Contractor_Responsibility_Questionair_-_New.rtf

CONTRACTOR’S RESPONSIBILITY QUESTIONNAIRE

It is the general policy of the United States Coast Guard that contracts shall be awarded only to contractors determined to be responsible in accordance with Part 9 of the Federal Acquisition Regulation (FAR).

No contract shall be awarded to any person or firm unless the Contracting Officer first makes an affirmative determination that the prospective contractor is responsible within the meaning of the FAR, Part 9.

Before making a determination of responsibility, the Contracting Officer shall have in his/her possession or obtain information sufficient to satisfy himself/herself that a prospective contractor currently meets the minimum FAR Part 9 standards.

In order to make the required determination and also to expedite the contract award, the following information must be submitted by the Contractor as directed. SEE SECTION L.8

Completed contractor experience data form with supplemental schedules A-D (Attached).

Latest financial statements. If the financial statement is more than 60 days old, submit a certificate stating that the firm's financial condition is substantially the same, or, if not the same, state the changes that have taken place.

Provide letters from banks or other financial institutions with which the contractor conducts business. The letters should contain information about your firm's accounts, loans, lines of credit, etc., providing information leading to a determination that your firm is "responsible" as defined in the federal acquisition regulation, part 9, "has the financial resources to perform the contract or the ability to obtain them". The government is interested in financial stability, timely payments, the length and nature of the relationship between the firm and the financial institution, etc. that reveals the firm's financial ability to perform the contract. The letters should also provide the name and telephone number of the bank representative the government may contact.

THESE DOCUMENTS SHALL BE TREATED BY THE GOVERNMENT AS CONFIDENTIAL.

CONSTRUCTION CONTRACTOR EXPERIENCE DATA

DATE:

Firm Name and Telephone Number Main Office Address (Street, City, and State) Branch Offices Services Rendered Construction Design Consultant Organization

Date Organized Date Incorporated:

State:

Names of Officers and Other Key Personnel I – PRESENT PAYROLL PERSONNEL (List Number of Each Category Below) Partners: Officers: Other Key:

Remainder:

Subtotal Permanent:

Maximum Personnel at Any Time: Date:

Total:

II—EQUIPMENT OWNED

III—FINANCIAL DATA AS OF (DATE):

Present Value ($)

Current Assets:

Acquisition Cost ($) Current Liabilities:

Net Worth:

IV—TOTAL VALUE OF CONSTRUCTION AND DEMOLITION WORK IN PAST 6 YRS EXCLUSIVE OF JOINT VENTURE (LIST MOST RECENT FIRST)

V—LARGEST JOB EVER CONTRACTED

(If Other Than in Past Six Years)

LARGEST JOB IN PAST 6 YRS

Contract Amount: Date: Description:

Owner:

Contract Amount: Date: Description:

Owner:

Avg. Annual Income

VI—TYPE OF WORK IN WHICH FIRM SPECIALIZES

NAME AND POSITION/TITLE OF PERSON SIGNING

SIGNATURE

NOTE: Use reverse side for explanations or detailed description of item(s) reported above.

SCHEDULE A

CONSTRUCTION CONTRACTOR EXPERIENCE DATA

EXISTING COMMITMENTS: List below ongoing Construction project or projects including those on which you are presently the low bidder but have not received an award.

CONTRACT NUMBER: AMOUNT:

DESCRIPTION OF WORK/LOCATION:

*FOR WHOM PERFORMED: PERCENT COMPLETE:

* PROVIDE NAME OF ORGANIZATION, POINT OF CONTACT AND TELEPHONE NUMBER FOR CONTACT.

SCHEDULE B

EXPERIENCE DATA: List below similar scoped projects your firm has completed within the past six (6) years.

CONTRACT NUMBER: AMOUNT:

DESCRIPTION OF WORK/LOCATION: COTACT PERSON/PHONE NUMBER:

SCHEDULE C

CONSTRUCTION AND/OR TECHNICAL EOUIPMENT: List total equipment and facilities owned for performing the work and present status as to whether or not it is committed to existing contracts.

DESCRIPTION: QUANTITY: CONDITION:

YEARS OF PRESENT SERVICE STATUS: