830800preqFfax.pdf

Jones Point Facilities Rehabilitation (Pump Station) Pre-Qualification Invitation

DEPARTMENT OF PUBLIC WORKS AND COUNTY OF FAIRFAX

ENVIRONMENTAL SERVICES VIRGINIA

WASTEWATER DESIGN AND CONSTRUCTION DIVISION

12000 Government Center Parkway, Suite 463 Fairfax, Virginia 22035-0052 Tel: 703-324-5111

JONES POINT FACILITIES REHABILITATION (PUMP STATION)

INVITATION TO APPLY FOR PRE-QUALIFICATION FOR

PROJECT NO. WW-000001-023

Fairfax County is soliciting pre-bid qualifications for the construction of the Jones Point Facilities Rehabilitation (Pump Station), located in Fairfax County’s Mount Vernon District at 5840 Cameron Run Terrace, Alexandria, VA 22303. Only firms that have been pre-qualified in accordance with the procedures in the Pre-qualification Application will be eligible to submit bids for this project. Construction bids for this project are scheduled to be received in November 2026. Bids received from those who have not been pre-qualified will not be considered.

The Jones Point Facilities Rehabilitation project will replace the existing 1.43 Million Gallon Per Day (MGD) wastewater pump station with a new 1.48 MGD pump station and 8-inch diameter force main. The existing pump station will remain in service during construction of the new pump station and force main. An access road will be constructed to provide access to the pump station and to serve as an alternative access to the existing Huntington Levee access road. Once the new pump station and force main are completed and have passed testing, the old pump station will be partially demolished. This project will utilize the Envision Verification Program with Envision Silver Verification being pursued.

The General Contract for this project is anticipated to be advertised for bid in October 2026 with bid opening in November 2026. The projected Contract Award date is planned for February 2027, with an anticipated construction start of March 2027. The overall construction duration is planned to be 548 calendar days. These are estimated dates and durations and are subject to change. The cost for this project is estimated to be $8 to $10 million. This project shall be subject to prevailing wages in accordance with Fairfax County’s Prevailing Wage Ordinance.

Pre-qualification applications will be received in the Office of the Director, Wastewater Design and Construction Division, Department of Public Works & Environmental Services, 12000 Government Center Parkway, Suite 463, Fairfax, Virginia until 4:00 PM on Wednesday, July 22, 2026. Applications received after this time will not be accepted. Hard copies of the applications may be delivered by hand or via a delivery carrier. Applications may also be submitted electronically by email in portable document format (PDF) to DPWESCAPWastewaterCollectionInquiry@fairfaxcounty.gov and must be 20MB or smaller in file size. Either delivery method may be used, and the applicant is solely responsible for the delivery of their application.

Docusign Envelope ID: BD7784DD-33E4-8167-82E8-B2F09DB52517 mailto:DPWESCAPWastewaterCollectionInquiry@fairfaxcounty.gov

Pre-Qualification Invitation

Pre-qualification Applications may be obtained commencing on Wednesday, June 24, 2026, available on-line using the Commonwealth of Virginia electronic procurement portal at www.eVA.virginia.gov and at the Fairfax County website, https://www.fairfaxcounty.gov/publicworks/capital-projects/invitation-pre-qualification

An optional virtual Pre-qualification Meeting for interested parties will be held on Wednesday, July 8, 2026, at 11:00 AM via Microsoft Teams. This meeting is not mandatory, but all interested contractors are encouraged to attend and partial plans for the project are to be shared and the project explained during the meeting. If you are interested in attending this meeting, send your name, email address and company name to Natasha.Schmidt@fairfaxcounty.gov by 4:00 PM on Thursday, July 2, 2026, as the Teams meeting invitation will be sent out by 5:00 PM that day.

All questions concerning this Pre-qualification Application procedure shall be submitted in writing to the Director, Wastewater Design and Construction Division, email address: DPWESCAPWastewaterCollectionInquiry@fairfaxcounty.gov. To be considered, such requests must be received at least seven (7) calendar days prior to the deadline for submittal of the Pre-qualification Application indicated in this Invitation for Pre-qualification. Should any addenda be issued, they will be posted to the website at least three (3) days prior to the deadline for application submission. This office is the only point where information will be disseminated.

The Board of Supervisors of Fairfax County, Virginia reserves the right to reject any and all applications, and to waive informalities and irregularities in the Pre-qualification Application procedure.

COUNTY OF FAIRFAX, VIRGINIA

By: __________________________________ Magdi Imbabi, Director Wastewater Design and Construction Division

Dated: ________________________

Docusign Envelope ID: BD7784DD-33E4-8167-82E8-B2F09DB52517

06/18/2026

/s/ http://www.eva.virginia.gov/ https://www.fairfaxcounty.gov/publicworks/capital-projects/invitation-pre-qualification mailto:Natasha.Schmidt@fairfaxcounty.gov mailto:DPWESCAPWastewaterCollectionInquiry@fairfaxcounty.gov

Jones Point Facilities Rehabilitation (Pump Station)

Pre-Qualification Instructions

FAIRFAX COUNTY

DEPARTMENT OF PUBLIC WORKS AND ENVIRONMENTAL SERVICES

PRE-QUALIFICATION APPLICATION INSTRUCTIONS FOR:

JONES POINT FACILITIES REHABILITATION (PUMP STATION)

PROJECT NO. WW-000001-023

1. GENERAL

Fairfax County (“County”) is soliciting pre-qualifications for the Jones Point Facilities Rehabilitation (Pump Station). The estimated construction cost is anticipated to be in the range of $8,000,000 to $10,000,000. Approved pre-qualification applications shall be valid for one year from the notification date.

Only firms that have been pre-qualified in accordance with the procedures in this Pre-qualification Application will be eligible to submit bids for this project.

Bids received from those who have not been pre-qualified will not be considered.

The decision to pre-qualify an Applicant shall not constitute a determination that the Applicant is responsible, and such Applicant may be subsequently rejected as non-responsible on the basis of subsequently discovered information. All bidders will be required to meet the Fairfax County Safety Resolution at the time of bid. See Attachment G for the current Fairfax County Safety Resolution.

The County shall not be responsible for any costs incurred by Applicants because of their participation in this procurement process. Each Applicant shall bear its own expenses in connection with such participation including the provision of any supplemental information, which may be requested. The County shall have no liability for costs incurred by Applicants in connection with the preparation and evaluation of pre-qualification materials and any findings and determinations made therefrom.

All material submitted by the applicant shall become the property of the County and will not be returned. Applications will be treated as confidential documents.

The County reserves the right to extend the Application submission deadline, by way of an addendum, should such action be deemed in the best interest of Fairfax County.

Termination of the Pre-qualification process can occur, and the County reserves the right to do so when necessary. Applicants will be so notified in writing. If the process is terminated, no compensation will be made to any applicants regardless of the stage of completion of the process.

This is not a request for proposal.

Pre-Qualification Instructions

2. DESCRIPTION OF WORK

The Jones Point Facilities Rehabilitation project will replace the existing 1.43 Million Gallon Per Day (MGD) wastewater pump station with a new 1.48 MGD pump station and 8-inch diameter force main. The existing pump station will remain in service during construction of the new pump station and force main. An access road will be constructed to provide access to the pump station and to serve as an alternative access to the existing Huntington Levee access road. Once the new pump station and force main are completed and have passed testing, the old pump station will be partially demolished. Envision Silver Verification is being pursued for this project.

The General Contract for this project is anticipated to be advertised for bid in October 2026 with bid opening in November 2026. The projected Contract Award date is planned for February 2027, with an anticipated construction start of March 2027. The overall construction duration is planned to be 548 calendar days. These estimated dates and durations are subject to change. The cost for this project is estimated at $8 to $10 million. This project shall be subject to prevailing wages in accordance with Fairfax County’s Prevailing Wage Ordinance.

3. PREPARATION AND SUBMISSION OF PRE-QUALIFICATION APPLICATION

A. Pre-qualification Applications must be received by the County no later than the date, time, and in the manner indicated in the Invitation to Apply for Pre-qualification. The Applicant shall assume full responsibility for timely delivery of the Application. The sealed Application package must be clearly and legibly marked on the outside lower left corner as follows:

DO NOT OPEN

SEALED PRE-QUALIFICATION APPLICATION

WASTEWATER DESIGN AND CONSTRUCTION DIVISION

JONES POINT FACILITIES REHABILITATION

PROJECT NO. WW-000001-023

The sealed Application package must be received at the location and time as stated in the Invitation to Apply for Pre-qualification.

B. The Pre-qualification Application Form must be typed or printed. Submit One (1) original in a suitable binder. All pages should be consecutively numbered.

C. Applicant shall provide all Supplemental Information including any additional information requested in the Invitation or submitted as part of the Pre-qualification Application Form. This information shall be typed or clearly printed on the Applicant’s letterhead in an organized, concise manner and should follow the same sequence as the Pre-qualification Application Form with the item numbers cross-

Pre-Qualification Instructions referenced. County or assigned designee may, at their sole discretion, contact one or more Applicants during the evaluation process for clarification of any entries in the Pre-qualification Application and may request additional information. Such additional information must be submitted to the County no later than seven (7) calendar days after the receipt of the request by the Applicant.

D. The County intends to contact all references listed in the application to establish Applicant’s performance in all aspects. The relationship of the reference to the Applicant shall be established and the title of the reference recorded. Applicants must provide functional and current phone numbers and contact information for every reference.

E. Applicants must provide prompt notice to the County if the Applicant experiences a substantial change in its financial condition, ownership, corporate structure or personnel after the Pre-qualification Application Form and related information have been submitted and prior to completion of the bidding process.

Failure to notify the County of any substantial change in financial condition, corporate structure or personnel may constitute grounds for rescinding the Applicant's qualification to bid or for rejection of their bid proposal.

4. APPLICANT QUESTIONS, ADDENDA, AND INTERPRETATIONS

A. All requests for interpretation of the meaning of the Pre-qualification Application Instructions and Application Form must be made in writing addressed as indicated in the Invitation to Apply for Pre-Qualification, and to be given consideration, such requests must be received at least seven (7) calendar days prior to the advertised deadline for submittal of the Application for Pre-qualification.

B. Any and all such interpretations and any supplemental instructions or changes will be in the form of written addenda which, if issued, will be posted to the website not later than (3) three calendar days prior to the deadline for submittal of the Application for Pre- qualification. Failure of any Applicant to receive any such addenda shall not relieve the Applicant from any obligation under these Pre-qualification Application Instructions. All addenda so issued shall become part of the Application for Pre-qualification and acknowledgment of receipt must be indicated by all Applicants on page 1 of the Application for Pre-qualification.

5. EVALUATION OF PRE-QUALIFICATION APPLICATIONS

A. The County will determine whether applicants are either "qualified" or "not qualified” to bid on this Project. The County will notify all Applicants in writing whether or not they have been determined to be a pre-qualified contractor within thirty (30) calendar days after the deadline for receipt of the Pre-qualification Application. This decision shall be final and conclusive unless the Applicant appeals within ten (10) calendar days of receipt of the Notice by instituting legal action as provided in the

Pre-Qualification Instructions

Code of Virginia.

If, upon appeal, it is determined that the action taken by the County was arbitrary or capricious, or not in accordance with the Constitution of Virginia, statutes or regulations, the sole relief available to the Applicant shall be restoration of eligibility.

The Applicant may not institute legal action until all statutory requirements have been met.

In determining whether an Applicant should be pre-qualified, the County, in its sole and absolute discretion, will decide whether the Applicant is capable of fully performing the contractual requirements for the Project, in all respects. The pre-qualification process is designed to determine the applicant's performance capability as well as its business integrity and reliability.

B. Any unsatisfactory references may serve as a basis for disqualification of the Applicant. Examples of unsatisfactory references include but are not limited to untimely performance, failure to properly schedule the work, failure to complete the work, defective work not corrected, failure to complete punch list work, lack of proper manpower to meet scheduled activities, poor workmanship, submission of unreasonable claims, failure to make prompt payments, inappropriate staffing, or any other documented evidence of noncompliance with the terms and conditions of prior construction contracts.

C. In evaluating each Application for Pre-qualification, the County will consider information provided in the Application for Pre-qualification and the following criteria:

1. The Applicant must have been established as a full-time construction contractor for a minimum of ten (10) years holding or eligible to hold a Virginia Class A contracting license.

2. The Applicant shall have acted as a General Contractor and have completed at least three (3) wastewater pumping station projects (new construction) of similar scope, each with an original contract value of $8,000,000 or more within the last seven (7) years. At least one of the projects must have included the successful utilization of the Envision Verification Program.

3. Satisfactory performance as a general contractor within the past ten (10) years on projects similar in size, complexity, and scope including the ability to meet scheduled completion dates.

4. Ability to obtain Performance and Payment Bonds in the amounts required for this project.

5. Possession of a valid Class A Virginia Contractor's license prior to bid submission.

D. Applications will be evaluated in accordance with the criteria listed in these Instructions. An unsatisfactory rating in any one category may be considered

Pre-Qualification Instructions sufficient cause to determine that an Applicant is “not qualified to bid”.

E. By submitting an Application, the Applicant agrees that the County and/or its representatives may research the information provided and contact entities associated with such information, at its discretion.

F. The County or its designee may deny pre-qualification to any Applicant if it finds any of the following (in addition to other criteria outlined in this Application):

1. Pre-qualification submittals that fail to conform to the requirements of the Application for Pre-qualification may be considered non-responsive and the Applicant determined to be "not qualified to bid".

2. If any Applicant knowingly makes a misrepresentation in submitting information to the County, such misrepresentation may be sufficient grounds for denying pre- qualification to that Applicant or rescinding the Applicant's pre-qualification. Any such misrepresentation may also result in debarment of the Applicant by the County.

3. The Applicant does not have sufficient financial ability, including bonding capacity, to perform the contract.

4. Applicant does not meet minimum experience requirements.

5. Applicant does not have the appropriate staff or experience to perform the work.

6 The Applicant (or any officer, director, or owner thereof) has had judgments entered against him/her within the past ten (10) years for the breach of contract for governmental or non-governmental projects, including but not limited to, construction, design-build, or construction management contracts.

7. The Applicant has been in substantial non-compliance with the terms and conditions of prior construction contracts without good cause.

8. The Applicant (or any officer, director, owner, project manager, procurement manager, or chief financial official thereof) has been convicted within the past ten years of a crime related to construction or contracting.

9. The Applicant (or any officer, director, owner thereof) is currently debarred pursuant to an established debarment procedure from bidding or contracting by any public body, agency or another state, or agency of the Federal Government.

10. The Applicant fails to provide to the County any additional information requested by the County within time frames established in this solicitation.

Pre-Qualification Instructions

6. APPLICATION REQUIREMENTS

Application Forms and Supplemental Information must be typed or printed clearly.

Information presented therein shall be clear, complete, and concise. Page 1 of the Application for Pre-qualification shall be the cover page for each copy of the Application submitted. The following forms and attachments comprise the Application:

A. Applicant's Pre-qualification Statement: The Applicant shall provide the information required. The form in Attachment A shall be used.

Project Experience: List construction projects currently being performed or performed during the past ten (10) years as outlined in Attachment B.

Provide details of at least three (3) similar construction projects that included construction of wastewater pumping station projects of similar scope, each with an original contract value of $8,000,000 or more within the last seven

(7) years. At least one of the projects must have included the successful utilization of the Envision Verification Program.

B. Key Personnel: Information about the experience of the key personnel that the applicant plans to assign to this project.

C. Contractor's License: A statement of applicant's ability to acquire a Virginia Class A Contractor's License, if currently unlicensed, prior to bidding; and a commitment to require that all affected subcontractors obtain applicable Virginia licenses.

D. Surety Statement: Applicant's ability to acquire bid, performance, and payment bonds for this project.

E. Safety Program and History: Description of Applicant’s Safety Program, Safety Record and EMR, during the past three (3) years.

F. Fairfax County Construction Safety Resolution

G. Quality Control Program: Applicant shall outline its Quality Control Program and its implementation plan.

H. Affidavit of Accuracy: Certification that the information contained in the Application for Pre-qualification is true and accurate. The form in Attachment K shall be used.

I. Prevailing Wage Ordinance: All bidders will be required to meet the Fairfax County Prevailing Wage Ordinance at the time of bid.

7. PROJECT EXPERIENCE

The pre-qualification application shall demonstrate the experience of the Applicant as a general contractor of new wastewater infrastructure. The Applicant shall describe their experience, specifically identifying and describing the following:

Pre-Qualification Instructions

A. Minimum Experience Requirement:

1. Applicant must have been established as a full-time construction contractor for a minimum of ten (10) years holding or eligible to hold a Virginia Class A contracting license.

2. The Applicant shall have acted as a General Contractor and have completed at least three (3) similar construction projects that included construction of wastewater pumping station projects of similar scope, each with an original contract value of $8,000,000 or more within the past seven (7) years. At least one of the projects must have included the successful utilization of the Envision Verification Program.

B. Satisfactory experience in the General Contracting of new wastewater infrastructure within the last ten (10) years. Provide the current status of projects in progress, including the project duration and anticipated completion of each project. Explanations shall be given for any project that finished or is currently behind schedule. Since Envision Silver Verification is being pursued for this project, please note any projects where the Envision Verification Program was used or is being used.

C. Name, address, and telephone number of individual(s) representing owners of each listed construction project who is familiar with the services provided by the Applicant. Fairfax County will contact the individual to verify the experience and satisfactory performance of services by the applicant.

8. KEY PERSONNEL / PROJECT TEAM

The Applicant must identify the Applicant's proposed key personnel including project executive, project manager, and field superintendent intended to be assigned to the project in the event award is made to the Applicant's firm.

Such personnel shall be, insofar as practical, assigned to the project for the duration of such project. The applicant must provide a detailed resume’ for each such individual. The Applicant shall describe in the application the individuals' responsibilities on previous projects and their proposed responsibility on this project.

The application must demonstrate that the Applicant has the capability, in terms of both types and quantities of personnel, facilities and equipment required to accomplish the contract goals on schedule.

The Applicant's project management team must reflect at least ten (10) years of experience for each key person on similar type work and in similar capacity as proposed for this Contract. Those key people who do not have ten years of experience will be removed from the proposed organization chart and the chart thus evaluated. If the Applicant does not propose a project management team meeting the minimum experience and qualification criteria, the Applicant may be considered "not qualified to bid". The successful Applicant must assign the proposed project manager to this

Pre-Qualification Instructions project or replace them with individuals having equal or greater relevant construction experience.

Pre-Qualification Application

FAIRFAX COUNTY

DEPARTMENT OF PUBLIC WORKS AND ENVIRONMENTAL SERVICES

APPLICATION FOR PRE-QUALIFICATION FOR:

JONES POINT FACILITIES REHABILITATION (PUMP STATION)

PROJECT NO. WW-000001-023

A. This page shall be the cover page for each copy of Application submitted.

B. All required attachments and any additional information requested in this Solicitation must be attached herein.

Attachments:

A. Applicant's Pre-qualification Statement (Forms and Supplemental Information) B. Project Experience (Forms and Supplemental Information) C. Key Personnel D. Virginia Class A Contractor’s License Statement (by Applicant) E. Suggested Surety Statement F. Safety Program (Forms and Supplemental Information) G. Fairfax County Construction Safety Resolution H. Quality Control Program I. Affidavit of Accuracy (Form) J. Prevailing Wage Ordinance

Acknowledge receipt of addendum below if applicable (initial and date):

Addendum No. 1 _______/________ Addendum No. 2 _______/________ Initial Date Initial Date

Submitted by:

Applicant Name: _____________________________________________________

Address: ___________________________________________________________

City/State/Zip Code: ___________________________________________________

Signed by: __________________________________________________________

Printed Name and Title: ________________________________________________

Telephone No: _______________________________________________________

Fax No._____________________________________________________________

Email_______________________________________________________________

ATTACHMENT A

APPLICANT'S PRE-QUALIFICATION STATEMENT

JONES POINT FACILITIES REHABILITATION (PUMP STATION)

Submitted By: ________________________________________________________

Applicant Name and Address: ____________________________________________

Applicant Telephone No.: (____)____________ Fax No.: (____)__________________

Applicant's Virginia Contractor's License Number: _________________ Class: _______

Tax ID No. (Soc. Sec. No. If Sole Proprietor): _________________________________

Person who can respond authoritatively to any questions about this statement:

Name: _________________________ Title: ______________ Tel.: ______________

Email: _________________________

Indicate if: Corporation Sole Proprietor Partnership

Joint Venture Other (Indicate) __________________

The Applicant may attach additional information deemed appropriate to respond. Do not attach additional information irrelevant to the response.

1. Organization

A. How many years has your organization been in business as a construction contractor? ____________

B. How many years has your organization been in business under its present business name? ____________

C. Under what other or former names has your organization operated?

D. If your organization is a corporation, please indicate:

Date of Incorporation: ____________

State of Incorporation: ____________

President's Name: _______________________

Vice President's Name(s): _______________________

Secretary's Name: _______________________

Treasurer's Name: _______________________

E. If your organization is a partnership, please indicate:

Date of Organization: _______________________

Type of Partnership (If Applicable): _______________________

Name(s) of General Partners: _______________________

F. If your organization is a sole proprietorship, please indicate:

Date of Organization: ___________________________________

Name of Owner: _______________________________________

G. If the form of your organization is other than those listed above, describe it and name the principals and date of commencement of business:

H. Submit a copy of the applicant's current organization chart showing numbers of employees by discipline and project and the names and titles down through Project Field Superintendent.

I. Provide proposed organizational chart for the project with names of key personnel.

J. Is the applicant related to another firm as a parent, subsidiary or affiliate?

Yes___ No___

If yes, give names and addresses of all affiliated parent and/or subsidiary companies. Indicate which companies are subsidiaries.

2. Judgments

A. Has the applicant or any officer, director or owner thereof had any judgments entered against him within the past ten years for breach of contracts for governmental or non-governmental construction, including, but not limited to, design-build or construction management?

If yes, provide details on any such judgment.

3. Contract Compliance

A. Has your firm been found to be in substantial noncompliance with the terms and conditions of prior construction contracts in the past 10 years?

Yes _____ No ______

If yes, provide details on any such instance.

B. Has the Applicant ever failed to complete any work awarded to it? If yes, state date(s), project(s), owner or A/E reference(s), and reason(s).

Yes _____ No ______

C. Has the Applicant ever been party to a construction contract, which was terminated by the owner, for the owner’s convenience or otherwise? If yes, state date(s), project(s), owner or A/E reference(s), and reason(s).

Yes _____ No ______

D. Has the Applicant ever been declared to be in default or partial default on a construction contract or project? If yes, state date(s), project(s), owner or A/E reference(s), and reason(s).

Yes _____ No ______

E. Has the Owner or Owner’s Agent ever taken steps to complete contract work, which was the Applicants own responsibility? If yes, indicate date(s), project(s), owner or A/E references, and reason(s).

Yes _____ No ______

F. Has the Applicant ever been the subject of a stop work order on a construction project? If yes, state date(s), project (s), and reason(s).

Yes _____ No ______

G. Are there any judgments, claims, suites, arbitration proceedings, or other legal proceedings pending or outstanding to which the Applicant is a party? If yes, state date(s), project(s), and reason(s).

Yes _____ No ______

H. Has the Applicant filed or caused to be filed, any suits, arbitration requests or claims with regard to any construction contracts within the past five (5) years? If yes, state date(s), project (s), and reason(s).

Yes _____ No ______

I. Has the Applicant been assessed liquidated damages for failure to complete a project by contract date within the past ten (10) years? If yes, state date(s), project (s), and reason(s).

Yes _____ No ______

J. Has the Applicant ever failed to complete punch list work on time.

Yes _____ No ______

4. Convictions

Has the applicant or any officer, director or owner thereof been convicted within the past ten (10) years of a crime related to governmental or non-governmental construction or contracting, including, but not limited to, violation of (i) Ethics in Public Contracting (Article 4 - § 11-72 et seq.), (ii) the Virginia Governmental Government (Chapter 4.2 - § 59.1 - 68.6 et seq.) of Title 59.1), or (iv) any substantially similar law of the United States or another state? If yes, provide details on any such convictions on a separate sheet.

Yes _____ No ______

5. Debarment

Is the applicant or any officer, director or owner thereof currently debarred pursuant to an established debarment procedure from bidding or contracting by any public body, agency of another state or agency of the federal government?

Yes _____ No ______

If yes, provide details:

6. References

(Provide at least five (5) references in each category and include for each reference its name, address, telephone number, and name of contact person.)

A. ENGINEERS/ARCHITECTS:

1. _____________________________________________________________

2. _____________________________________________________________

3. _____________________________________________________________

4. _____________________________________________________________

5. _____________________________________________________________

B. MAJOR SUBCONTRACTORS:

1. _____________________________________________________________

2. _____________________________________________________________

3. _____________________________________________________________

4. _____________________________________________________________

5. _____________________________________________________________

C. OWNERS:

1. _____________________________________________________________

2. _____________________________________________________________

3. _____________________________________________________________

4. _____________________________________________________________

5. _____________________________________________________________

7. Financial

A. Does any individual, company or corporation own a 10% or more interest in the outstanding shares of the capital stock of the Applicant?

Yes _____ No ______

If yes, list the name and percent interest of ownership held in the Applicant.

B. Audited financial statements for the Applicant’s previous three fiscal years may be required. These financial statements, if requested, shall include a complete report of Applicant’s financial resources, liabilities, equipment, and personnel.

C. Is the Applicant currently a debtor in any bankruptcy case or has been in bankruptcy at anytime during the previous five (5) years? If yes, state date(s), and reason(s).

Yes _____ No ______

8. Workers Compensation Experience

List your Experience Modification Rate (EMR) for workers compensation and OSHA incidence rate for the past three years:

EMR Incidence Rate

9. Surety and Insurance

A. Provide documentation from your Surety identifying Applicant’s total bonding capacity, individual job bonding capacity, and maximum the Applicant can be bonded on a single project. Provide Surety Statement as outlined in Attachment E.

B. List all other sureties (name and address) that have written bonds for the Applicant during the last five years.

C. Provide the following information:

Average annual contract volume for the past 5 years $ _____________

Total value of work in progress or under contract: $ _____________

D. Has any surety company made a payment on Applicant’s behalf as a result of default, to satisfy any claims made against a performance or payment bond in connection with any construction project during the previous five (5) years? If yes, state date(s), project(s), and reasons.

Yes _____ No ______

E. Has any insurance carrier, for any form of insurance, refused to renew insurance policy for your firm? If yes, state date(s), and reason(s).

Yes _____ No ______

10. Confidential and Proprietary Information

Initial here ____ if the applicant requests that all information submitted as part of this prequalification process be considered a trade secret or as proprietary information subject to the provisions of subsection D of § 2.2-4342, Code of Virginia.

ATTACHMENT B

PROJECT EXPERIENCE

Applicant shall demonstrate conformance to the experience requirements of this solicitation and provide the following:

1. On a separate sheet(s), list all construction projects your organization has in progress, giving the name of project, scope, owner, design engineer/architect, contract amount, percent complete and scheduled completion date.

2. On a separate sheet(s), list all projects similar to the work herein being performed or performed during the past ten (10) years, giving the name of project, owner, design engineer/architect, contract amount, and date of completion and project scope description. Since Envision Silver Verification is being pursued for this project, please note any projects where the Envision Verification Program was used. Please verify prior to submission that all contact information is accurate and current.

3. Provide on the following pages (attachment B1, B2, and B3) the details of three (3) similar construction projects for governmental, institutional, or private owners for which the Applicant has acted as a General Contractor and successfully completed construction of wastewater pumping station projects of similar scope in the last seven (7) years. Each of these three (3) projects must have had an original contract value of $8,000,000 or more and must have included construction of new wastewater pumping stations of similar scope. At least one of the projects must have included the successful utilization of the Envision Verification Program.

ATTACHMENT B1

SIMILAR PROJECTS

PROJECT 1

DETAILS OF PROJECT

1. Applicant Name: _____________________________________________

Project Manager Name: __________________________________

Superintendent Name: ___________________________________

2. Name of Project: ________________________ Contract No. ___________ Project Number ______________

3. Owner Name: __________________________ Address: _____________________________________________ Contact Person: ________________________________________

Telephone Number: (____)______________

4. Engineer/Architect: ___________________________________________

Address: ______________________________________________

Contact Person: ________________________________________

Telephone Number: (____)______________

5. Contract Dates - Attach additional information if project was not on schedule.

Started: ____________

Original Contractual Completion: ____________

Final Contractual Completion: ______________

Actual Completion: ______________________

6. Description of the project: ___________________________________________

7. Original Contract Value: $_____________________

Final Contract Value: $_____________________

Value of Change Orders to Date: $______________ Value of Outstanding Claims to Date: $____________

8. Name of Bonding Company: __________________________ Address:__________________________________________ Contact Person: ____________________________________

Telephone Number: (____)________________

9. Major Subcontractor(s) Name:________________________________ Address:________________________________ Contact Person:__________________________ Telephone Number: (____)_________________ Role In Project:__________________________

Name:_________________________________ Address: _______________________________ Contact Person:_________________________ Telephone Number: (____)________________ Role In Project:_________________________

Name: _________________________________ Address: _______________________________ Contact Person: __________________________ Telephone Number: (____)__________________ Role In Project: ___________________________

ATTACHMENT B2

SIMILAR PROJECTS

PROJECT 2

DETAILS OF PROJECT

1. Applicant Name: _____________________________________________

Project Manager Name: __________________________________

Superintendent Name: ___________________________________

2. Name of Project: ________________________ Contract No. ____________________Project Number: ______________

3. Owner Name: ______________________________ Address: ______________________________________________

Contact Person: ________________________________________ Telephone Number: (____)________________________________

4. Engineer/Architect: ___________________________________________

Address: ______________________________________________

Contact Person: ________________________________________

Telephone Number: (____)________________________________

5. Contract Dates - Attach additional information if project was not on schedule.

Started: __________

Original Contractual Completion: ____________

Final Contractual Completion: ______________

Actual Completion: _______________________

6. Description of the Project: ___________________________________________

7. Original Contract Value: $_____________________

Final Contract Value: $_____________________

Value of Change Orders to Date: $_______________ Value of Outstanding Claims to Date: $_____________

8. Name of Bonding Company: ______________________ Address:________________________________

Contact Person: ________________________________ Telephone Number: (____)________________________

9. Major Subcontractor(s) Name: _________________________________ Address: _______________________________ Contact Person: _________________________ Telephone Number: (____)_________________ Role In Project: __________________________

Name: _________________________________ Address: _______________________________ Contact Person: _________________________ Telephone Number: (____)_________________ Role In Project: __________________________

Name:_________________________________ Address: _______________________________ Contact Person: _________________________ Telephone Number (____)_________________ Role In Project: _________________________

ATTACHMENT B3

SIMILAR PROJECTS

PROJECT 3

DETAILS OF PROJECT

1. Applicant Name: _____________________________________________

Project Manager Name: __________________________________

Superintendent Name: __________________________________

2. Name of Project: ________________________ Contract No.:______________ Project Number: ______________

3. Owner Name: ______________________________ Address: _____________________________________________

Contact Person: ________________________________________

Telephone Number: (____)________________________

4. Engineer/Architect: ___________________________________________

Address: ______________________________________________ Contact Person: _________________________________________ Telephone Number: (____)_________________________________

5. Contract Dates - Attach additional information if project was not on schedule.

Started: __________

Original Contractual Completion: ___________________

Final Contractual Completion: _____________________

Actual Completion: ______________________________

6. Description of the Project: ___________________________________________

7. Original Contract Value: $__________________

Final Contract Value: $__________________

Value of Change Orders to Date: $_______________ Value of Outstanding Claims to Date: $_____________

8. Name of Bonding Company: ____________________________________ Address: ______________________________________________ Contact Person: ________________________________________ Telephone Number: (____)________________________________

9. Major Subcontractor(s) Name: __________________________________ Address: ________________________________ Contact Person: __________________________ Telephone Number: (____)__________________ Role In Project: ___________________________

Name: __________________________________ Address: ________________________________ Contact Person: __________________________ Telephone Number: (____)__________________ Role In Project: ___________________________

Name: __________________________________ Address: ________________________________ Contact Person: __________________________ Telephone Number: (____)__________________ Role In Project: ___________________________

ATTACHMENT C

KEY PERSONNEL

1. Provide information about the experience of key personnel of the Applicant that will be associated with this project. The information shall include name, title, intended assignment, years of construction experience, last employer, last position, and experience on similar projects.

2. Applicant must also provide the percentage of time the key personnel will dedicate to the project.

ATTACHMENT D

VIRGINIA CLASS A CONTRACTOR’S LICENSE STATEMENT

Provide a Statement of applicant's ability to possess a Virginia Class A Contractor's License prior to bidding, and a commitment to ensure that affected subcontractors obtain applicable Virginia Contractor's Licenses.

ATTACHMENT E

SUGGESTED SURETY STATEMENT

REFERENCE: APPLICATION FOR PRE-QUALIFICATION - FAIRFAX COUNTY

JONES POINT FACILITIES REHABILITATION (PUMP STATION)

(Name of Applicant) has been a client of (name of Surety Company) for over (______) years. During that time, we have supported this firm in their pursuit of projects in the $________ range and total programs in excess of $_____________. We are prepared to provide Bid, Performance, and Payment Bonds on the aforementioned project, provided (name of Applicant) is awarded the contract.

We also possess certificates of authority as an acceptable surety authorized to do business in the Commonwealth of Virginia as published annually in the Federal Register, Department of Treasurer, Fiscal Service, Department Circular 570.

Sincerely, Attorney-In-Fact (Name of Surety Company)

Name of Surety: __________________

Signature: _______________________

Typed Signature: _________________

Date: ___________________________

Address: ________________________

Telephone: ______________________

ATTACHMENT F

SAFETY PROGRAM and HISTORY

A. Does your firm have a written safety program?

Yes _____ No _____

If yes, provide detail of your safety program on separate sheet.

B. Does the firm incorporate safety and health related issues into their new employee orientation programs?

Yes _____ No _____

C. Does the firm include work safety as a part of an employee's performance evaluation?

Yes _____ No _____

D. To what degree does senior/corporate management support safety related matters? Does the firm have a safety policy statement signed by a member of senior/corporate management?

Provide detail on separate sheet.

E. Does the firm have a full time Safety Manager? Does this person report to a high level, authoritative position within the Company?

Yes _____ No _____

If yes, provide detail on separate sheet.

F. Are safety inspections conducted at work sites? If so, how often and by whom?

Provide detail on separate sheet.

G. Are safety training programs conducted for employees? If so, how often and by whom?

Provide detail on separate sheet.

H. Are safety "tailgate meetings" and “toolbox meetings” conducted by the firm? If so, how frequently?

Provide detail on separate sheet.

I. Does the firm have a visibly active safety committee? If so, how often does it meet? Who serves on the committee?

Provide detail on separate sheet.

J. Is the firm an active member of a recognized construction safety organization in the Washington Metropolitan area, or in the state of contractor's domicile?

Yes _____ No _____

K. What is the firm's Workers Compensation Experience Modification Factor?

Are there any evident trends?

Provide detail on separate sheet.

L. In the previous three years has your firm been cited for a serious violation, willful violation, violation for failure to abate or repeated violation (as defined by OSHA)? See attachment G, Fairfax County Construction Safety Resolution.

Yes _____ No _____

If yes, provide detail on separate sheet.

M. Attach OSHA form 300 and OSHA form 300A with a summary of occupation injuries and illness for the last thirty six (36) months.

ATTACHMENT G

All bidders will be required to meet Fairfax County Safety Resolution at the time of bid. The current Fairfax County Safety Resolution is provided below.

FAIRFAX COUNTY CONSTRUCTION SAFETY RESOLUTION

The Contractor shall comply with the resolution adopted by the Fairfax County Board of Supervisors on December 8, 2003, as amended:

A. It shall be required that each bid submitted to the County for a contract for construction, alteration, and/or repairs, including painting or decorating of a building, highway, street, bridge, sidewalk, culvert, sewer, excavation, grading, or any other construction, include a list of all the following actions which have become final in the three years prior to the bid submission:

1. Willful violations, violations for failure to abate, or repeated violations, for which the bidder was cited by (a) the United States Occupational Safety and Health Administration; (b) the Virginia Occupational Safety and Health Administration; or (c) the occupational safety and health plan for any other public jurisdiction; or

2. Three (3) or more serious construction safety violations for which the bidder was cited by the (a) United States Occupational Safety and Health Administration; or (b) the Virginia Occupational Safety and Health Administration; or (c) the occupational safety and health plan from any other public jurisdiction.

3. Termination of a contract between the contractor and any public entity by their purchasing agent or his designee for safety violations.

B. If the bidder has not received or been the subject of any such violations referenced in paragraph A in the three (3) years prior to the bid submission, then the bidder shall so indicate by certification on the bid form entitled Certification of Safety Violations. The bidder will also indicate on this form each state in which work was performed in the three (3) years prior to the bid submission.

C. No bidder or contractor may bid on a County construction contract who has been the subject of any citations for the type and number of violations listed in aforementioned paragraph A, which have become final within the three (3) years prior to the bid submission.

1. Notwithstanding the language of paragraph C, above, any bidder or contractor who has been the subject of a violation, as described in paragraph A.1, which has become final in the three (3) years prior to the bid submission, may bid, if the bidder or contractor meets the eligibility criteria set forth in paragraph E, below.

2. Notwithstanding the language of paragraph C, above, any bidder or contractor who has been the subject of the type and number of violations as described in paragraph A.2, which have become final within three (3) years prior to bid submission, may bid, if the bidder or contractor meets the eligibility criteria in paragraph E, below.

3. Notwithstanding the language of paragraph C, above, any bidder or contractor who has previously been terminated from a public contract, as described in paragraph A.3, within three (3) years prior to the bid submission, may bid, if the bidder or contractor meets the eligibility criteria in paragraph E, below.

D. Prior to bidding on a project, under the provisions of paragraph C above, a contractor may request that a determination be made by the County's Purchasing Agent or designee, regarding their eligibility to submit a bid on a contract under the terms of this resolution. However, this request for determination and any subsequent adjudication process must be completed prior to submitting a bid on any project and the request for determination must be received by the County's Purchasing Agent or designee no later than twenty-one (21) days before bids are due unless otherwise stated in the Solicitation. A notice of the bidder’s request for determination of eligibility will be posted publicly for comments by any interested party. The bidder’s request for determination of eligibility and all supporting documentation provided by the bidder to the County in support of its request shall be open to the inspection of any interested person, firm or corporation in accordance to the requirements of Fairfax County Purchasing Resolution and Virginia Freedom of Information Act.

E. At the request of the Purchasing Agent or designee, the County…