AFQ 034020143 Appendix D - Required Disclosures1 Rev13114.doc
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- Attached to
- Specialty Preservation Construction
- Solicitation number
- 034020143
- Issued by
- Dauphin County, Harveys Lake Borough, Pennsylvania
About this file
This document is an Appendix D - Required Disclosures for the AFQ 034020143 state and local contract opportunity. The document requires the applicant to answer a series of questions related to their past three years of business activities, including whether they have been debarred, suspended, or prohibited from doing business with any government or private entity, if they have defaulted on or failed to complete any projects, and if they have had any legal or licensing issues. The applicant must provide written explanations for any affirmative responses.
The related state and local contract opportunity is for Specialty Preservation Construction, offered by the Pennsylvania Historic & Museum Commission (PHMC). This is an open enrollment process for pre-qualified preservation and traditional trade contractors, craftspeople, and artisans to bid on preservation construction projects on historic buildings at PHMC's sites and museums throughout Pennsylvania. The contract opportunity is open from now until June 30, 2019, and covers the jurisdictions of Dauphin County and Harrisburg City.
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Text version
APPENDIX D
Required Disclosures
The Applicant shall answer the following questions with regard to the past three (3) years. If any question is answered in the affirmative, the Applicant shall submit a written explanation which shall provide details concerning the matter in question, including applicable dates, locations, names of projects/project owners and current status of any such matter.
1. Is the Applicant currently debarred or suspended from doing business with any federal, state or local government agency or private entity?
Yes ___ No ___
2. Has the Applicant ever been debarred or suspended from doing business with any federal, state or local government agency or private entity?
3. Is the Applicant currently or has the Applicant been otherwise prohibited from doing business with any federal, state or local government agency or private entity?
4. Has the Applicant been denied prequalification (not including short listing), declared non-responsible, or otherwise declared ineligible to submit bids or proposals for work by any federal, state or local government agency or private entity?
5. Has the Applicant defaulted, been terminated for cause or otherwise failed to complete any project that it was awarded?
6. Has the Applicant been assessed or required to pay liquidated damages in connection with work performed on any project?
7. Has the Applicant had any business or professional license, registration, certificate or certification suspended or revoked?
8. Have any liens been filed against the Applicant as a result of its failure to pay subcontractors, suppliers, or workers?
9. Has the Applicant been denied bonding or insurance coverage or been discontinued by a surety or insurance company?
10. Has the Applicant been found in violation of any laws, including but not limited to contracting or antitrust laws, tax or licensing laws, labor or employment laws or environmental laws by a final decision of a court or government agency?
*Note: information regarding health and safety violations is addressed in a previous section.
11. Has the Applicant or its owners, officers, directors or managers been the subject of any criminal indictment or criminal investigation concerning any aspect of the Applicant’s business?
Yes ___ No ___
12. Has the Applicant been the subject to any bankruptcy proceeding?
AFQ 2013-02
File details come from the government source that posted it. Updated .