ADV_Offerors Qualifications Form.doc
DOC document 80 KB Posted
- Attached to
- Landslide Repairs - West Region Contract 1
- Solicitation number
- 693C73-22-R-000006
About this file
This document contains a federal contract opportunity solicitation for landslide repair work in Puerto Rico. The U.S. Department of Transportation Federal Highway Administration is seeking proposals from certified Small Business Concerns for the Landslide Repairs - West Region Contract 1 project. Repair work will be conducted on PR-2, PR-119, PR-123, PR-128 and PR-440 in the municipalities of San Sebastian, Las Marias, San German, Yauco, Utuado, Aguada, and Aguadilla and includes embankment restoration, retaining walls, drainage, and other miscellaneous work. The total project cost is estimated between $1,000,0000 and $5,000,000 and will be split into multiple work schedules. An offeror's qualifications form and the solicitation will require details on construction experience. A pre-bid meeting and two-step proposal process including technical and price proposals will take place by the specified due date. Interested vendors must register at the provided website for notification of solicitation documents and changes.
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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 proposal to the address shown in the Request For Proposal on or before the proposal due date and time. The prospective Offeror shall provide any additional information requested by the Government during evaluation of the proposals.
If the prospective Offeror is a joint venture or general partnership, a separate Offeror's Qualifications form shall be provided individually for each joint venture participant or partner.
1. Project Name:
PR ER PRMNT RPR (9)
Solicitation No.: 693C73-22-R-000006 Landslide Repairs – West Region Contract 1
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
□ Limited Liability Company (LLC)
□ Joint Venture
State
Incorporated in: __________
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
H:\PROCUOFF\construction\ADV_Bidder's Qualifications form.doc
File details come from the government source that posted it. Updated .