B08_Attachment___5_Past_Performance_Questionnaire.docx

Attachment 5 page 1 of 4

TECHNICAL/PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

Your Company Name:

Street Address:

Email Address:_____________________________________ City, State and ZIP Code:

1. GENERAL BUSINESS INFORMATION

Date Firm Organized/Established:

Is company; Sole Propriety [ ] Partnership [ ] Corporation [ ] Division [ ] N/A [ ]

2. PAST EXPERIENCE

a. Provide at least three examples of past experience of Construction Contractor for building drain pipelines, trenching, valves, interior trench drains, concrete, horizontal and vertical survey alignment, earthwork, demolition, and other work similar to that shown in the plans and specifications for this project.

b. Provide proof of ability to obtain bonding for the magnitude of this contract.

c. Provide proof of state registration of specialty trade contractors for performing work in Oklahoma on this contract.

Contractors may be required to possess and maintain state licenses, as required by Oklahoma state regulations. The following information is provided on construction contractor license requirements in Oklahoma:

Building and General Construction Contractors In Oklahoma, general contractors are not required to have state licenses to perform their construction services. This includes commercial or residential buildings, roads, bridges and highways, installation of residential and municipal utilities, industrial and oil field installations, and other various projects. Likewise, state licenses are not required of subcontractors who perform general construction services on projects for general contractors. Such services, normally, include areas such as: site clearing and leveling, concrete stemming, framing, carpentry, drywall, painting, guttering, sodding, fencing, etc. Also, state licenses are not required for small general contractors or subcontractors who do commercial or residential renovation, remodeling, and repair construction projects.

Out-of-state Contractors An out-of-state contractor who obtains a construction contract in Oklahoma is required to complete a special “Non-Resident Contractor” registration with the Oklahoma Tax Commission (OTC) prior to starting a project. For contracts more than $100,000, a bond for 10% of the amount is required to be posted (or the deposit of a cash equivalent amount). Information regarding the special registration and possible bonding is provided in OTC’s informational document, “Packet N.” The packet can be obtained off OTC’s website.

3. CONTRACTS/SUBCONTRACTS COMPLETED OR IN PROGRESS

Complete and submit the information requested on page 2-4 below on prime contracts or subcontracts completed or in progress. Government contracts are preferred; but, if you have not performed Government contracts, indicate any other contracts completed or in progress.

a. First Contract:

Contracting Agency or Company:

Project Title and Location:

General Scope of Design Build Project:

Your Role (General Contractor [ ], Joint Venture [ ], Designer [ ], or Subcontractor [ ]) and the work your firm performed:

Describe any Work You Subcontracted to Others:

Total Amount of Subcontract(s): $ Period of Performance: days Scheduled Completion Date:

Actual Completion Date: Percentage of Work Completed: % Were You Terminated?

Were You Assessed Liquidated Damages? (If the answer to either Question is “Yes”, Explain:

Did you use a Quality Control Plan? _________ Did you use a Safety Plan?_______________ Quality Control or Safety Problems encountered (if any):

How were the problems resolved? _____

b. Second Contract:

Contracting Agency or Company:

Project Title and Location:

General Scope of Construction Project:

Your Role (General Contractor [ ], Joint Venture [ ], Designer [ ], or Subcontractor [ ]) and the work your firm performed:

Describe any Work You Subcontracted to Others:

Total Amount of Subcontract(s): $ Period of Performance: days Scheduled Completion Date:

Actual Completion Date: Percentage of Work Completed: % Were You Terminated?

Were You Assessed Liquidated Damages? (If the answer to either Question is “Yes”, Explain:

Did you use a Quality Control Plan? _________ Did you use a Safety Plan?_______________ Quality Control or Safety Problems encountered (if any):

How were the problems resolved? _____

c. Third Contract:

Contracting Agency or Company:

Project Title and Location:

General Scope of Construction Project:

Your Role (General Contractor [ ], Joint Venture [ ], Designer [ ], or Subcontractor [ ]) and the work your firm performed:

Describe any Work You Subcontracted to Others:

Total Amount of Subcontract(s): $ Period of Performance: days Scheduled Completion Date:

Actual Completion Date: Percentage of Work Completed: % Were You Terminated?

Were You Assessed Liquidated Damages? (If the answer to either Question is “Yes”, Explain:

Did you use a Quality Control Plan? _________ Did you use a Safety Plan?_______________ Quality Control or Safety Problems encountered (if any):

How were the problems resolved? _____

4. Certification of Past and Present Performance Information:Type or Print Information

Name of Survey Preparer_______________________________

Title__________________________________________

Signature______________________________________

Date__________________________________________