ATT D - Min Qls On-Call_5-13 AK.pdf

WAYNE COUNTY AIRPORT AUTHORITY ATTACHMENT D

REQUEST FOR BIDS #25-01937 Page 1 of 8

ATTACHMENT D - VERIFICATION OF MINIMUM QUALIFICATIONS

FORM

Failure to complete this form or provide the required information for verification of minimum qualifications will result in your Bid being deemed nonresponsive and rejected without further evaluation.

a) The Proposer must have, as a business, a written safety program, provide evidence of implementation of the written safety program, and provide evidence of an EMR (Experience Modification Rate) with an average less than or equal to 1.0 over the past three (3) calendar years:

Proposer Name:

Include information to demonstrate that the company's safety program meets this Minimum Qualification.

Is evidence of implementation of written company safety program attached to the Proposal?

Yes:

Provide the EMR for the past three calendar years:

1. 2022 EMR ______________________

2. 2023 EMR ______________________

3. 2024 EMR ______________________

Is the letter of verification attached to the Bid?

1. 2022 EMR Yes:

2. 2023 EMR Yes:

3. 2024 EMR Yes:

Provide copies of the company's OSHA 300 forms for the past three (3) years with the Proposal. Are the company’s OSHA 300 forms for the past three (3) years attached to the Proposal?

1. 2022 OSHA 300 Form Yes:

2. 2023 OSHA 300 Form Yes:

3. 2024 OSHA 300 Form Yes:

REQUEST FOR BIDS #25-01937 Page 2 of 8

VERIFICATION OF MINIMUM QUALIFICATIONS FORM (continued)

b) The Proposer must provide evidence that a minimum of five (5%) of the bid amount will be assigned to and performed by a Wayne County Airport Authority Certified Small Business Enterprise. Such evidence shall be provided through completion of the table below form and through completion a Subcontractor Form, an attachment to this solicitation, for all subcontractors and suppliers proposed to be used if awarded the contract.

SBE Commitment Percentage SBE Minimum Qualification must be listed as a percentage of total contract cost. If SBE participation is to be completed through the use of subcontractors or suppliers, Subcontractor Forms must confirm the value and description of work to be performed.

Proposer understands that its SBE commitment, continues through the entire duration of the contract and if the contract value should change through a change order or other means of modification, then the SBE commitment follows the change, either increase or decrease

WCAA Certified SBEs Commitment Summary Percentage

1. SBE Prime Contractor %

2. SBE Subcontractor(s) and SBE Suppliers (Total from Subcontractor Forms) %

Proposer’s overall WCAA Certified SBE Commitment Total

(Must meet or exceed 5%)

REQUEST FOR BIDS #25-01937 Page 3 of 8

c) The Proposer must have served as the Prime Contractor self-performing the work on a minimum of two

(2) concrete repair or building restoration projects involving structural concrete and/or waterproofing repairs with a contract value of at least $100,000 each and both Substantially Completed in the year 2017 or later and by the Bid Deadline.

Proposer Name:

Provide information on a minimum of two (2) concrete deck repair or building restoration projects below to demonstrate compliance with this Minimum Qualification.

i) Project Name/Location:

Client Name: _____________________________________ Title: ______________________________

Client Contact: __________________________ Phone Number: _______________________________

Client Email Address: __________________________________________________________________

Substantial Completion Date: _______________________ Contract Value: $_____________________

Project Description: ____________________________________________________________________

ii) Project Name/Location:

Client Contact: __________________________ Phone Number: _______________________________

Client Email Address: __________________________________________________________________

Substantial Completion Date: _______________________ Contract Value: $______________________

Project Description: ____________________________________________________________________

REQUEST FOR BIDS #25-01937 Page 4 of 8

d) The Bidder must have on staff a Project Manager that will be assigned to the Project resulting from this RFB, that has served as the Project Manager on a minimum of two (2) concrete repair or building restoration projects involving structural concrete and/or waterproofing repairs with a minimum construction contract value of $100,000 each and Substantially Completed in the year 2017 or later and by the Bid Deadline. Provide a resume for the Project Manager (include with Attachment D: Verification of Minimum Qualification Forms).

Project Manager Name:

Has the Proposer included the Project Manager’s Resume? Yes _______ Provide information on a minimum of two (2) parking deck repair or building restoration projects below to demonstrate compliance with this Minimum Qualification.

Client Contact: __________________________ Phone Number: _______________________________

Client Email Address: __________________________________________________________________

Substantial Completion Date: _______________________ Contract Value: $_____________________

Project Description: ____________________________________________________________________

ii) Project Name/Location:

Client Name: _____________________________________ Title: ______________________________

Client Contact: __________________________ Phone Number: _______________________________

Client Email Address: __________________________________________________________________

Substantial Completion Date: _______________________ Contract Value: $______________________

Project Description: ____________________________________________________________________

REQUEST FOR BIDS #25-01937 Page 5 of 8

e) The Proposer must have a Project Superintendent on staff that will be assigned to the contract resulting from this RFB, who will be on-site and responsible for the performance of the work. The Project Superintendent must have performed in a supervisory role on a minimum of two (2) concrete repair or building restoration projects involving structural concrete and/or waterproofing repairs with a minimum construction contract value of $100,000 each and Substantially Completed in the year 2017 or later and by the Bid Deadline Provide a resume for the Project Superintendent (include with Attachment D:

Verification of Minimum Qualification Forms).

Project Superintendent Name:

Has Proposer included the Project Superintendent’s Resume? Yes _______

Provide information on a minimum of two (2) parking deck or building restoration projects below to demonstrate compliance with this Minimum Qualification.

Client Contact: __________________________ Phone Number: _______________________________

Client Email Address: __________________________________________________________________

Substantial Completion Date: _______________________ Contract Value: $_____________________

Project Description: ____________________________________________________________________

ii) Project Name/Location:

Client Name: _____________________________________ Title: ______________________________

Client Contact: __________________________ Phone Number: _______________________________

Client Email Address: __________________________________________________________________

Substantial Completion Date: _______________________ Contract Value: $______________________

Project Description: ____________________________________________________________________

REQUEST FOR BIDS #25-01937 Page 6 of 8

f) The Proposer must have on staff (or on the staff of a Team Member), at least one individual that will be assigned to the Project resulting from this RFP, that are licensed person(s) that will perform electrical portions of the work in accordance with the State of Michigan “Skilled Trades Regulation Act” (Act No.

407 of 2016) Information regarding this Act may be accessed on the State of Michigan website at the following weblink:

http://www.legislature.mi.gov/(S(bufluj41g15mqamy4ebruymd))/mileg.aspx?page=GetObject&objectna me=2016-PA-0407 Provide a copy of the licenses for the individuals that will be performing this work (include with Attachment D: Verification of Minimum Qualification Forms)

Has the Proposer attached copies of the licenses for the individuals listed below as evidence that the individuals meet the requirements of this qualification?

Yes:

List names of licensed electricians to be responsible for this project below:

First Name Last Name Company http://www.legislature.mi.gov/(S(bufluj41g15mqamy4ebruymd))/mileg.aspx?page=GetObject&objectname=2016-PA-0407 http://www.legislature.mi.gov/(S(bufluj41g15mqamy4ebruymd))/mileg.aspx?page=GetObject&objectname=2016-PA-0407

REQUEST FOR BIDS #25-01937 Page 7 of 8

g) The Proposer must have on staff (or on the staff of a Team Member), at least one individual that will be assigned to the Project resulting from this RFB, that are licensed person(s) that will perform plumbing portions of the work in accordance with the State of Michigan “Skilled Trades Regulation Act” (Act No.

407 of 2016) Information regarding this Act may be accessed on the State of Michigan website at the following weblink:

http://www.legislature.mi.gov/(S(bufluj41g15mqamy4ebruymd))/mileg.aspx?page=GetObject&objectna me=2016-PA-0407 Provide a copy of the licenses for the individuals that will be performing this work (include with Attachment D: Verification of Minimum Qualification Forms).

Has the Proposer attached copies of the licenses for the individuals listed below as evidence that the individuals meet the requirements of this qualification?

List names of licensed plumbers to be responsible for this project below:

http://www.legislature.mi.gov/(S(bufluj41g15mqamy4ebruymd))/mileg.aspx?page=GetObject&objectname=2016-PA-0407 http://www.legislature.mi.gov/(S(bufluj41g15mqamy4ebruymd))/mileg.aspx?page=GetObject&objectname=2016-PA-0407

REQUEST FOR BIDS #25-01937 Page 8 of 8

h) The Proposer must have on staff (or on the staff of a Team Member), at least one individual that will be assigned to the Project resulting from this RFB, that are licensed and certified person(s) that will perform welding portions of the work in accordance with the American Welding Society AWS D1.1 Structural Welding – Steel. Provide a copy of the licenses and certifications for the individuals that will be performing this work (include with Attachment E: Verification of Minimum Qualification Forms)

Has the Proposer attached copies of the licenses and certifications for the individuals listed below as evidence that the individuals meet the requirements of this qualification?

List names of licensed welders to be responsible for this project below: