COA Prequal Application-2025-27~2.pdf

Public Works - Engineering Division 51 Winburn Way Ashland, OR 97520

20 East Main Street

Ashland, OR 97520 www.ashlandoregon.gov

Phone: (541) 488-5587

TTY: (800) 735-2900

Fax: 541-488-6006

CONTRACTOR PREQUALIFICATION APPLICATION 2025-27

Application of: ______________________________________________________________________

Legal Business Name

Assumed Business Name

Individual Sole Proprietorship

General Partnership

Corporation

S-Corporation

Limited Liability Company (LLC)

Limited Liability Partnership (LLP)

Limited Partnership (LP)

Assumed Business Name (ABN)

Joint Venture (JV)

Purpose of Prequalification application

(Check all that apply)

CCB/CBL Verification Date:___________________________

Important Application Information

To be eligible to bid on City of Ashland public improvement projects this application must be received at least 5 days prior to the first anticipated bid opening date.

Prior to starting work in the right-of-way all contractors are required to have a current, approved prequalification application on file with the City of Ashland Public Works Engineering. City of Ashland Business License is required upon bid award, must be obtained before work begins.

ODOT and/or City of Medford Prequalification may be submitted for the City of Ashland contractor prequalification.

Applicant must fill out page one, notarize the affidavit on the last page of this application, and include ODOT or City of

Medford’s Prequalification letter.

The affidavit must be notarized. Signature must be of an individual who is authorized to execute bids and contracts.

Address to which all correspondence should be mailed:

Street:

City, State, Zip:

Application Date:

Physical Address:

City, State, Zip:

Phone No.:

24hr contact Phone

Fax No.:

Email Address:

Expiration: 08/31/2027

City Business License No.:

*Required upon bid award. Must be obtained before work begins.

CCB License No.:

CCB Expiration Date:

ODOT/Medford Prequalification Date:

General Right-of-Way Permitted Work

Public Works Construction Project

Project Name:

Scheduled Bid Opening Date:

INTRODUCTORY STATEMENT:

In accordance with the statutes of the State of Oregon, every public contracting agency contemplating receiving bids for and awarding any contract for a public improvement may require any prospective bidder (herein referred to as applicant) to submit a full and complete statement concerning their equipment and experience in constructing public improvements. The application and questionnaire forms which are bound herewith comply with the requirements of public contracting rules and must be used in determining the qualifications of applicants and in assigning limits as to the size and kinds of projects for which the applicant may submit bids. The applicant should use care and integrity in preparing this information. The public contracting agency may make independent inquiries concerning the contractor’s past performance and/or capabilities.

Manner of Preparing and Filling in Forms:

This application shall include equipment and experience information for only the specific single business organization or entity which is applying for prequalification, and which would be the signatory on a contract with the public contracting agency.

It shall be the responsibility of the applicant to return all pages whether applicable or not. Failure to do so may be grounds for rejection. All answers and entries shall be specific and complete in detail.

The prequalification application shall be signed by the applicant and sworn to as the form indicates. The signatory of the statement guarantees the truth and accuracy of all statements and of all answers to questions. An original signed application must be sent to the public contracting agency (photocopy or fax signatures will not be accepted).

Use of Attachments:

Schedules, reports, and other forms of prequalification statement may be used as attachments to the prescribed form, provided that the information contained therein specifically includes the information required by this form.

Place of Submission of Submission:

Prequalification applications shall be submitted by mail or delivered to the Community Development Engineering Services Building located at 51

Winburn Way, Ashland OR 97520. Mailing address: 20 East Main Street, Ashland OR 97520.

Appeal Due to Denial or Revocation of Prequalification:

In case the applicant’s application for prequalification is denied or in case an existing prequalification is revoked, the applicant may appeal the denial or revocation in accordance with the rules adopted by the Department of Administrative Services or the appropriate local contract review board.

Notification of Action Taken:

The applicant will be notified, in writing, of the action on their application. Applicant will then be allowed to bid on such projects as are within the limits of size and kind of work for which applicant has been declared qualified.

Period during which a Qualified Applicant Remains Qualified:

An applicant who has been notified of prequalification for projects of a given size and kind will usually remain qualified until the date specified in the notification. The public contracting agency may limit prequalification approval to individual public improvement projects. Unless such applicant is otherwise notified by the public body the applicant will be permitted to submit bids for any and all projects of said kind and size for which bids are to be received. The public body may from time to time require new or revised prequalification applications and have them approved prior to allowing a bid.

Requirement of Continuing Prequalification:

Applicants who have once been qualified with an agency requiring prequalification and who desire to maintain an uninterrupted prequalification standing are required to submit a new application periodically as required by such agency (September 1st to August 31st biennium cycle).

Uninterrupted prequalification is contingent upon favorable action on the application. A prequalification may be revoked under the provision of

ORS 279C.375.

Changes:

Requests for revision of the prequalification standing of any applicant will be considered whenever the applicant can make a showing of materially improved ability, but not more often than once in three months. Major changes must be submitted with a new prequalification application. If the changes are minor, such changes may be requested to the public contracting agency. Minor changes involve, but are not limited to, company name, adding or deleting classes of work. Contact Public Contracting Agency for specific procedures when there are changes to the information submitted in the application. With or without a request from a prequalified applicant, the prequalification limitation on class of work or size of project MAY be reviewed and increased or decreased as found appropriate. The prequalified applicant will be notified in writing of any such revision.

Nonresident Bidders:

ORS 279A.120 (3) states: When a public contract is awarded to a nonresident bidder and the contract price exceeds $10,000, the bidder shall promptly report to the Department of Revenue on forms to be provided by the department the total contract price, terms of payment, length of contract and such other information as the department may require before the bidder may receive final payment on the public contract. The contracting agency shall satisfy itself that the requirement of this subsection has been complied with before the contracting agency issues a final payment on a public contract.

The form referred to is the Application for Final Payment Release. It is available for download from the Department of Revenue web site at:

http://www.oregon.gov/DOR/BUS/docs/102-050.pdf http://www.oregon.gov/DOR/BUS/docs/102-050.pdf http://www.oregon.gov/DOR/BUS/docs/102-050.pdf http://www.oregon.gov/DOR/BUS/docs/102-050.pdf http://www.oregon.gov/DOR/BUS/docs/102-050.pdf

CITY OF ASHLAND WORK AND PERMITTING INFORMATION

All contractors performing work in the Public Right-of-Way whether under contract or by permit, must have an approved and current Contractor’s Prequalification form on file with the Public Works Department of the City of Ashland. The contractor must be pre-approved to perform the work for which they are bidding/applying before a contract will be entered into or a permit will be issued.

Any Contractor or Subcontractor applying for Prequalification must have a current CCB license in good standing. A City of

Ashland business license is required upon bid award and must be obtained before work begins.

In the event that the entity actually performing the work is to be a Subcontractor, the General Contractor must fill out any necessary permit application form(s) stating that a Subcontractor will be employed. The General Contractor shall specify the name of the Subcontractor and list the Sub’s CCB license number on the permit application form. The Subcontractor must also be pre-qualified to perform work in the Public Right-of-Way.

Contractor Evaluation: The City of Ashland will regularly evaluate the performance of Contractors working in its right-ofway based on reference checks and the Contractor’s level of responsibility regarding past projects to make determinations about the Contractor’s eligibility for future prequalification.

Miscellaneous Construction (sidewalk) Permits obtained by Property Owner: Property owners wishing to obtain a permit to perform concrete work in the public right-of-way (sidewalk) without employing the services of a pre-qualified contractor may do so at their own risk. All work performed by the property owner must meet the same standards and specifications as is required of a licensed contractor; however, property owners are not required to obtain prequalification.

Any work performed by a property owner which fails to pass City inspection is subject to the requirement of removal and replacement at the discretion of the City of Ashland Engineering Department. The costs associated with this action will be the sole responsibility of the property owner. Property owners will also be held accountable for any work performed without the proper permit(s) and will be charged at 1.5 times that of the current rate for the permit(s).

Substandard Workmanship: In the event of unsatisfactory work performed under permit, a City of Ashland representative will take pictures and document the failings of the work. The pictures and subsequent site investigations will be considered by Engineering Department staff members in order to determine the appropriate course of action to be taken to resolve the substandard work.

If the work is determined by staff to be unacceptable, a verbal directive will be given to the Contractor or Subcontractor to correct the work and bring it to departmental/industry standards. If action is not taken to correct the defect within 14 days of verbal notice, then a written warning will be sent to the Contractor defining the necessary corrective measures and a timeline for completion. It will also state that further action will be taken if corrective measures are not undertaken in a timely manner.

If the Contractor is un-responsive and fails to correct the deficiencies within the timelines for completion given in the first letter, then a second letter will be sent placing the Contactor on notice that their Surety Agent will be contacted and directed to complete the sub-standard work. If further actions are required, the Contractor will be placed on probation for a period of 1 year with the condition that any further failures (i.e., not meeting department/industry standards) will result in a permanent ban from work for the City of Ashland in its public right-of-way.

Failure to Obtain Permit: In the event a City of Ashland representative should discover that construction work is being, or has been, performed in the Public Right-of-Way without proper application and permit issue, a verbal warning will be given to the Contractor/Owner requiring them to obtain the proper permit(s). The contractor/owner will be charged at 1.5 times that of the current rate for the proper permit(s).

For a second offense, the Contractor will be placed on probation for a period of 1 year. Any further failure to obtain proper permit(s) will result in a permanent ban from work in the City of Ashland’s public rights-of-way.

1 Supplemental Questions: (Required)

A. Have you ever been denied prequalification by any state, local or federal agency in this or any other state?

2 Name of contact person for information regarding this application

2 Affidavit

STATE OF__________________ )

) SS.

County of___________________)

I, __________________________________________________________________ being first sworn, state that I am of the applicant herein and that the statements made in this

(Title) application are true and I acknowledge that any false, deceptive or fraudulent statements on the application or at a hearing will result in the denial of prequalification, and may subject me to charges of false swearing or perjury; should there be any subsequent material reduction in applicant’s ability to carry out any project for which applicant desires to submit a bid; applicant will give written notice of such change to the designated officer to whom this application is submitted at least ten days prior to the bid opening and that it is understood that such notice may change the eligibility of applicant to submit the bid.

(Original Signature) (Title)

Subscribed and sworn to before me this _____________ day of___________________________, Year_____________

Notary Seal or Stamp ______________________________________________

Original Notary Public Signature

My commission expires: ___________________________

Check one: Yes No If yes, please explain:

B. Have you ever been debarred from bidding on contracts by any state, local or federal agency in this or any other state under any State Law or Federal Law?

Check one: Yes No If yes, please explain:

C. Has any officer or partner of the applicant ever applied for prequalificat ion with the public contracting agency under a different name?

Check one: Yes No If yes, please explain:

D. Has the applicant ever failed to complete a state, local or federal public improvement (w orks) contract?

Check one: Yes No If yes, please explain:

E. Has any officer or partner of the applicant ever been found in breach of a local, state or federal contract?

Check one: Yes No If yes, please explain:

3 Please fill in the classes of work you wish to work on. Classes of work include, but are not limited to, Airports, Highways, Streets and Roads. *If more space is required, attach additional sheets*

For Each Class of Work

A. Enter the maximum dollar amount of work you are capable of performing.

B. Enter the maximum dollar amount of work you are qualified to undertake in other states.

C. Enter the state(s) qualified for the amount shown in column ‘B’.

D. Enter the number of years of experience in this class of work.

Class of Work (AB) Aggregate Bases

(AC) Asphalt Concrete Paving and Oiling (Asphalt Paving, Chip Sealing, Crack Sealing, Slurry Sealing, Cold Plane Pavement Removal)

(EARTH) Earthwork (Excavation, Grading, Riprap)

(ELEC) Electrical (Conduits, Traffic Signals, Illumination)

(LS) Landscaping (Roadside Seeding, Lawns, Shrubs, Trees, Irrigation Systems, Topsoil, Temporary and Permanent

Erosion Control)

(MISC) Misc. Highway Appurtenances (Guardrail, Fences, Rumble Strips)

(PCP) Portland Cement Concrete Structures (Curbs, Driveways, Walks, Monolithic Curb & Sidewalk, Miscellaneous Surfaces)

(ST) Pavement Markings (Permanent - Painted, Durable, Markers, Delineators)

(SD) Storm Drain Construction (Culverts, Manholes, Inlets, Storm Sewers)

(SS) Sanitary Sewer Line Construction (Manholes, Sanitary Sewers)

(SIGN) Signs (Permanent & Temporary Signage)

(TTC) Temporary Traffic Control (All

Temporary Traffic Control Items Including Flaggers and Pilot Cars)

(WATER) Potable Waterline Construction (Water

Pipe, Fittings, Hydrants)

(OTHER) Other (List specific class)

A. Max dollar amount B. Qualified Dollar Amount

C. State(s)

Experience D. Years Experience

Yes No

6 If a foreign (out of State) corporation, complete this: N/A

When incorporated:

In what state:

Date of authorization to transact business in the State of Oregon:

Has applicant filed with the Department of Revenue forms required by ORS 279.021?

President:

1st Vice President:

Secretary:

What officers are authorized to execute contracts:

(Additional documentation may be required by the public contracting agency) Name and address of registered agent in Oregon:

4 If an Oregon corporation, complete this section:

N/A

5 If a general partnership, complete this section:

N/A

When Incorporated: Date of Organization:

President: If a foreign (out of State) co - partnership or persons engaging in business in the state under an assumed name, but not domiciled within this state, state w hether or not such partnership or business organization has been registered as may be required in compliance with Chapter 648, Oregon Revised Statutes.

1 st Vice President:

Secretary:

Treasurer:

What officers are authorized to execute contracts: Name and address of partners:

( Additional documentation may b e required by the public contracting agency.)

7 If a limited liability company, limited liability partnership or a limited partnership indicate below: N/A

Check One:

Limited liability company

Limited liability partnership

Limited partnership

Have you registered with the State Corporation Division, Business Registry? Yes No

Name and address of organizer:

List who is authorized to execute contracts:

(Additional documentation may be required by the public contracting agency)

If doing business under an assumed business name, fill out the following information: N/A

Name of assumed business:

8 If doing business as a sole proprietorship, fill out the following information: N/A

Individual’s name liable for all obligations of business:

If you are a sole proprietor using an assumed business name, please list name:

Registration date: Expires: ______

Owner’s name and address:

Registration date: Expires:

9 Ownership and Control

A. List any organization, owned, or controlled by the applicant, its officers, directors, partners, and anyone owning at least 10% interest in the firm, or in which the applicant was or is an officer, director, partner, doing business in Oregon under another name. If none, so state.

B. List those individuals, companies or corporations owning 10% or more of applicant’s firm.

C. List all other personnel in applicant’s organization who have a financial interest in or serve as officers or partners in another firm prequalified to bid in this or another state.

Individual’s Name Present Position or Office Other Firm or Firms Position in Other Firm(s) State of Other Firm

10 Is your firm currently certified by the State of Oregon as a Disadvantaged Business Enterprise (DBE)?

Check one: Yes No

11 Experience

A. How many years has applicant been in business under present name?

As a prime contractor? As a subcontractor?

B. How many years’ experience in construction work has applicant had:

As a prime contractor? As a subcontractor?

12 What is the construction experience of all owners, officers, partners, and principal individuals in applicant’s organization? Also list any other individuals or organization who, in any way and to any extent, controls or influences the bidding.

Individual’s Name Present Position or

Office Years of Construction

Magnitude and Type of Work In What

Capacity

13 Experience (If more space is required, attach additional sheets)

List major projects applicant has undertaken in the last five years. (List most recent projects first)

Name and Address of Owner Name of Project Class of Work Contract Amount

* Indicate whether: (P) Prime Contractor, (JM) Joint Venture, (Sub) Subcontractor. Include name, address and phone number including area code.

14 Equipment (If more space is required, attach additional sheets)

A. Plants and equipment owned by the applicant: List only major items and combine small equipment and tools.

Quantity, Description and Capacity of Items Age in Years Condition of Equipment

B. Total market value of equipment: $

C. Does applicant intend to rent equipment? If so, provide a general description:

*Production Facility or Plant Yes No (if yes complete below)

Description Location Capacity

* City of Ashland’s acceptance of this prequalification does not imply approval as material sources for City of Ashland projects.

15 Indicate contractor’s licenses or registration numbers held as required by Oregon Statutes:

Corporation Division Registration No.

Construction Contractors Board No.

Landscape Contractors License No.

Electrical License No.

Plumbing License No.

Pressure Vessel Installers License No.

Other License No.

ODOT Prequalification*

* ODOT Prequalification may be submitted for the City of Ashland contractor prequalification. Applicant must fill out page one, notarize the affidavit on the last page of this application, and include ODOT’s Prequalification letter.

16 The following space may be used for general remarks and explanations pertaining to the foregoing prequalification statements: (Also explain here any experience claimed which is that of a business organization or entity, other than the applicant, including a business entity superseded by the applicant).