B.02.09_Attachment E PreAward Survey.pdf

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US ARMY CORPS OF ENGINEERS

NORFOLK DISTRICT

PRE-AWARD SURVEY

A. GENERAL INFORMATION

1) Name of Firm: ___________________________________________________________________

Address: __________________________________________________________________________

Phone: _____________________________________ Fax:__________________________________

Email: ____________________________________________________________________________

CAGE CODE:

If your company has more than one CAGE Code, please list all that apply.

2) Location where accounts are kept (if different than item 1 above): ____________________________

3) Type of Firm (Please check one):

Sole Proprietorship [ ] Partnership [ ] Corporation [ ] Joint Venture [ ] Other

Date Organized: ____________________________________

Date Incorporated: __________________________________

State of Incorporation: _______________________________

4) Attach list of Name of Officers.

Please check "Yes" or "No" for each of the following:

Have current officers of your firm ever been indicted? Yes [ ] No [ ]

Are any of your officers currently under indictment? Yes [ ] No [ ]

If you have answered "Yes" to either of the above, please attach an explanation.

5) Has your firm been terminated for default on any contracts in the past six years? Yes [ ] No [ ] (If yes, please attach an explanation)

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B. PROPOSED SCHEDULE

Submit a preliminary schedule depicting your project plan from start to final completion. The schedule you submit will be used to determine your ability to successfully perform the project within the time frame stated in the specifications.

IAW FAR 52.236-15, Schedules for Construction Contracts, you will be required to submit a fully loaded schedule within five days after work commences on the awarded contract.

C. PERFORMANCE AND PAYMENT BOND INFORMATION

1) Performance & Payment Bonds will be furnished by:

Name of Company: _______________________________________________________________

Phone No: _____________________________________________________________________

2) Firm's bonding capacity as authorized by your Insurance Company:

Single Project: ___________________________________________________________________

Aggregate Basis: _________________________________________________________________

D. BANKING INFORMATION

Name of Bank: ___________________________________________________________________

Address: ________________________________________________________________________

Account Representative: ____________________________________________________________

Phone No: ________________________________ E-mail: _______________________________

Authorized Credit Line: ________________________________________________

If additional banks are utilized, please provide this information for each.

E. INSURANCE INFORMATION

Name of Insurance Company: ______________________________________________________

Type of Insurance Provided: _______________________________________________________

Insurance Agency: _______________________________________________________________

Address: _______________________________________________________________________

Agent: _________________________________________________________________________

Phone No: ______________________________ Email: _________________________________

If more than one insurance company is utilized, please provide this formation for each.

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F. FINANCIAL DATA

Please provide the last two certified public accountant's financial statements.

G. SAFETYDATA

Please check "Yes" or "No" for each of the following:

1. Does your firm have a Standard Operating Procedure for Safety?

Yes [ ] No [ ] If yes, please provide a copy.

Does your firm have a Policy Letter dealing with Safety?

Yes [ ] No [ ] If yes, please provide a copy.

2. What was your accident rate for last year? _____________________

3. What is your accident rate to date for this year? ____________________

H. QUALITY CONTROL DATA

Please check "Yes" or "No" for each of the following:

1. Does your firm have a Standard Operating Procedure for Quality Control?

Yes [ ] No [ ] If yes, please provide a copy.

2. Does your firm have a Policy Letter dealing with Quality Control?

Yes [ ] No [ ] If yes, please provide a copy.

I. EQUIPMENT DATA

Please provide the following data for each piece of construction equipment (including equipment you will rent or lease), intended to be used on the project. Do not include consumables.

Make Year Mfg.

Description Purchase Price (if equipment is owned) Size Book Value (if equipment is owned) Model Number Unpaid Balance (if equipment is owned)

J. EXPERIENCE DATA

1. Please provide the following data for all major projects in progress or completed within the past three years.

Also, provide the same data for Corps of Engineer projects completed within the last five years. Those projects containing work similar in nature to that involved under this solicitation are to marked with an asterisk (*).

Name and Address of Owner Point of Contact and Telephone Number Project Location Type of Work performed by your firm Indicate whether you performed as a prime or subcontractor Name of Architect/Engineer in charge for Owner Address of Architect/Engineer Contract or Subcontract Amount Approximate date completed or, if not completed provide percent complete

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Were time extensions necessary? Were penalties imposed? Were liens, claims or stop work orders filed?

2. How many years have you been in business as a contractor? ________________________________

3. How many years experience in the type of work involved in the subject solicitation do you have

a) as prime contractor? ___________________________________

b) as a subcontractor? ___________________________________

K. KEY PROJECT PERSONNEL

Please provide resumes for each of the following key personnel to be assigned to this project:

Project Engineer, Superintendent, Quality Control Manager/Technician, Safety Technician, Office Engineer

(Signature of Person Supplying Data)

(Print or Type Name and Title of Person Supplying Data)

(Phone No.)

(Email Address)

J. EXPERIENCE DATA