Att D Min Qual.pdf

WAYNE COUNTY AIRPORT AUTHORITY ATTACHMENT D

SOLICITATION #25-00618 Page 1 of 8

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 Bidder 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 equal to or less than 1.0 over the past three (3) calendar years:

Bidder 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 Bid? Yes:

Provide the following company EMR* with a letter of verification from the company's insurance carrier. If 2024 EMR is unavailable, the Contractor must provide 2021 – 2023 EMR:

1. 2021 EMR ______________________

2. 2022 EMR ______________________

3. 2023 EMR ______________________

4. 2024 EMR ______________________

Is the letter of verification attached to the Bid?

1. 2021 EMR Yes:

2. 2022 EMR Yes:

3. 2023 EMR Yes:

4. 2024 EMR Yes:

Provide a copy of the company's OSHA 300 forms for the past 3 years attached to the Bid. If the 2024 OSHA 300 forms is unavailable, the Contractor must provide 2021 – 2023 OSHA 300 forms.

Are the company’s OSHA 300 forms for the past 3 years attached to the Bid?

1. 2021 OSHA 300 Form Yes:

2. 2022 OSHA 300 Form Yes:

3. 2023 OSHA 300 Form Yes:

4. 2024 OSHA 300 Form Yes:

SOLICITATION #25-00618 Page 2 of 8

VERIFICATION OF MINIMUM QUALIFICATIONS FORM (continued)

b) The Bidder must provide evidence that a minimum of twenty (20%) 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.

Bidder 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) %

Bidder’s overall WCAA Certified SBE Commitment Total (Must meet or exceed 20%) %

SOLICITATION #25-00618 Page 3 of 8

c) The Bidder must have served as the Prime Contractor on a minimum of two (2) projects at a Public-use

Airport or Similar Government or Private facility, in the year 2014 or later and by the Bid Deadline that consisted of a minimum of 5,000 square foot each of interior and exterior building restoration/renovation, for commercial or industrial purposes.

Provide information on a minimum of two (2) projects below to demonstrate compliance with this Minimum Qualification. Duplicate this form as needed.

1. Project Name:

Project Location:________________________________________________________________________

Total Building Area of Construction (Square Feet)

Project Description:

Date of Substantial Completion:

Contract Value:

Client Name:

Client Contact: Title:

Phone Number:

2. Project Name:

Project Location: _______________________________________________________________________

Project Description:

Date of Substantial Completion:

Contract Value:

Client Name:

SOLICITATION #25-00618 Page 4 of 8

d) Provide information that the Bidder or a Team Member that will be assigned to the Project resulting from this RFB, has managed and Substantially Completed two (2) projects that included rehabilitation or restoration of a building with historic detailing, including brick restoration, tuckpointing and plaster detailing in the year 2014 or later and by the Bid Deadline.

Bidder (or Team Member) Name:

Provide information on a minimum of two (2) projects below to demonstrate compliance with this Minimum Qualification. Duplicate this form as needed.

Project Description:

Date of Substantial Completion:

Client Name:

Date of Substantial Completion:

Client Name:

SOLICITATION #25-00618 Page 5 of 8

e) Provide information confirming that the Bidder’s proposed Project Manager assigned to the Project resulting from this RFB has served as the Construction Project Manager with a minimum of ten (10) years of experience, including the management of the construction of a minimum of two (2) projects Substantially Completed in the year 2014 or later and by the Bid Deadline that each consisted of a minimum of 5,000 square foot of interior and exterior building restoration/renovation, for commercial or industrial purposes. Provide a resume for the Project Manager (include with Attachment D: Verification of Minimum Qualification Forms).

Project Manager Name: ______________________________________________________________

Is a copy of the Project Manager’s resume included with this Bid? Yes:_______

Provide information below to demonstrate compliance with this Minimum Qualification. Duplicate this form as needed.

Date of Substantial Completion:

Client Name:

Date of Substantial Completion:

Client Name:

SOLICITATION #25-00618 Page 6 of 8

f) Provide information confirming that the Bidder’s proposed Project Superintendent assigned to the Project resulting from this RFB has served as the Construction Project Superintendent with a minimum of ten (10) years of experience, including the management of the construction of a minimum of two (2) projects Substantially Completed in the year 2014 or later and by the Bid Deadline that each consisted of a minimum of 5,000 square foot of interior and exterior building restoration/renovation, for commercial or industrial purposes. Provide a resume for the Project Superintendent (include with Attachment D: Verification of Minimum Qualification Forms).

Project Superintendent Name: _____________________________________________________________

Is a copy of the Project Superintendent resume included with this Bid? Yes:_______

Provide information below to demonstrate compliance with this Minimum Qualification. Duplicate this form as needed.

a. Total Building Area of Construction (Square Feet)

b. Project Description:

c. Date of Substantial Completion:

d. Client Name:

e. Client Contact: Title:

f. Phone Number:

a. Total Building Area of Construction (Square Feet)

b. Project Description:

c. Date of Substantial Completion:

d. Client Name:

e. Client Contact: Title:

f. Phone Number:

SOLICITATION #25-00618 Page 7 of 8

g) The Bidder must have on staff (or on the staff of a Team Member), a minimum of one (1) individual that will be assigned to the contract resulting from this RFB, that is currently licensed to 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

Name of licensed Team Member:

Employer:

License Number: Issuing State:

Copy of Electrical license included with this Bid? Yes:

h) The Bidder must have on staff (or on the staff of a Team Member), a minimum of one (1) individual that will be assigned to the Project resulting from this RFB, that are licensed person(s) that will perform mechanical 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

Name of licensed Team Member:

Employer:

Copy of Mechanical license included with this Bid? Yes: ____ 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 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

SOLICITATION #25-00618 Page 8 of 8

I) The Bidder must have on staff (or on the staff of a Team Member), a minimum of one (1) 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

Name of licensed Team Member:

Employer:

Copy of Plumbers license included with this Bid? Yes: ____ 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