B8 WC2608 Contractor Qualification Statement updated 10.24.26.pdf

Contractor Qualification Statement

BID #WC2608 Page 1 of 6

WEST CHESTER UNIVERSITY OF PENNSYLVANIA

Construction Procurement Office 201 Carter Drive, Suite 200, West Chester, PA 19383 610-436-2121 / fax 610-436-2720 e-mail: Rwalker514@wcupa.edu

CONTRACTOR QUALIFICATION STATEMENT

COMPANY NAME: __________________________________________

PRINCIPLE ADDRESS: __________________________________________

PHONE: __________________________________________

WEBSITE: __________________________________________

PRIMARY CONTACT PERSON: ____________________________________

PRIMARY CONTACT E-MAIL: ____________________________________

TYPE OF ORGANIZATION: (Corporation - Partnership – Individual – Joint Venture – Other) (circle type)

FEDERAL TAX ID# ___________________________________

TYPE OF WORK: Circle Type Below (Submit separate form for each classification of work)

General Construction Fence Contractor

HVAC Construction Floor Layer Contractor

Plumbing Construction / Drain Cleaning Metal Fabrication / Welding

Electric Construction Waterproofing & Caulking

Sprinkler Construction Concrete / Paver Installation

Roofing Concrete / Masonry Restoration

Networking/Telecommunication/Converged Communications

BID #WC2608 Page 2 of 6

1. ORGANIZATION:

1.1 How many years has your organization been in business as a contractor? _________

1.2 How many years has your organization been in business under its present name? ____

1.2.1 Under what other or former names has your organization operated?

1.3 If your organization is a corporation, answer the following:

1.3.1. Date of incorporation __________________

1.3.2. State of incorporation __________________

1.3.3. President’s name __________________

1.3.4. Vice President’s name __________________

1.3.5. Secretary’s name: __________________

1.3.6. Treasurer’s name: __________________

1.4 If your organization is a partnership, answer the following:

1.4.1. Date of organization __________________

1.4.2. Type of partnership (if applicable) ______________________

1.4.3. Name(s) of general partner(s) _________________________

1.5 If your organization is individually owned, answer the following:

1.5.1. Date of organization____________________

1.5.2. Name of owner: _______________________

1.6 If the form of your organization is other than those listed above, describe it and name the principles.

2. LICENSING

2.1. List the jurisdictions and trade categories in which your organization is legally qualified to do business and indicate registration or licenses numbers, if applicable.

BID #WC2608 Page 3 of 6

2.2 List jurisdictions in which your organization’s partnership or trade name is filed.

3. EXPERIENCE

3.1. List the categories of work that your organization normally performs with its own forces:

3.2. List the categories of work that your organization normally subcontracts:

3.3. Claims and Suits (If the answer to any of the questions below is yes, please attach details).

3.3.1. Has your organization ever failed to complete any work awarded to it?

3.3.2. Are there any judgments, claims, arbitration proceedings or suits pending or outstanding against your organization or its officers? _________________

3.3.3. Has your organization filed any lawsuit or requested arbitration with regard to construction contracts within the last five years? ________________________

BID #WC2608 Page 4 of 6

3.4. Within the last five years, has any officer or principal of your organization ever been an officer or principal of another organization when it failed to complete a construction contract? _________________ (If the answer is yes, please attach details).

3.5. On a separate sheet, list major construction projects your organization has in progress, giving the name of the project, owner, architect, contract amount, percent complete and scheduled completion date.

3.5.1. State the total value of work in progress and under contract. $_______________

3.6. On a separate sheet, list the major projects your organization has completed in the past five years, giving the name of the project, owner, architect, contract amount, date of completion and percentage of the cost of the work that was performed with your own forces.

3.6.1 State the average annual value of construction work performed during the past five years.________________

3.7. On a separate sheet, list the construction experience and present commitments of the key individuals of your organization.

4. REFERENCES

4.1. Trade References (provide at least three).

4.2. Bank Reference

4.3. Surety Reference

4.3.1. Name of bonding company ___________________________________________

4.3.2. Name and address of agent ___________________________________________

5. FINANCING

5.1. Financial Statement

5.1.1. Provide the most recent, audited, full year (12 month) financial statement. Include your organization’s latest Balance Sheet and Income Statement showing the following items:

BID #WC2608 Page 5 of 6 o Current Assets (e.g. cash, joint venture accounts, accounts receivable, notes receivable, accrued income, deposits, materials inventory and pre-paid expenses);

o Net Fixed Assets o Other Assets o Current Liabilities (e.g. accounts payable, notes payable, accrued expenses, provision for income taxes, advances, accrued salaries and accrued payroll taxes);

o Other Liabilities (e.g. capital, capital stock, authorized and outstanding shares par values, earned surplus and retained earnings).

5.1.2. Name and address of the firm preparing the attached Financial Statement, and the date thereof: ___________________________________________

5.1.3. Is the attached financial statement for the identical organization named on page one?

5.1.4. If not, explain the relationship and financial responsibility of the organization whose financial statement is provided (e.g., parent-subsidiary).

5.2. Will the organization whose financial statement is attached, act as guarantor of the contract for construction?

6. AUTHORIZED SIGNATURE

6.1. Dated at _______________________________this_________ day of __________

(City, State) (month , year)

( Name of Organization)

By: ________________________________________

(Signature)

____________________________________________ being duly sworn, deposes and says that

BID #WC2608 Page 6 of 6

(Type or print signer’s name and title)

The information provided herein is true and sufficiently complete so as not to be misleading.

Subscribed and sworn before me this ____________ day of __________________

Notary Public:

My Commission Expires: