7-Attachment D - Statement of Offeror Qualifications.pdf
PDF 150 KB Posted
- Solicitation number
- 26/0071
- Issued by
- Harris County, Texas
About this file
This is a Statement of Offeror Qualifications form required by the Harris County Flood Control District for the Dinner Creek Stormwater Detention Basin - Phase 1 project, with an estimated budget of $35,656,303. The form must be completed in its entirety and submitted with all proposals. Offerors are required to provide comprehensive and truthful information, with failure to fully disclose information potentially resulting in proposal disqualification or contract termination. The document requests general company information including name, address, business entity type, year established, and primary contact details, along with verification that the organization has operated under its present name for at least five years.
The form extensively evaluates offeror responsibility through detailed inquiries into litigation history, contract performance, and relevant experience. Offerors must disclose any claims, litigation, or arbitration involving Harris County or other government entities within the past five years, as well as any administrative proceedings or pending exposures. The experience record section requires documentation of years providing similar services to government and private entities, submission of three to five comparable projects completed within the past five years, description of team collaboration approaches, identification of work performed with in-house forces versus subcontractors, and specification of proposed sublet work including amounts and types. All submissions must be notarized and accompanied by an affidavit confirming proper licensure, accuracy of responses, and truthfulness of all statements and experience records provided.
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Attachment D
STATEMENT OF OFFEROR QUALIFICATIONS
This Statement of Offeror Qualifications requests information about Offeror that will be used in the evaluation of Offeror responsibility. All Offerors must complete this form in its entirety and submit with the Proposal. Answers should be as thorough and definitive as possible and include all pertinent data. Failure to fully and truthfully disclose the information required may result in the disqualification of your Proposal from consideration or termination of the contract, once awarded. Supplemental materials, additional pages, or requested lists providing additional information may be attached to further clarify answers.
General Information
1. Name of company/organization: _______________________________________________
2. Address of company/organization:
3. Home office address (if other than above):
4. Telephone No: Fax No.:
5. Type of business entity (corporation, partnership, sole proprietorship, etc.):
A. If your organization is a corporation, please provide on a separate sheet(s), detailing the following: Date of incorporation, State of incorporation, Names of President, Vice-president, Secretary, and Treasurer.
B. If your organization is a partnership or individually owned, please attach a list detailing the following: Date of organization, Name of owner(s) or partners.
6. Place of incorporation (if applicable):
7. Type of work performed by your company:
8. Year founded/established:
9. Has your organization been in business under its present name for at least five (5) years? ☐ YES ☐ NO
A. If not, please explain why.
10. Primary individual to contact:
Litigation Record
Have you or any member of your organization or team brought any claim, litigation, or arbitration against Harris County or any other Federal, State or Local Government during the last five (5) years?
☐ YES ☐ NO
If yes, attach a list of any claims, lawsuits, or requested arbitrations and their final outcome.
Has Harris County or any other Federal, State or Local brought any claim or litigation against you or any member of your organization or team during the last five (5) years?
☐ YES ☐ NO
If yes, attach a list of any claims, lawsuits, or requested arbitrations and their final outcome.
Has you or any member of your organization or team filed any lawsuits or requested arbitration with regards to any contracts within the last five (5) years?
☐ YES ☐ NO
If yes, attach a list of any lawsuits or requested arbitrations and their final outcome.
Are there any administrative proceedings, claims, lawsuits, or other exposures pending against you or any member of your organization or team?
☐ YES ☐ NO
If yes, explain:
Have any subcontractors, in which your organization has some ownership, filed any lawsuits or requested arbitration with regards to any contracts within the last five (5) years?
☐ YES ☐ NO
If yes, explain:
Have you or any member of your organization or team to be assigned to this engagement been terminated (for cause or otherwise) from any work being performed for Harris County or any other Federal, State or Local Government, or Private Entity?
☐ YES ☐ NO
If yes, explain:
Have you ever failed to complete any work awarded to you? ☐ YES ☐ NO
If yes, explain, indicating what was not completed and the reasoning:
Have you ever defaulted on a contract? ☐ YES ☐ NO
If yes, explain:
Experience Record
How many years has your organization been providing the services identified in this RFP to the following types of entities?
Government (Public) Entities: ____________
Private (Commercial) Entities: ____________
List three to five (3-5) similar projects as the one specified in this solicitation that your organization has completed over the last five (5) years. Attach additional pages as necessary:
1. _____________________________________________________________________________________________________________
2. _____________________________________________________________________________________________________________
3. _____________________________________________________________________________________________________________
4. _____________________________________________________________________________________________________________
5. _____________________________________________________________________________________________________________
Describe your organization’s concepts for working in a team relationship with the owner and user groups during the completion of projects similar to that identified in this RFP. Identify which of the project(s) listed on Attachment F, References, best exemplify these concepts and experiences. Attach additional pages as necessary:
Please list categories of work that your organization normally performs with its own forces.
Please list subcontractors/subconsultants in which your organization has some ownership or relationship and list the categories of work those subcontractors/subconsultants normally perform.
1. _____________________________________________________________________________________________________________
2. _____________________________________________________________________________________________________________
3. _____________________________________________________________________________________________________________
4. _____________________________________________________________________________________________________________
Portions of work Offeror proposes to sublet in case of award of contract, including amount and type:
1. ______________________________________________________________________________________________________________
2. ______________________________________________________________________________________________________________
3. ______________________________________________________________________________________________________________
Dated this day _________ of _______________ 20___
(Name of Organization)
By:_______________________________________ (Title)
Submitted by______________________________ an individual a partnership a corporation with principal office at ________________________________________________________ (Full Address or City, State)
To be filled in by Corporation: To be filled in by Partnership Date incorporated _____________ Date formed ________________ Under the laws of _____________State. State whether partnership is general, limited or associated
Executive Officer ___________________ List Members:
State of ___________________
County of _________________
_________________________________________, being duly sworn, deposes and attests that he/she is (Name of Offeror’s Representative)
____________________________________ of ____________________________________________, (Position Title) (Name of Organization) and that: (1) the Offeror submitting a Statement of Qualifications for this contract opportunity and the contractors / subcontractors anticipated to perform the work are properly licensed, as applicable, and shall provide proof of said licensure needed to complete the scope of work; (2) the answers to the foregoing questions on the attached/associated forms and all statements therein are correct to the best of their knowledge; (3) the experience record are made part of this affidavit as though written in full herein; and (4) all statements and answers to the questions given in the above-mentioned experience record are true and correct.
_______________________________________________________, sworn to before me this _____ day (Name of Offeror’s Representative) of ______________, 20__.
____________________________ (Seal) Notary Public My Commission expires
| 1. Name of company/organization: _______________________________________________ |
| 2. Address of company/organization: |
| 3. Home office address (if other than above): |
| 4. Telephone No: Fax No.: |
| 5. Type of business entity (corporation, partnership, sole proprietorship, etc.): |
| A. If your organization is a corporation, please provide on a separate sheet(s), detailing the following: Date of incorporation, State of incorporation, Names of President, Vice-president, Secretary, and Treasurer. |
| B. If your organization is a partnership or individually owned, please attach a list detailing the following: Date of organization, Name of owner(s) or partners. |
| 6. Place of incorporation (if applicable): |
| 7. Type of work performed by your company: |
| 8. Year founded/established: |
| 9. Has your organization been in business under its present name for at least five (5) years? ☐ YES ☐ NO |
| A. If not, please explain why. |
| 10. Primary individual to contact: |
| Litigation Record |
| Have any subcontractors, in which your organization has some ownership, filed any lawsuits or requested arbitration with regards to any contracts within the last five (5) years? |
| If yes, explain: |
| Have you or any member of your organization or team to be assigned to this engagement been terminated (for cause or otherwise) from any work being performed for Harris County or any other Federal, State or Local Government, or Private Entity? |
| If yes, explain: |
| Have you ever failed to complete any work awarded to you? ☐ YES ☐ NO |
| If yes, explain, indicating what was not completed and the reasoning: |
| Have you ever defaulted on a contract? ☐ YES ☐ NO |
| If yes, explain: |
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