9-c Alt Contractor Qualification Statement.docx
DOCX document 39 KB Posted
- Attached to
- Coblentz Corner Phase 1 Project
- Solicitation number
- Not on record
- Issued by
- Clearfield County, Pennsylvania
About this file
This is a Contractor Qualification Statement form issued by the City of Johnstown for evaluation and prequalification of contractors for the Public Safety Building Elevator Addition and Alterations project located at 401 Washington Street, Johnstown, Pennsylvania 15901, with UpStreet Architects, Inc. serving as the architect/construction manager. The document functions as a comprehensive questionnaire designed to assess contractor qualifications across organizational structure, licensing, construction experience, current workload, financial capacity, project team composition, subcontracting practices, safety record, and legal history. Contractors must complete all applicable sections and provide supporting documentation, including at least three to five completed projects demonstrating relevant experience, identification of key personnel with their years of experience, details of self-performed work versus subcontracted trades, and reference contacts from previous projects. The form requires disclosure of any suspensions, debarments, license denials or revocations, OSHA citations, workers' compensation records, litigation, mechanic's liens, bankruptcy proceedings, and other material contract-performance issues within the past five years.
The qualification statement requires contractors to demonstrate bonding capacity, insurance coverage, and financial stability, with the Owner reserving the right to request financial statements and other financial documentation from apparent low bidders to determine responsibility and performance ability. Contractors must certify their ability to furnish performance and payment bonds as required and disclose any surety declines, cancellations, or material restrictions within the past five years, as well as any material adverse financial changes within two years. The statement specifically addresses project-specific qualifications including experience with comparable project size and complexity, public-sector work, prevailing wage compliance, grant-funded project requirements, occupied facility operations, proposed schedule adherence, and adequate personnel and resource availability. All information provided must be certified as true and accurate, with the understanding that submission does not constitute a contract award or guarantee of selection.
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CONTRACTOR QUALIFICATION STATEMENT
For Prequalification and Consideration for Construction Contracts Purpose. This form is intended to provide an Owner, Architect, Construction Manager, or other authorized party with information needed to evaluate a contractor’s organization, experience, financial and bonding capacity, safety record, legal history, staffing, and ability to perform the proposed work. Complete all applicable sections and identify any requested information that is provided separately.
| PROJECT INFORMATION |
| CONTRACTOR INFORMATION |
Project Name:
Public Safety Building Elevator Addition and Alterations
Legal Business Name:
Owner:
City of Johnstown
Business Address:
Architect / Construction Manager:
UpStreet Architects, Inc.
City / State / ZIP:
Project Location:
401 Washington Street, Johnstown PA 15901
Primary Contact / Title:
Submission Date:
Phone / Email:
1. ORGANIZATION AND OWNERSHIP
1.1 Business name under which the contractor will perform the work: ______________________________________________________________________
1.2 Year established: ______________________________________________________________________
1.3 Years operating under the present business name: ______________________________________________________________________
| Legal Structure |
| Check One |
| State / Jurisdiction of Organization |
| Corporation |
| ☐ |
| Limited Liability Company |
| ☐ |
| Partnership |
| ☐ |
| Sole Proprietorship |
| ☐ |
| Other |
| ☐ |
1.4 Former business names, mergers, acquisitions, or reorganizations during the past 10 years:
1.5 Parent, subsidiary, affiliated, or commonly owned entities:
1.6 Name(s) and title(s) of principal owner(s) / officer(s):
2. LICENSING, REGISTRATION, AND LEGAL AUTHORITY
Has the contractor ever been suspended, debarred, denied a license, or had a required license revoked? ☐ Yes ☐ No If yes, explain and attach details.
Is the contractor presently eligible to bid on and perform public work in the project jurisdiction? ☐ Yes ☐ No ☐ N/A Is the contractor presently eligible to obtain a contractor license in the project jurisdiction? ☐ Yes ☐ No ☐ N/A
3. CONSTRUCTION EXPERIENCE AND CAPABILITIES
3.1 Years of experience performing the type of work proposed: ______________________________________________________________________
3.2 Principal types of construction routinely performed: ______________________________________________________________________
3.3 Approximate percentage of work normally self-performed: ______________________________________________________________________
3.4 Typical project size range (contract value): ______________________________________________________________________
3.5 Relevant capabilities and experience. Describe experience applicable to this project, including public work, occupied facilities, historic structures, renovation, new construction, accelerated schedules, complex MEP coordination, accessibility work, structural repairs, or other project-specific conditions.
4. CURRENT AND COMMITTED WORKLOAD
List active projects and awarded projects expected to overlap the anticipated construction period.
| Project / Location |
| Owner |
| Original Contract |
| % Complete |
| Remaining Work |
| Scheduled Completion |
4.1 Pending awards or proposals that may materially affect available staff or resources: ______________________________________________________________________
4.2 Describe the contractor’s ability to staff this project without adversely affecting current commitments: ______________________________________________________________________
5. BONDING, INSURANCE, AND FINANCIAL CAPACITY
Financial Statements. The Owner reserves the right, at its discretion, to request financial statements and other financial information from the apparent low responsive bidder as part of the Owner's determination of the bidder's responsibility and ability to successfully perform the Contract. Such information may include current and prior-year financial statements, work-in-progress schedules, bank or credit information, and other documentation reasonably necessary to evaluate financial capacity. Failure to provide requested information within the time specified by the Owner may be considered in determining whether the bidder is a responsible bidder.
| Surety / Bonding Company |
| Agent / Contact |
| Single Project Capacity |
| Aggregate Capacity |
5.1 Current bonded work (approximate total): ______________________________________________________________________
5.2 Name of primary financial institution: ______________________________________________________________________
5.3 Is the contractor able to furnish performance and payment bonds in the amount required for this project? ☐ Yes ☐ No ______________________________________________________________________
5.4 Has any surety declined, canceled, or materially restricted bonding within the past five years? If yes, explain: ______________________________________________________________________
5.5 Has the contractor experienced a material adverse change in financial condition within the past two years? If yes, explain: ______________________________________________________________________
6. RELEVANT PROJECT EXPERIENCE
Provide at least three and preferably five completed projects that demonstrate experience relevant to the proposed work.
| Project / Location |
| Owner / Contact |
| Architect / Contact |
| Contract / Final Cost |
| Dates |
| Scope & Relevance |
7. PROJECT TEAM AND KEY PERSONNEL
Identify personnel proposed for this project.
| Role |
| Name |
| Years with Firm |
| Years in Position |
| Relevant Experience |
Project Executive
Project Manager
Project Superintendent
8. SUBCONTRACTING AND SELF-PERFORMED WORK
Identify major portions of the work expected to be self-performed and major trades expected to be subcontracted.
| Trade / Scope |
| Self-Perform or Subcontract |
| Proposed Subcontractor (if known) |
| Relevant Experience |
8.1 Describe the contractor’s process for selecting, reviewing, and managing subcontractors:
9. SAFETY AND REGULATORY RECORD
| Item |
| Yes / No / N/A |
| Explanation / Details |
| Written safety program maintained and implemented |
| ☐ Yes ☐ No ☐ N/A |
| Designated safety responsibility within the organization |
| ☐ Yes ☐ No ☐ N/A |
| OSHA citations or significant safety violations within the past 5 years |
| ☐ Yes ☐ No ☐ N/A |
| Work-related fatality within the past 5 years |
| ☐ Yes ☐ No ☐ N/A |
| Serious or repeat OSHA citations within the past 5 years |
| ☐ Yes ☐ No ☐ N/A |
| Workers’ compensation experience modification information available upon request |
| ☐ Yes ☐ No ☐ N/A |
| Other material safety or regulatory issue affecting qualification |
| ☐ Yes ☐ No ☐ N/A |
10. CLAIMS, DISPUTES, LITIGATION, AND CONTRACT PERFORMANCE
For the past five years, disclose matters that are material to the contractor’s ability to perform work or that materially affected a construction contract.
| Matter |
| Yes / No |
| Brief Description / Outcome |
| Termination for default or cause |
| ☐ Yes ☐ No |
| Failure to complete a construction contract |
| ☐ Yes ☐ No |
| Owner claim or substantial dispute |
| ☐ Yes ☐ No |
| Contractor claim resulting in litigation or arbitration |
| ☐ Yes ☐ No |
| Mechanic’s lien or payment dispute of material significance |
| ☐ Yes ☐ No |
| Bankruptcy, receivership, or formal insolvency proceeding |
| ☐ Yes ☐ No |
| Debarment, suspension, or government enforcement action |
| ☐ Yes ☐ No |
| Other material contract-performance issue |
| ☐ Yes ☐ No |
11. PROJECT-SPECIFIC QUALIFICATIONS
Complete this section for the project identified on Page 1. If a question is not applicable, mark N/A.
| Qualification |
| Yes / No / N/A |
| Details / Supporting Information |
| Experience with projects of comparable size, complexity, and construction type |
| ☐ Yes ☐ No ☐ N/A |
| Experience with public-sector owners or publicly funded projects |
| ☐ Yes ☐ No ☐ N/A |
| Experience complying with applicable prevailing wage requirements |
| ☐ Yes ☐ No ☐ N/A |
| Experience with federal, state, or local grant-funded project requirements |
| ☐ Yes ☐ No ☐ N/A |
| Experience working in an occupied facility while maintaining operations |
| ☐ Yes ☐ No ☐ N/A |
| Ability to meet the proposed construction schedule |
| ☐ Yes ☐ No ☐ N/A |
| Ability to provide required bonds and insurance |
| ☐ Yes ☐ No ☐ N/A |
| Adequate personnel and resources available during the project |
| ☐ Yes ☐ No ☐ N/A |
12. REFERENCES
Provide owners or other knowledgeable representatives who can comment on the contractor’s performance on comparable projects.
| Reference |
| Project / Location |
| Contact Person |
| Phone / Email |
| Year |
13. ATTACHMENTS
List all attachments provided as further explanation.
14. CONTRACTOR CERTIFICATION
The undersigned authorized representative certifies that:
• The information contained in this qualification statement and its attachments is true and accurate to the best of the undersigned’s knowledge and belief.
• The contractor has disclosed material information that could reasonably affect an evaluation of its qualifications or ability to perform the proposed work.
• The undersigned is authorized to make this submission on behalf of the contractor.
• The Owner and its representatives may verify the information provided, including contacting references and reviewing publicly available licensing, safety, regulatory, and contract-performance information.
• The contractor understands that submission of this statement does not constitute a contract, commitment of award, or guarantee of selection unless expressly stated in the solicitation.
| AUTHORIZED REPRESENTATIVE |
| NOTARY / ACKNOWLEDGMENT |
Contractor Legal Name:
State of: __________________________
Signature:
County of: _________________________
Printed Name and Title:
Subscribed and sworn before me on:
Date:
Notary Signature:
Phone / Email:
Commission Expires:
Seal / Additional Information:
Notary Seal:
END OF CONTRACTOR QUALIFICATION STATEMENT
Contractor Qualification Statement | Page 1
File details come from the government source that posted it. Updated .