CCMWA DIP Pipeline Contractor Application 11_.pdf

Application for Pre-Qualification 11-2025

COBB COUNTY - MARIETTA WATER AUTHORITY

APPLICATION FOR PRE-QUALIFICATION FOR DUCTILE IRON PIPE WATER MAIN CONSTRUCTION

Instructions

A. General

Bids are accepted by the Cobb County - Marietta Water Authority (CCMWA) for water main installation projects from contractors who have been pre-qualified for such work by CCMWA. Interested contractors must complete and submit the Application for Pre-Qualification documents regardless of whether the firm has previously been pre-qualified for a specific CCMWA project.

These instructions shall be used when completing the CCMWA Contractor’s Qualification Statement. The information requested must be furnished to CCMWA in order for a firm to be considered for pre-qualification for work on CCMWA projects. The opportunity for contractor pre-qualification will be advertised at least every two years and all previously approved contractors will re-qualify on a 2-year cycle from the original advertisement. All contractors will be required to submit a new application at the beginning of the 2-year cycle regardless of approval date; however, firms must submit revised information to CCMWA at any time changes occur.

All information submitted for the pre-qualification process shall become the sole property of CCMWA. To the extent of Georgia law, financial information will be considered confidential by CCMWA and after the review; they will be either returned to the contractor or destroyed as per the contractor’s request. Please submit one (1) sealed envelope containing the firm’s financial information for the CCMWA’s Director of Finance’s review.

CCMWA reserves the right, but does not have the obligation, to request the submittal of additional information.

Applicant acknowledges that CCMWA is subject to the Georgia Open Records Act and the Georgia Open Meetings Law.

The Applicant is advised that additions to CCMWA’s list of pre-qualified contractors are made by the CCMWA Board. Contractors must be pre-qualified before the first advertisement of a particular project to be eligible to submit a bid.

B. Completeness

Pre-Qualification Application packages which have not been completed properly or do not include the necessary attachments will be returned for correction without a complete review. The enclosed “Applicant’s Checklist” is intended to serve as a reminder of the required information to be included in the submittal. This form must be included with the application.

Note: This symbol ( ) indicates required attachments.

C. Forms

The information requested must be submitted on the forms provided within the Contractor’s Qualification Statement. Any additional pages attached to the form must include the Applicant’s name and cross references to item numbers on the application form. The Contractor’s Qualification Statement shall be filled out in full by typing on the supplied forms. All pages may be copied as needed. Five (5) hard copies and a PDF copy on a USB drive of the Contractor’s Qualification Statement and Application in a manila envelope clearly marked with the responding firm’s name and titled “Pre-Qualification for Ductile Iron Pipe Water Main Construction Projects for the Cobb County-Marietta Water Authority” and required attachments provided (not including the one (1) sealed envelope containing the firm’s financial information) must be submitted to:

Mr. Austin Woodall Cobb County - Marietta Water Authority 1170 Atlanta Industrial Drive Marietta, GA 30066

COBB COUNTY – MARIETTA WATER AUTHORITY

APPLICATION FOR PRE-QUALIFICATION

FOR DUCTILE IRON PIPE WATER MAIN CONSTRUCTION

Contractor’s Qualification Statement

1. Name of Contractor: ________________________________________________________________

(AS REGISTERED WITH THE SECRETARY OF STATE)

2. Contact Information:

a. Mailing Address: _______________________________________________________________

b. Business Address: _______________________________________________________________

c. Telephone number: ( ) ________________________________________________________

d. Fax number: ( ) ______________________________________________________________

e. Email Address: __________________________________________________________________

3. Licensing:

a. State of Georgia Utility Contractor, Number: __________________________________________

b. Business License, Number: ___________________ County of Issue: ______________________

4. If Contractor is a corporation, indicate:

a. State of incorporation:_____________________________________________

b. Names and addresses of officers of the corporation and their length of time with corporation. Indicate by an asterisk (*) those authorized to sign contracts.

___________________________________ ________________ years

c. Number of years the corporation has been in business _________________________________

5. If Contractor is a partnership, indicate:

a. Names and addresses of all partners:

b. Date of organization: ____________________________________________________________

6. If Contractor is sole proprietorship, how long have you been in continuous business? ____________

7. How many persons does your company permanently employ? _______________________________

8. How many years of experience in the proposed type and size of construction work has your organization had as a general contractor? ___________________________________________________

9. Have you ever failed to complete any work awarded to you? Yes: _________ No: __________

If yes, attach a detailed explanation.

10. List all names previously used by Contractor: _____________________________________________

11. List all companies, firms, or organizations that own any part of your organization:

12. Provide a summary of the background and experience of the members of your organization who perform key functions on construction projects. The summary must include the individual’s name, position and number of years with the firm, details regarding work experience with project names and dates, information about education, specialized training and/or certifications, and other pertinent information. At a minimum, the following positions on your project team shall be identified in this submittal.

Office Management Jobsite Management Principal-in-Charge Project Superintendent Project Manager(s) Foremen

Attach personnel summaries for current members of your organization that include individual experiences for up to twenty years (2003-2023), with emphasis on projects completed in the last five years with your firm.

13. Submit an audited or reviewed financial statement for each of the past three years, including the most recent fiscal year activity. The statements must be prepared by an independent, licensed certified public accountant. Financial statements must include balance sheets, income statements, and a statement of retained earnings, supporting schedules, and notes. To the extent of Georgia law, CCMWA will keep all such financial information private and confidential. After the pre-qualification review, the financial information will be either returned to the contractor or destroyed as per the contractor’s request.

Provide Financial Statements for the last three years, including the most recent fiscal year. Please designate if you would like for the financial documents shredded and destroyed or returned to you after review. Please provide these documents in a separate sealed envelope.

Destroy: ________ Return: _________

14. What is your approximate bonding capacity?

a. Single Project Capacity: $ _______________________

b. Total Aggregate Capacity: $ _____________________

c. Remaining Capacity: $ _________________________

Provide a current letter from your surety company agent that certifies the bonding limits stated above.

15. What is the name and AM Best rating of your bonding company? List the name and telephone number of your bonding company agent.

Bonding Company: ___________________________ AM Best Rating: _______________________

Agent Name: ________________________________ Telephone No.: ( ) __________________

16. Have you ever been refused surety, bond, or liability insurance? Yes: ________ No: _________

If yes, attach an explanation.

17. Liability Insurance: Provide the following information regarding your insurance coverage.

a. Name of Primary Agent or Broker: __________________________________________________

b. Telephone No.: ( ) ______________________ Fax No.: ( ) _____________________

c. Indicate current insurance coverage amounts in the table below:

Commercial

General Liability Automobile

Liability Workers Comp.

Other

Name of Carrier

Amount - Single

Amount - Aggregate

Expiration Date

18. Does your firm comply with Georgia Security & Immigration Compliance Act? Yes: _____ No: ______

You will be required to sign the appropriate Affidavit regarding compliance.

Complete and sign the attached Contractor Affidavit & Agreement, Exhibit A.

19. Has your firm received any OSHA violations (citations) in the past three years?

Yes: ________ No: _________

If yes, attach a separate page describing the citations, including information about the dates of the citations, the nature of the violation, the project on which the citation was issued, the amount of penalty paid, if any. This question must be answered “Yes” and information provided if citations have been appealed or contested, but have not yet been resolved. If the citation was appealed and a decision has been issued, state the case number and the date of the decision.

20. Do Applicant’s business policies conform with government regulations regarding nondiscrimination of employment and employment practices on the basis of sex, race, color, national origin, ancestry, age, religious conviction, veteran status, handicap status, political beliefs or non-job related criteria?

Yes: ________ No: ________

21. Has the Applicant been assessed liquidated damages on any project in the past five years?

If yes, attach a detailed explanation.

22. Has the Applicant been involved in claims, arbitration, mediation, and lawsuits on public works projects, either a plaintiff or defendant, in the last five years?

If yes, attach a separate sheet listing the name of the claim, the nature of the claim, when and where filed, status, final disposition if resolved, and the name and location of the project involved.

23. Provide a list of the major items of equipment that are available for water main construction. Indicate any equipment that is leased.

Attach a detailed list denoting owned and leased major equipment.

24. Submit information regarding your experience (use the attached Form for Similar Projects and References) for a minimum of three Ductile Iron Pipe water main construction projects completed by your firm and/or by current members of your organization who perform key functions on construction projects over the past twenty (20) years (2003-2023) for the category for which you are applying. The firm and/or the key individuals’ previous employer must have self-performed more than 50% of the pipeline construction. The names, addresses, location of the jobs performed, contract amounts, dates, and reference contact names with telephone numbers must be indicated on the form. Please be complete and ensure that all reference contact information is accurate and current. Letters of Reference may be submitted, if desired, but only in addition to the current reference contact information.

One Form for Similar Projects and References shall be completed for each project, using the blank form attached. Supplemental information in other formats may also be attached to the Form if desired; however, a completed Form must be submitted for each project. A “Similar Project” is considered to involve the following linear feet of pipeline installation requirements and to include the following components in varying combinations as shown in the chart below.

CCMWA has approximately 200 miles of both potable and non-potable water pressure pipe ranging from 20” to 64”. Due to the vast range of pipeline sizes, CCMWA has chosen 4 categories in which to allow contractors to pre-qualify for pipeline installations that match their experience in Ductile Iron Pipe and size.

Categories and requirements are as follows:

Complete the Form for Similar Projects and References for at least three Ductile Iron Pipe water main construction projects completed within the past twenty (20) years (2003-2023) by current members of your organization who perform key functions on construction projects. Firms and/or the individuals’ previous employer should only supply Similar Projects and References for projects that they self-performed 50% or more of the pipeline construction.

Note: This symbol ( ) indicates required attachments.

CATEGORY 20” Diameter to

Required Size

Experience Total Footage

Required Qualified to install

% of Existing Water Mains in

System

Category 1 24" 20” or 24” 5,000 Category 1 only 13%

Category 2 36" 30” or 36” 10,000 Categories 1 and 2 49%

Category 3 48" 42 or 48” 5,000 Categories 1, 2 and 3 27%

Category 4 Unlimited 54” and above 5,000 Categories

1, 2, 3, and 4 11%

CONTRACTOR AFFIDAVIT & AGREEMENT

EXHIBIT A

By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is contracting with Cobb County- Marietta Water Authority has registered and is participating in a federal work authorization program* [and electronic verification of work authorization program operated by the U.S. Department of Homeland Security or any equivalent federal work authorization program operated by the U.S.

Department of Homeland security to verify information of newly hired employees, pursuant to the Immigration Reform and Control act of 1986 (IRCA), P.L. 99-6031], in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91.

The undersigned further agrees that should it employ or contract with any subcontractor(s) for the physical performance of services pursuant to the contract with Cobb County-Marietta Water Authority the contractor will secure from the subcontract tor(s) verification of compliance with O.C.G.A. § 13-10-

91. The contractor further agrees to maintain records of such compliance and shall provide a copy of each such verification to Cobb County-Marietta Water Authority at the time the subcontractor(s) is retained to perform such services.

BY: Authorized Officer or Agent Date (Contractor Name)

Title

Printed Name

SUBSCRIBED AND SWORN BEFORE ME ON THIS ___________ DAY OF _____________, 20_____

Notary Public My Commission Expires:

* The applicable federal work authorization program as of the effective date of the statute is the “EEV/Basic Pilot Program” operated by the U.S. Citizenship and Immigration Services Bureau of the U.S.

Department of Homeland Security, in conjunction with the Social Security Administration (SSA).

COBB COUNTY - MARIETTA WATER AUTHORITY

APPLICATION FOR PRE-QUALIFICATION

FOR DUCTILE IRON PIPE WATER LINE CONSTRUCTION

Applicant’s Checklist

Applicant's Name:

Date Submitted:

Contractor’s Qualification Statement form filled out in its entirety?

Information regarding failure to complete work attached (if applicable)?

Background and experience summaries for key personnel attached?

Financial statements attached in a separately sealed envelope?

Letter from bonding company agent attached?

Information regarding inability to obtain surety, bond, or liability insurance attached (if applicable)?

OSHA citation information attached (if applicable)?

Liquidated damages assessment information attached (if applicable)?

Information regarding claims, arbitration, mediation, and lawsuits attached (if applicable)?

Equipment list attached?

Signed and notarized Affidavit for Contractor attached?

Form for Similar Projects and References completed in it’s entirely and attached?

Five (5) hard copies and PDF copy on a USB drive of forms and attachments submitted?

Please submit this form with your application package. Note that the review of applications will not begin until all required information is received.

FORM FOR SIMILAR PROJECT AND REFERENCES – DUCTILE IRON PIPE WATER MAIN

CONSTRUCTION

Please use one form per project.

Name of Contractor: _____________________________________________________ Project Manager: ______________________ Project Superintendent:___________________

Project Name: _______________________________________________________________ Location: ___________________________________________________________________

Project Owner: ______________________________________________________________________

Address: ____________________________________________________________________ Contact Person: ______________________________________________________________ Contact Person’s Telephone: ____________________________________________________

Project Engineer: ____________________________________________________________________

Address: ____________________________________________________________________ Contact Person: ______________________________________________________________ Contact Person’s Telephone: ____________________________________________________

Contract Amount: Original: $________________ Final: $________________________

Year Installed: _______________ % Self Performed: _______________

Contract Completion Time: On Time: _________________ Late: _________________________

Description of water pipeline:

Pipe Size: ______________________________ Pipe Material: __________________________

Pipe Length: ____________________________ Bores (approx. length & size): _____________

Restrained Length (approx.) ________________

Did you provide performance and/or payment bonds on this project? Yes___ No ___

Was this water main constructed within the right-of-way of an active public roadway and/or at a road intersection? Yes___ No___

Did this project require traffic control, diversion, and maintenance within the right-of-way and/or at a road intersection? Yes ___ No ___

Did this project include wet taps or cut ins? Yes___ No ___ #________

Did this project include rock excavation? Yes___ No ___

Did you perform work within “wetlands”? Yes____ No_____

Did this project include the restoration of landscape? Yes ___ No ___

Did this project include pavement replacement? Yes ___ No ___

Did this project include coordination and work in conjunction with Georgia DOT? Yes ___ No ___

Did this project encounter any lawsuits or judgments? Yes___ No___

Was this project performed under your current company name? Yes ___ No ___

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