Attachment E 2024~1.docx

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Attached to
Request for Responses - AccRep_OPM - 2024
Solicitation number
BD-24-1211-MSBA-MASS-101047
Issued by
Suffolk County, Massachusetts

About this file

Written by GovTribe AI ·

This document is the Owner's Project Manager Application Form for the Massachusetts School Building Authority's (MSBA) Accelerated Repair Program. It outlines the requirements and procedures for interested firms or joint ventures to submit qualifications to provide owner's project management services for eligible districts invited to participate in the MSBA's Accelerated Repair Program. The application form requests information about the respondent firm, key personnel including the project director, project manager(s), and project representative(s), as well as the firm's and key personnel's past performance on similar projects. The completed application must be submitted by the due date specified in the related state and local contract opportunity.

The application form also requires respondents to provide details on their current capacity and ongoing work, as well as references for completed and current projects for which the firm has provided owner's project management services for public agencies within the Commonwealth of Massachusetts over the past 10 years. Pricing terms, set asides, funding requirements and sources are not explicitly covered in this document, as it is focused on the qualifications of the respondent and their key personnel.

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Other files

File Type Posted
OPM RFR_Addendum No. 2 Q&A.pdf PDF
Attachment E 2024.docx DOCX document
Attachment F Invest in MA Form_Revised.pdf PDF
Attachment A Authorized Respondent Signature and Acceptance Form~34.pdf PDF
Attachment B Certification Statement~31.pdf PDF
2024 ARP OPM RFR Final Draft_Clean~1.pdf PDF
Addendum No.1 (1).pdf PDF
Attchment D Supplier Diversity Program (1).pdf PDF
2024 ARP OPM RFR Final Draft_Clean.pdf PDF
Attachment C - ARP_OPM_Contract_2021 FINAL.docx DOCX document
Attachment D~20.pdf PDF
Attachment F Invest in MA Form~3.pdf PDF
Attachment C - ARP_OPM_Contract_2021 FINAL~1.pdf PDF
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ATTACHMENT E

Owner’s Project Manager Application Form for the Accelerated Repair Program

1a.
Respondent Firm Or Joint Venture - Name And Address Of Primary Office To Perform The Work:
1b.
Name And Address Of Other Participating Offices:

1c.

Date Present And Predecessor Firms Were Established:

1d.
Name And Address Of Parent Company, If Any:
1e.
Federal ID #:
1f.
Name of Proposed Project Director:
2.
Personnel From Prime Firm Included In Question 2a Above By Discipline (List Each Person Only Once, By Primary Function - Average Number Employed Throughout The Preceding Six Month Period. Indicate Both The Total Number of Employees and the Number In Each Discipline:

Admin. Personnel

Cost Estimators

Other

Architects

Electrical Engrs.

Acoustical Engrs.

Environmental Engrs.

Civil Engrs.

Licensed Site Profs.

Code Specialists

Mechanical Engrs.

Construction Inspectors

Total

3.
Has this Joint Venture previously worked together?
q Yes

q No

4.
Key Personnel: Using the organization chart below, show the names, titles, and firms of ONLY the Key Personnel who are proposed for each project phase. As specified in the Request for Responses Key Personnel include the Project Director, Project Manager(s), Project Representative(s), and named subconsultants, if any. The chart may be modified to fit the Respondent’s proposed management approach.

CITY/TOWN/DISTRICT

Construction Phase Name of Project Representative (s) (Number of years of experience for each Project Representative) Subconsultant Prime Consultant Name of Project Director Name of Project Manager (s)

5.

Key Personnel: List and provide the following information for ONLY the Key Personnel specified in the Request for Services: Project Director, Project Manager(s), Project Representative(s), and named subconsultants, if any. Additional sheets should be provided only as required for these key personnel and must be in the format provided below. By including a firm as a subconsultant, the Respondent certifies that the listed subconsultant has agreed to work on this project, should the team be selected.

a.
Name And Title Within Firm:
a.
Name And Title Within Firm:
b.
Project Assignment: Project Director
b.
Project Assignment: Project Manager
c.
Name And Address Of Office In Which Individual Identified In “a” Works:
c.
Name And Address Of Office In Which Individual Identified In “a” Works:
d.
Years of Experience: With This Firm:

With Other Firms:

d.
Years of Experience: With This Firm:

With Other Firms:

e.
Education: Degree(s) /Institution/Year/Specialization
e.
Education: Degree(s) /Institution/Year/Specialization
f.
MCCPO Certification:

q Yes(submit copy of certificate) q No (submit copy of registration form, if applicable)

f.
MCCPO Certification:

q Yes(submit copy of certificate) q No (submit copy of registration form, if applicable)

g.
Applicable Registrations and Certifications:
g.
Applicable Registrations and Certifications:
h.
Current Work Assignments And Availability. Indicate the hours per week committed to current work assignments as well as the scheduled project completion dates.
h.
Current Work Assignments And Availability For This Project. Indicate the hours per week committed to current work assignments as well as the scheduled project completion dates.
i.
Other Experience And Qualifications Relevant To The Proposed Project (Identify Firm By Which Employed, If Not Current Firm):
i.
Other Experience And Qualifications Relevant To The Proposed Project: (Identify Firm By Which Employed , If Not Current Firm):
5.
Key Personnel (continued).

Subconsultant

a.
Name And Title Within Firm:
a.
Name And Title Within Firm:
b.
Project Assignment: Project Representative
b.
Project Assignment:
c.
Name And Address Of Office In Which Individual Identified In “a” Works:
c.
Name And Address Of Office In Which Individual Identified In “a” Works:
d.
Years of Experience: With This Firm:

With Other Firms:

d.
Years of Experience: With This Firm:

With Other Firms:

e.
Education: Degree(s) /Institution/Year/Specialization
e.
Education: Degree(s) /Institution/Year/Specialization
f.
MCCPO Certification:

q Yes(submit copy of certificate) q No (submit copy of registration form, if applicable)

f.
MCCPO Certification:

q Yes(submit copy of certificate) q No (submit copy of registration form, if applicable)

g.
Applicable Registrations and Certifications:
g.
Applicable Registrations and Certifications:
h.
Current Work Assignments And Availability For This Project. Indicate the hours per week committed to current work assignments as well as the scheduled project completion dates.
h.
Current Work Assignments And Availability For This Project. Indicate the hours per week committed to current work assignments as well as the scheduled project completion dates.
i.
Other Experience And Qualifications Relevant To The Proposed Project (Identify Firm By Which Employed, If Not Current Firm):
i.
Other Experience And Qualifications Relevant To The Proposed Project (Identify Firm By Which Employed , If Not Current Firm):
6
Key Personnel’s Past Performance
6A
Past Performance – Project Director: List and provide the required information on projects with total project costs of $1,000,000 or more for which the Project Director has performed Owner’s Project Management Services for any public or private owner within the past seven (7) years. Indicate whether the project 1) entailed energy efficient renovations consisting of roofing (replacement or restoration), windows/doors replacement, and/or heat pump conversion in existing building, 2) was MSBA funded, and/or 3) qualified under the Massachusetts Stretch Energy Code and/or the International Energy Conservation Code.
a. Project name, location, owner, and owner contact (name, title, telephone, and email)
b.Brief description of project and role of proposed Project Director
c.Total Project Budget
d. Completion date
e. On time
f. Original construction bid value
g.Change Orders and Claims
h. Accidents and Safety Violations
i. Legal Actions
j. Check all that apply

(1) q Actual q Estimated q Yes q No

Number:

Value:

Value of fines:

Outcomes:

q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source) q Heat pump conversion (geothermal)

(2) q Estimated q Yes

Number:

q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(3) q Estimated q Yes

Number:

q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(4) q Estimated q Yes

Number:

Number:

q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(5) q Estimated q Yes

Number:

Number:

q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(6) q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(7) q Qualified under energy code q MSBA funded q Roof replacement or restoration q Windows/doors replacement q Heat pump conversion (air source)

(8) q Qualified under energy code q MSBA funded q Roof replacement or restoration q Windows/doors replacement q Heat pump conversion (air source) q Heat pump conversion (geothermal)

6B
Past Performance – Project Manager: List and provide the required information on projects with total project costs of $1,000,000 or more for which the Project Manager has performed Owner’s Project Management Services for any public or private owner within the past seven (7) years. Indicate whether the project 1) entailed energy efficient renovations consisting of roofing (replacement or restoration), windows/doors replacement, and/or in existing buildings, 2) was MSBA funded, and/or 4) qualified under the Massachusetts Stretch Energy Code and/or the International Energy Conservation Code.
a. Project name, location, owner, owner contact (name, title, telephone, and email)
b.Brief description of project, role of proposed Project Manager, and identity of Project Director.
c.Total Project Budget
d. Completion date
e. On time
f. Original construction bid value
g.Change Orders and Claims
h. Accidents and Safety Violations
i. Legal Actions
j. Check all that apply

(1) q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(2) q Estimated q Yes

Number:

q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(3) q Estimated q Yes

Number:

q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(4) q Estimated q Yes

Number:

Number:

q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(5) q Estimated q Yes

Number:

Number:

q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(6) q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(7) q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(8) q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(9) q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source) q Heat pump conversion (geothermal)

6C
Past Performance – Project Representative: List and provide the required information on projects with total project costs of $1,000,000 or more for which the Project Representative has performed Owner’s Project Management Services for any public or private owner within the past seven (7) years. Indicate whether the project 1) entailed energy efficient renovations consisting of roofing (replacement or restoration), windows/doors replacement, and/or heat pump conversion in existing buildings, 2) was MSBA funded, and/or 3) qualified under the Massachusetts Stretch Energy Code and/or the International Energy Conservation Code.
a. Project name, location, owner, owner contact (name, title, telephone, and email)
b.Brief description of project, role of proposed Project Representative, and identity of Project Director and Project Manager
c.Total Project Budget
d. Completion date
e. On time
f. Original construction bid value
g.Change Orders and Claims
h. Accidents and Safety Violations
i. Legal Actions
j. Check all that apply

(1) q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(2) q Estimated q Yes

Number:

q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(3) q Estimated q Yes

Number:

q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(4) q Estimated q Yes

Number:

Number:

q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(5) q Estimated q Yes

Number:

Number:

q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(6) q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(7) q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(8) q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(9) q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(10) q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(11) q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

6D
Past Performance – Subconsultant: List and provide the required information on projects with total project costs of $1,000,000 or more, for which each Subconsultant has provided services for any public or private owner within the past seven (7) years. Indicate whether the project 1) entailed energy efficient renovations consisting of roofing (replacement or restoration), windows/doors replacement, and/or heat pump conversion in existing buildings, 2) was MSBA funded, and/or 3) qualified under the Massachusetts Stretch Energy Code and/or the International Energy Conservation Code.
a. Project name, location, owner, owner contact (name, title, telephone, and email)
b.Brief description of project and role of proposed subconsultant. Please indicate whether subconsultant worked with prime Respondent on the project.
c.Total Project Budget
d. Completion date
e. On time
f. Original construction bid value
g.Change Orders and Claims
h. Accidents and Safety Violations
i. Legal Actions
j. Check all that apply

(1) q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(2) q Estimated q Yes

Number:

q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(3) q Estimated q Yes

Number:

q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(4) q Estimated q Yes

Number:

Number:

q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(5) q Estimated q Yes

Number:

Number:

q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(6) q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(7) q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(8) q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(9) q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(10) q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement

7
Respondent’s Past Performance: List and provide the required information on projects with total project costs of $1,000,000 or more, for which the Respondent firm has performed, or has entered into a contract to perform Owner’s Project Management Services for any public or private owner within the past seven (7) years. Indicate whether the project 1) entailed energy efficient renovations consisting of roofing (replacement or restoration), windows/doors replacement, and/or heat pump conversion in existing buildings, 2) was MSBA funded, and/or 3) qualified under the Massachusetts Stretch Energy Code and/or the International Energy Conservation Code.
a. Project name, location, owner, owner contact (name, title, telephone, and email)
b.Brief description of project and services
c.Total Project Budget
d. Completion date
e. On time
f. Original construction bid value
g.Change Orders and Claims
h. Accidents and Safety Violations
i. Legal Actions
j. Check all that apply

(1) q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(2) q Estimated q Yes

Number:

q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(3) q Estimated q Yes

Number:

q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(4) q Estimated q Yes

Number:

Number:

q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(5) q Estimated q Yes

Number:

Number:

q Energy efficient renovations q MSBA funded q Multi-phase renovation project in occupied building q Qualified under Energy Codes

(6) q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(7) q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(8) q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(9) q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement q Heat pump conversion (air source)

(10) q Qualified under energy code q MSBA funded q Roof replacement q Roof restoration q Windows/doors replacement

8
Respondent’s Capacity: Identify all current/ongoing work by the Respondent, Joint Venture Members, or Subconsultants. Identify the role of any proposed Key Personnel.
a. Project name, location, and owner contact (name, title, telephone, and email)
b.Brief Description Of Project And Services
c. Role of any proposed Key Personnel
d. Current Project Budget
e. Provide current forecast

completion date and Indicate whether project is on time

1.

2.

3.

4.

5.

6.

7.

8.

9.

References: Provide the following information for completed and current Projects listed above in 7 and 8 for which the Prime Applicant has performed, or has entered into a contract to perform, Owner’s Project Management Services for all Public Agencies within the Commonwealth within the past 10 years.

a.
Project Name And Location

Project Director

Client’s Name, Address and Phone Number. Include Name of Contact Person
Project Name And Location

Project Director

Client’s Name, Address and Phone Number. Include Name of Contact Person
Project Name And Location

Project Director Client’s Name, Address and Phone Number. Include Name of Contact Person

1)

5)

9)

2)

6)

10)

3)

7)

11)

4)

8)

12)

10.

I hereby certify that the undersigned is an Authorized Signatory of Firm and is a Principal or Officer of Firm. The information contained in this application is true, accurate, and sworn to by the undersigned under the pains and penalties of perjury.

Submitted By (Signature)

Printed Name And Title

Date

01/00 DSB 2000 Application Page 1

File details come from the government source that posted it. Updated .