Attachment_P1_-_Questionnaire.pdf

Attachment P 1. Experience Questionnaire

Information furnished in response to this questionnaire and any verification made by the MVA shall provide a basis for determining the responsibility of bidders. In the event the MVA deems references insufficient, the State reserves the right to determine the respondent non-responsive and to reject that respondent's bid.

NOTICE TO BIDDERS: FAILURE TO FULLY ADDRESS ALL QUESTIONS MAY CAUSE YOUR

BID TO BE DISQUALIFIED AND BIDDER NOT RESPONSIBLE.

I. CONTRACTOR COMPANY INFORMATION:

Company Name: ____________________________________________________________

Address of Parent Company: __________________________________________________

Federal ID or Social Security No: _______________________________________________ eMaryland Marketplace Vendor ID: _____________________________________________

Date of Incorporation: ______________________________

Number of years in business under the present name: _______________________________

Contact Person: _____________________________________________________________

Phone No: ___________________ E-Mail Address: ________________________________

Small Business Reserve (SBR) Certification Number (if applicable): ____________________________

Veteran-Owned Business Enterprise (VSBE) Certification Number (if applicable): _________________

MDOT Minority Business Enterprise (MBE) Certification Number (if applicable): ___________

II. COMPANY EXPERIENCE:

Brief description of your organization's primary experience: ___________________________________

Give name and data about any contracts you have failed to complete, including any terminations of default (use separate sheet if necessary). ____________________________________________________

Has your organization or any of its employees ever been party to any criminal action relating directly or indirectly to the general conduct of your business? __________ if yes, Explain:

Has your organization ever been denied an award on which you were low bidder? __________ if yes, Explain:

III. COMPANY EXPERIENCE:

List three (3) current clients under contract or whom you have serviced in the last Five (5) years as a Commercial General Contractor performing major facility repair work of similar or comparable type, scope, complexity, and magnitude of services described in the IFB on commercial and/or transportation buildings and/or facilities. Give name, address and phone number of company and client’s representative that we may contact and who will provide us information for references: All references must be reachable and willing to furnish information by telephone conversation or facsimile. Attach additional pages if necessary.

1.

Name_________ of Com______pany _

Company Representative Phone Number & E-Mail Length of Contract: __________________ Contract Value: ___________________

Examples(s) of work performed:

2.

Name of Company

Company Representative

Length of Contract: __________________

Phone Number & E-Mail

Contract Value: ___________________

Examples(s) of work performed:

3.

Name of Company

Company Representative

Length of Contract: __________________

Phone Number & E-Mail

Contract Value: ___________________

Examples(s) of work performed:

IV. STATE OF MARYLAND EXPERIENCE: List all current and past State Contracts. (Attach additional pages, if necessary)

1.

Name of State Agency

Company Representative Phone Number/E-Mail

Length of Contract: __________________ Contract Value: ___________________

Examples(s) of work performed:

2.

Name of State Agency

Company Representative Phone Number/E-Mail

Length of Contract: __________________ Contract Value: ___________________

3.

Name of State Agency

Company Representative Phone Number/E-Mail

Length of Contract: __________________ Contract Value: ___________________

The MVA also reserves the right to visit the vendor’s company location prior to award, or during the duration of the contract. The MVA also reserve the right to request any other information and data for the purposes of determining the Vendor's ability to perform the contract.

6) Have any service contracts held by your company ever been canceled?

YES (_______) NO (_______)

If yes, give details on a separate sheet.

FORM COMPLETED BY:

(SIGNATURE) ______________________________________________________

(PLEASE PRINT NAME and TITLE) _____________________________________

Attachment P 1. Experience Questionnaire