Att D - Min Quals.pdf

WAYNE COUNTY AIRPORT AUTHORITY ATTACHMENT D

REQUEST FOR BIDS #25-02696 Page 1 of 15

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 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 less than or equal to 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.

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:

Attach a copy of the company's Occupational Safety and Health Administration (OSHA) 300 forms for the past 3 years attached to the Bid. Are the company’s OSHA 300 forms for the past 3 years attached to the Bid?

1. 2022 OSHA 300 Form Yes:

2. 2023 OSHA 300 Form Yes:

3. 2024 OSHA 300 Form Yes:

REQUEST FOR BIDS #25-02696 Page 2 of 15

VERIFICATION OF MINIMUM QUALIFICATIONS FORM (continued)

b) The Bidder must have served as the prime contractor, managed and Substantially Completed at least two (2) projects at a Public-use Airport or with a State Department of Transportation with a minimum construction value of $10M. One of the projects must include the installation of at least 15,000 square yards (SYD) of a minimum 14-inch thick Portland cement concrete pavement, in the year 2014 or later, and by the Bid Deadline. At least one (1) of the projects must have been performed at a Public-use Airport.

Bidder Name: _______________________________________________________

Provide reference and information on a minimum of two (2) projects below to demonstrate compliance with this Minimum Qualification.

i) Project Name/Location:

Date of Substantial Completion:

Portland Cement Concrete Pavement:

Yes: _____

No: _____

Contract Value: $______________________ Number of Subcontractors:_____________

SYD of Pavement______________________ Pavement Thickness (inches):_____________

Project Description (Scope of work included in project):

Client Name: _______________________________________________________________

Client Contact: _______________________________ Title: _________________________

Phone Number: ________________ Email Address: ______________________________

Was this project performed at a Public-use Airport? Yes: _____ No: _____

REQUEST FOR BIDS #25-02696 Page 3 of 15

ii) Project Name/Location: ______________________________________________________

Portland Cement Concrete:

Yes: _____

No: _____

Contract Value: $______________________ Number of Subcontractors:_____________

Client Contact: _______________________________ Title: _________________________

REQUEST FOR BIDS #25-02696 Page 4 of 15

c) The Bidder must have as a Prime Contractor (or have a first-tier Subcontractor that will be assigned to the contract resulting from this RFB) that has managed, performed and Substantially Completed at least two (2) projects at a Public-use Airport or with a State Department of Transportation, each requiring the installation of at least 15,000 square yards (SYD) of a minimum 14-inch thick Portland cement concrete pavement, in the year 2014 or later, and by the Bid Deadline. At least one (1) of the projects must have been performed at a Public-use Airport.

Name of Prime or first-tier Subcontractor:

Provide reference and information on a minimum of two (2) projects below to demonstrate compliance with

Portland Cement Concrete Installation Self-Performed:

Yes: _____

No: _____ Name of qualified first-tier Subcontractor who performed installation: _____________

Client Contact: _______________________________ Title: _________________________

REQUEST FOR BIDS #25-02696 Page 5 of 15

ii) Project Name/Location: ______________________________________________________

Portland Cement Concrete Installation Self-Performed:

Yes: _____

No: _____ Name of qualified first-tier Subcontractor who performed installation: _____________

Contract Value: $______________________ Number of Subcontractors:_____________

Client Contact: _______________________________ Title: _________________________

REQUEST FOR BIDS #25-02696 Page 6 of 15

d) The Bidder must have a Project Manager with a minimum of five (5) years of experience as a Project

Manager that has managed (as defined in the RFB) multiple Sub-contractors on construction projects, who will be assigned to the contract resulting from this RFB. Project Manager shall have also performed as the project manager on at least two (2) projects with at least 15,000 square yards (SYD) of a minimum 14-inch thick Portland cement concrete pavement that were Substantially Completed in the year 2014 or later, and by the Bid Deadline. At least one (1) of the projects must have been performed at a Public-use Airport that included Portland cement concrete airfield paving. Attach a copy of resume for the Project Manager illustrating that this minimum qualification has been met.

Project Manager Name: ___________________________________________________________

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

Provide reference and information on a minimum of two (2) projects below to demonstrate compliance with

Project Manager: Yes: _____ No:_____

Portland Cement Concrete Installation Self-Performed:

Yes: _____

No: _____

Was this project performed at a Public-use Airport? Yes: No:

Client Contact: _______________________________ Title: _________________________

REQUEST FOR BIDS #25-02696 Page 7 of 15

ii) Project Name/Location:

Project Manager : Yes:____ No:_____

Portland Cement Concrete Installation Self-Performed:

Yes: _____

No: _____

REQUEST FOR BIDS #25-02696 Page 8 of 15

e) The Bidder must have a Project Superintendent (as defined in the Contract Terms and Conditions) with a minimum of five (5) years as a Project Superintendent that has supervised construction projects, who will be assigned to the contract resulting from this RFB, and who will be on-site and responsible for the performance of the work outlined in this RFB. Project Superintendent shall have performed as the project superintendent on at least two (2) projects with at least 15,000 square yards (SYD) of a minimum 14-inch thick Portland cement concrete pavement that were Substantially Completed in the year 2014 or later and by the Bid Deadline. At least one (1) of the projects must have been performed at a Public-use Airport that included Portland cement concrete airfield paving. Attach a copy of resume for the Project Superintendent illustrating that this minimum qualification has been met.

Project Superintendent Name: ______________________________________________________

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

Provide reference and information on a minimum of two (2) projects below to demonstrate compliance with this Minimum Qualification.

i) Project Name/Location:

Superintendent had Supervisory Role: Yes: No:

Portland Cement Concrete Installation Self-Performed:

Yes: _____

No: _____

REQUEST FOR BIDS #25-02696 Page 9 of 15

Superintendent had Supervisory Role: Yes: No:

Portland Cement Concrete Installation Self-Performed:

Yes: _____

No: _____

Phone Number: Email Address:

REQUEST FOR BIDS #25-02696 Page 10 of 15

f) The Bidder must have as the prime contractor (or have a first-tier subcontractor that will be assigned to the contract resulting from this RFB) that has managed and performed the electrical portion of work on at least two (2) projects that included the installation of runway or taxiway lighting system component(s) and were Substantially Completed in the year 2014 or later, and by the Bid Deadline.

Name of Prime or first-tier Subcontractor:

Provide reference and information on a minimum of two (2) projects below to demonstrate compliance with

Name of entity who managed the electrical portion of work that included the installation and modification of runway or taxiway lighting system components:___________________________

Project Description, including lighting system component(s) installed:______________________

Client Name: _______________________________________________________________

REQUEST FOR BIDS #25-02696 Page 11 of 15

Name of entity who managed the electrical portion of work that included the installation and modification of runway or taxiway lighting system components:___________________________

Project Description, including lighting system component(s) installed:______________________

Client Name: _______________________________________________________________

REQUEST FOR BIDS #25-02696 Page 12 of 15

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 Project resulting from this RFB, that is a 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

Name of the Bidder or Team Member: ______________________________________

1. Name of licensed person with experience specified above:

License Number: Issuing State:

Copy of Electrical 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

REQUEST FOR BIDS #25-02696 Page 13 of 15

h) The Bidder must have on staff (or on the staff of a Team of a Team Member), a Project Scheduler with a minimum of five (5) years of scheduling experience in construction projects including at least two (2) projects at a commercial service airport, state highway, county, city or municipal projects with a minimum construction value of $10M and were Substantially Completed in the year 2014 or later, and by the Bid Deadline. The Project Scheduler will be assigned to the contract resulting from this RFB and will be on-site and responsible for developing and maintaining the project schedule per the contract documents.

Attach a copy of resume for the Project Scheduler illustrating that this minimum qualification has been met.

Project Scheduler Name: ___________________________________________________________

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

Provide reference and information on a minimum of two (2) projects below to demonstrate compliance with

Contract Value: $______________________

Project Description (Scope of work included in project):

REQUEST FOR BIDS #25-02696 Page 14 of 15

Contract Value: $______________________

Project Description (Scope of work included in project):

Client Name: _______________________________________________________________

REQUEST FOR BIDS #25-02696 Page 15 of 15

i) The Bidder must provide evidence that a minimum of ten (10%) 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 10%) %