ADV_Bidders Qualifications Form.doc
DOC document 80 KB Posted
- Attached to
- Inks Dam National Fish Hatchery Federal contract opportunity
- Solicitation number
- 693C7321B000005
About this file
This federal contract opportunity solicitation is seeking sealed bids from certified Small Business Concerns only for the rehabilitation or reconstruction of roads and associated parking areas at the Inks Dam National Fish Hatchery located in Burnet County, Texas. The work includes asphalt removal, grading, drainage, aggregate base, asphalt pavement, signing, markings and other miscellaneous work, with an estimated price range of $1,000,000 to $5,000,000. Interested vendors should monitor the Beta SAM website for the issuance of solicitation documents around November 13, 2020, with bid submissions due on the date specified in block 13a of the SF1442 form included in the solicitation. Annual Representations and Certifications must be completed in SAM, and Form Vets-4212 filed through the Labor Department website. All questions should be directed to the email address provided for the Eastern Federal Lands Highway Division of the Department of Transportation Federal Highway Administration, which is the agency issuing this opportunity.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Results of Bid Opening - TX FTFW INDA 10(1) 11(1).pdf | ||
| Bid Opening Slides Schedule A and B.pdf | ||
| VETS-4212 Form.pdf | ||
| FP14_Eng.pdf | ||
| SWPPP.pdf | ||
| Septic System Design and Specifications.pdf | ||
| Section 4f memo.pdf | ||
| Pavement Report.pdf | ||
| Plans - TX FTFW INDA 10(1) 11(1).pdf | ||
| IFB - TX FTFW INDA 10(1) 11(1).pdf | ||
| NEPA CE.pdf |
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Text version
INSTRUCTIONS: Answer all questions on this form inserting "none" or "not applicable" where appropriate. If more space is required attach additional sheets. Return the signed, dated and completed form with the bid to the address shown in the invitation for bids on or before the time set for bid opening. The prospective bidder shall provide any additional information requested by the Government during evaluation of the bids.
If the prospective bidder is a joint venture or general partnership, a separate Bidder's Qualifications form shall be provided individually for each joint venture participant or partner.
1. Project Name:
TX FTFW INDA 10(1), 11(1)
Solicitation No.: 693C73-21-B-000005 Inks Dam National Fish Hatchery
2. Name and address of business:
Contractor Tax ID
Company Name
Contractor DUNS Number
Street
City
State
Zip Code
County
Telephone Number (Include Area Code)
Fax Number (Include Area Code)
E-mail Address
Web site address
3. a. Type of organization (check appropriate box):
□ Individual
□ Non-profit organization
□ Corporation
□ Partnership
□ Joint Venture
State
Incorporated in: __________
□ Limited Liability Company (LLC)
If a foreign entity:
□ Individual
□ Non-profit organization
□ Corporation
| □ Partnership |
| □ Joint Venture |
b. Size of Business Concern (check appropriate boxes):
□ Large Business Concern
□ Small Business Concern
□ Emerging Small Business
Concern
□ Small Disadvantaged
Business Concern
□ Women-Owned Small
Business Concern
□ SBA 8(a) Certified SDBC
□ HUBZone Small Business
Concern
□ Veteran-owned Small
Business Concern
□ Service-Disabled Veteran Owned Small Business Concern
{See FAR Clauses 52.219-1 and 52.219-19 for small business definitions.}
4. If a joint venture or general partnership:
a. Provide the name under which the project will be bid, the home office address, and name of the principal who will represent the company with regard to this project if different from "1." above.
TAX ID:
Principal
DUNS #
Business Name
Street
b. Provide the name and home office addresses of each of the joint venture partners; indicate which partner is the sponsoring partner. Attach a separate sheet for additional partners.
Sponsoring Partner
Other Partner
Street
Street
5. Date business established: _________________________
6. Name of succeeded business, if any: _________________________
7. How many years have you been in business as:
a. General contractor: _______ Years.
b. Subcontractor: _______ Years.
8. a. Furnish the following information concerning the owner, partners, officers and directors:
| Name |
| Title |
| Percent of Business Owned |
| Years of |
Business Experience
| Contracting |
| Other |
b. Attach resumes of these key personnel as well as the on-site project manager(s) and superintendent(s), and specifically identify the following:
-Present position, responsibility, and length of employment.
-Amount and type of construction experience.
-Amount and type of highway construction experience, including position, responsibility, and a brief project description of each period of employment.
-Formal education and training, professional or technical registrations or licenses.
9. a. Active Contracts (Attach additional sheets if necessary) Must be completed. Provide contact person(s), phone numbers and e-mail addresses.
| Project Name and Contract Numbers |
| Owner's Name & Address |
Contact Person, Telephone Number, &
E-mail address Scope of Work Performed
By Your Company
| Contract Amount |
| Estimated Completion Date |
| Name of Surety |
b. Are there any unresolved claims or lawsuits associated with these projects? If so, state the amount in dispute, parties involved, nature and circumstances of the dispute, and status of the matter on a separate sheet.
10. a. List no more than five of the largest jobs you have completed in the last five years which are relevant in project work scope to this project.
(Attach additional sheets if necessary) Must be completed. Provide contact person(s), phone numbers and e-mail addresses.
| Project Name and Contract Numbers |
| Owner's Name & Address Contact Person, Telephone Number; & E-mail address |
| Scope of Work Performed By Your Company |
| Original and Final Contract Amounts |
| Original and Final Completion Dates |
| Names of On-site Project Manager and Superintendent |
| Name of Surety |
b. Are there any unresolved claims or lawsuits associated with these projects? If so, state the amount in dispute, parties involved, nature and circumstances of the dispute, and status of the matter on a separate sheet.
11. Termination:
a. Has your firm ever had a contract terminated for any reason? ________
b. If the answer is yes, identify the project and owner for each termination, and explain the circumstances surrounding each termination. Attach additional sheet if necessary.
12. Debarment and Suspension:
a. Has your firm or any of the principals been suspended or debarred from bidding by any agency? ______
b. If the answer is yes, identify the agency by which debarred or suspended, and date of reinstatement. Attach additional sheet if necessary.
13. What types of work do you perform as general contractor?
14. What types of work do you perform as subcontractor?
15. What types of work do you generally subcontract?
16. Affidavit:
Certification: For the purpose of establishing construction capabilities, we furnish the above as a true and correct statement of our construction experience and further certify that all other statements are true and correct.
By (Signature of Authorized Official)
Date
Title
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