable Reinsuring Companies” published in Department Circular 570 (as amended) by the Bureau of the Fiscal Service, U.S. Department of the Treasury?

☐ Yes ☐ No Mailing Address (principal place of business):

Physical Address

Phone (main): Phone (claims):

ARTICLE 7—INSURANCE

7.01 Provide information regarding Business’s insurance company(s), including but not limited to its Commercial General Liability carrier. Provide information for each provider.

Name of insurance provider, and type of policy (CLE, auto, etc.):

Insurance Provider Type of Policy (Coverage Provided)

Are providers licensed or authorized to issue policies in the Project location? ☐ Yes ☐ No Does provider have an A.M. Best Rating of A-VII or better? ☐ Yes ☐ No Mailing Address

Physical Address

Copyright© 2018 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved.

THIS FORM HAS BEEN SUBSTANTIALLY EDITED BY OWNER

Phone (main):

Phone (claims):

ARTICLE 8—CONSTRUCTION EXPERIENCE

8.01 Provide information that will identify the overall size and capacity of the Business.

Average number of current full-time employees:

Estimate of revenue for the current year:

Estimate of revenue for the previous year:

8.02 Provide information regarding the Business’s previous contracting experience.

Years of experience with projects like the proposed project:

As a general contractor: As a joint venturer:

Has Business, or a predecessor in interest, or an affiliate identified in Section 1.03:

Been disqualified as a Proposer by any local, state, or federal agency within the last 5 years?

☐ Yes ☐ No Been barred from contracting by any local, state, or federal agency within the last 5 years?

☐ Yes ☐ No Been released from a bid in the past 5 years? ☐ Yes ☐ No

Defaulted on a project or failed to complete any contract awarded to it? ☐ Yes ☐ No Refused to construct or refused to provide materials defined in the contract documents or in a change order? ☐ Yes ☐ No Been a party to any currently pending litigation or arbitration? ☐ Yes ☐ No

Provide full details in a separate attachment if the response to any of these questions is Yes.

8.03 List all projects currently under contract in Schedule A and provide indicated information.

8.04 List a minimum of five projects completed in the last 5 years in Schedule B and provide indicated information to demonstrate the Business’s experience with projects similar in type and cost of construction.

8.05 In Schedule C, provide information on key individuals whom Business intends to assign to the Project. Provide resumes for those individuals included in Schedule C. Key individuals include the Project Manager, Project Superintendent, Quality Manager, Foreperson, and Safety Manager.

Resumes may be provided for Business’s key leaders as well.

ARTICLE 9—QUESTIONNAIRE

9.01 General description of the type of work performed by the Proposer’s company:

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9.02 Has the Proposer ever failed to complete any job awarded to it? If so, please provide details including where and why.

9.03 Has the Proposer ever failed to complete a job on time? If so, please provide details including how late it was.

9.04 Has the Proposer ever been assessed liquidated damages? If so, please provide details including where and why.

9.05 Has the Proposer ever been in litigation or arbitration with the Owner or any other public body?

If so, please provide details including where and why.

9.06 Has Proposer ever defaulted on a contract? If so, please provide details including where and why.

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9.07 Has the Proposer ever refused to sign a Contract at the original bid price? If so, please provide details including where and why.

ARTICLE 10—REQUIRED ATTACHMENTS

10.01 Provide the following information with the Statement of Qualifications:

A. If Business is a Joint Venture, separate Qualifications Statements for each Joint Venturer, as required in Section 1.02.

B. Diverse Business Certifications if required by Section 3.01.

C. Certification of Business’s safety performance if required by Section 4.02.

D. Financial statements as required by Section 5.01.

E. Attachments providing additional information as required by Section 8.02.

F. Schedule A (Current Projects) as required by Section 8.03.

G. Schedule B (Previous Experience with Similar Projects) as required by Section 8.04.

H. Schedule C (Key Individuals) and resumes for the key individuals listed, as required by Section 8.05.

I. Additional items as pertinent.

Copyright© 2018 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved.

THIS FORM HAS BEEN SUBSTANTIALLY EDITED BY OWNER

This Statement of Qualifications is offered by:

Business:

(typed or printed name of organization)

By:

(individual’s signature)

Name:

(typed or printed)

Title:

(typed or printed)

Date:

(date signed)

(If Business is a corporation, a partnership, or a joint venture, attach evidence of authority to sign.)

Attest:

(individual’s signature)

Name:

(typed or printed)

Title:

(typed or printed) Address for giving notices:

Designated Representative:

Name:

(typed or printed)

Title:

(typed or printed)

Address:

Phone:

Email:

EJCDC® C-451, Qualifications Statement—Schedule A—Current Projects.

Copyright© 2018 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved.

Schedule A—Current Projects

Name of Organization Project Owner Project Name General Description of Project Bid Price/Contract Amount Final Project Cost Initial Contract Time Final Contract Time Date Project Completed Explain any variance in cost and/or time:

Key Project Personnel Project Manager Project Superintendent Safety Manager Quality Control Manager Name Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference) Name Title/Position Organization Telephone Email Owner Designer Construction Manager Major Subcontractors (or state if self-performed) Organization Subcontractor PM Address Telephone Email Electrical Instrumentation & Controls Other

Name of Organization Project Owner Project Name General Description of Project Bid Price/Contract Amount Final Project Cost

Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference) Name Title/Position Organization Telephone Email Owner Designer

EJCDC® C-451, Qualifications Statement—Schedule A—Current Projects.

Copyright© 2018 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved.

Construction Manager Major Subcontractors (or state if self-performed) Organization Subcontractor PM Address Telephone Email Electrical

General Description of Project Bid Price/Contract Amount Final Project Cost

Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference) Name Title/Position Organization Telephone Email Owner Designer Construction Manager Major Subcontractors (or state if self-performed) Organization Subcontractor PM Address Telephone Email Electrical

EJCDC® C-451, Qualifications Statement—Schedule B—Previous Experience with Similar Projects.

Copyright© 2018 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved.

Schedule B—Previous Experience with Similar Projects

Name of Organization Project Owner Project Name General Description of Project Bid Price/Contract Amount Final Project Cost

Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference) Name Title/Position Organization Telephone Email Owner Designer Construction Manager Major Subcontractors (or state if self-performed) Organization Subcontractor PM Address Telephone Email Electrical

General Description of Project Bid Price/Contract Amount Final Project Cost

Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference) Name Title/Position Organization Telephone Email

Designer

Copyright© 2018 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved.

Construction Manager Major Subcontractors (or state if self-performed) Organization Subcontractor PM Address Telephone Email Electrical

General Description of Project Bid Price/Contract Amount Final Project Cost

Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference) Name Title/Position Organization Telephone Email Owner Designer Construction Manager Major Subcontractors (or state if self-performed) Organization Subcontractor PM Address Telephone Email Electrical

Copyright© 2018 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved.

Schedule B—Previous Experience with Similar Projects

General Description of Project Bid Price/Contract Amount Final Project Cost

Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference) Name Title/Position Organization Telephone Email Owner Designer Construction Manager Major Subcontractors (or state if self-performed) Organization Subcontractor PM Address Telephone Email Electrical

General Description of Project Bid Price/Contract Amount Final Project Cost

Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference) Name Title/Position Organization Telephone Email

Copyright© 2018 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved.

Designer Construction Manager Major Subcontractors (or state if self-performed) Organization Subcontractor PM Address Telephone Email Electrical

General Description of Project Bid Price/Contract Amount Final Project Cost

Reference Contact Information (listing names indicates approval to contacting the names individuals as a reference) Name Title/Position Organization Telephone Email Owner Designer Construction Manager Major Subcontractors (or state if self-performed) Organization Subcontractor PM Address Telephone Email Electrical

EJCDC® C-451, Qualifications Statement—Schedule C—Key Individuals.

Copyright© 2018 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved.

Schedule C—Key Individuals

Project Manager Name of individual Years of experience as project manager Years of experience with this organization Number of similar projects as project manager Number of similar projects in other positions Current Project Assignments Name of assignment Percent of time used for this project Estimated project completion date

Reference Contact Information (listing names indicates approval to contact named individuals as a reference) Name Name Title/Position Title/Position Organization Organization Telephone Telephone Email Email Project Project Candidate’s role on project

Candidate’s role on project

Project Superintendent Name of individual Years of experience as project superintendent Years of experience with this organization Number of similar projects as project superintendent Number of similar projects in other positions Current Project Assignments Name of assignment Percent of time used for this project

Reference Contact Information (listing names indicates approval to contact named individuals as a reference)

Title/Position Title/Position Organization Organization Telephone Telephone Email Email Project Project Candidate’s role on project

Candidate’s role on project

Safety Manager

EJCDC® C-451, Qualifications Statement—Schedule C—Key Individuals.

Copyright© 2018 National Society of Professional Engineers, American Council of Engineering Companies, and American Society of Civil Engineers. All rights reserved.

Name of individual Years of experience as project manager Years of experience with this organization Number of similar projects as project manager Number of similar projects in other positions Current Project Assignments Name of assignment Percent of time used for this project

Reference Contact Information (listing names indicates approval to contact named individuals as a reference)

Title/Position Title/Position Organization Organization Telephone Telephone Email Email Project Project Candidate’s role on project

Candidate’s role on project

Quality Control Manager Name of individual Years of experience as project superintendent Years of experience with this organization Number of similar projects as project superintendent Number of similar projects in other positions Current Project Assignments Name of assignment Percent of time used for this project

Reference Contact Information (listing names indicates approval to contact named individuals as a reference)

Title/Position Title/Position Organization Organization Telephone Telephone Email Email Project Project Candidate’s role on project

Candidate’s role on project