Fairfax County Crossroads Renovation Prequalification Invitation

DEPARTMENT OF PUBLIC WORKS AND COUNTY OF FAIRFAX

ENVIRONMENTAL SERVICES VIRGINIA

BUILDING DESIGN AND CONSTRUCTION DIVISION

12000 Government Center Parkway, Suite 449

Fairfax, Virginia 22035-0052 Tel: 703-324-5800

INVITATION TO APPLY FOR PREQUALIFICATION:

CROSSROADS RENOVATION

PROJECT No. HS-000050-001

Fairfax County is soliciting pre-bid qualifications for the construction of the Fairfax County

Crossroads Renovations, located at 6901 South Van Dorn St., Alexandria, VA 22315. Only firms that have been prequalified in accordance with the procedures stated in the Prequalification

Application Instructions and Application to Prequalify will be eligible to submit bids for this project. Bids received from those who have not been prequalified will not be considered.

Construction bids for this project are currently scheduled to be opened in September 2026.

Crossroads is a residential substance abuse treatment and rehabilitation facility serving individuals with substance use disorders or co-occurring substance use and mental health disorders. The facility is currently vacant. The construction project scope includes full renovation of the

Crossroads Facility along with two small one-story additions and sitework improvements within the property boundaries. The existing facility is housed in two separate two-story buildings with a combined interior floorspace totaling approximately 40,000 sf, located on the same parcel. The two existing buildings require full interior renovation with complete building systems upgrades as well as exterior renovations. Expansion to the existing facility includes two single story building additions totaling approximately 4,800 sf of floorspace with foundations supported by helical piles.

The interior renovations include demolition and reconfiguration of interior walls, finishes and equipment, elevator modernization, and the associated structural and MEP work. This interior work will consist of the relocation of offices, clinical offices, meeting rooms, and bathrooms; space conversions to accommodate 24/7 residential rooms that have anti-ligature, barricade-resistant, and ADA compliant design; kitchen renovation; and elevator modernization, and the incorporation of an energy efficient building envelope with upgraded HVAC and electrical system. Exterior renovations include the incorporation of an energy efficient building envelope through the upgrade of HVAC and electrical system, the addition of photovoltaic (PV) roof panels, and the replacement of windows, siding, insulation, and roofing. The minor expansion to the building footprint includes a fitness center, additional offices, a building connector, and a covered porch. Renovation and expansion of the building will require upgrades to the existing fire detection and suppression systems.

Site improvements include the addition of Electric Vehicle (EV) charging stations, asphalt repaving and marking, additional accessible parking spaces, signage, the addition of a concrete pad and pavilion, and an underground stormwater management (StormTech) system to replace an existing pond.

Docusign Envelope ID: 115E7393-269D-4B87-A76F-57DCE5899122

Prequalification Invitation

The Construction Contract for this project is anticipated to be advertised for bid in July 2026, with bid opening in September 2026. Contract Award and start of construction are anticipated to occur in Fall 2026. The overall construction duration is planned to be approximately 24 months. These are estimated dates, seasons, and durations and are subject to change. The cost for this construction project is estimated to be approximately $25 million (USD).

Pre-qualification Applications may be obtained commencing on Wednesday, April 8, 2026, from the Building Design and Construction Division, Fairfax County Department of Public Works &

Environmental Services.

The Application Package in electronic form is available on-line at:

https://www.fairfaxcounty.gov/publicworks/capital-projects/invitation-pre-qualification

Please note that, by applying for prequalification, the applicant acknowledges that the subject project requires Contractor-compliance with the responsibilities and reporting requirements shown in the Fairfax County Prevailing Wage Ordinance and Virginia Code 2.2-4321.3 (latest editions). Additional information on the Prevailing Wage Ordinance can be found at the following webpage:

https://www.fairfaxcounty.gov/topics/prevailing-wage-ordinance

All questions concerning this Pre-qualification Application procedure shall be submitted in writing to the Director, Building Design and Construction Division, e-mail address:

building@fairfaxcounty.gov, and to be given consideration, such questions and concerns must be received at least seven (7) calendar days prior to the deadline for submittal of the Pre-qualification Application indicated in the Invitation to Apply for Pre-qualification.

The Board of Supervisors of Fairfax County, Virginia reserves the right to reject any and all

Applications, and to waive informalities and irregularities in the Pre-qualification Application procedure.

COUNTY OF FAIRFAX, VIRGINIA

By: ___________________________________

Vrushali Oak, Director

Building Design and Construction Division

Date: ________________________

04/08/2026 https://www.fairfaxcounty.gov/publicworks/capital-projects/invitation-pre-qualification mailto:building@fairfaxcounty.gov

Prequalification Instructions

FAIRFAX COUNTY

DEPARTMENT OF PUBLIC WORKS AND ENVIRONMENTAL SERVICES

PREQUALIFICATION APPLICATION INSTRUCTIONS

CROSSROADS RENOVATION

PROJECT No. HS-000050-001

1. GENERAL

Fairfax County (“County”) is soliciting prequalifications of bidders for construction of the Fairfax County Crossroads Renovation.

Only firms that have been prequalified in accordance with the procedures set forth herein will be allowed to submit bids for these projects. Bids received from those who have not been prequalified will not be considered.

The decision to prequalify an Applicant shall not constitute a determination that the Applicant is responsible and such Applicant may be subsequently rejected as non-responsible based on subsequently discovered information. All bidders will be required to meet the Fairfax County Safety Resolution at the time of bid. See Attachment G for the current Fairfax County Safety Resolution.

The County shall not be responsible for any costs incurred by Applicants resulting from their participation in this procurement process. Each Applicant shall bear its own expenses in connection with such participation including the provision of any supplemental information, which may be requested. The County shall have no liability for costs incurred by Applicants in connection with the preparation and evaluation of prequalification materials and any findings and determinations made therefrom.

All material submitted by the applicant shall become the property of the County and will not be returned. Applications will be treated as confidential documents.

The County reserves the right to extend the Application submission deadline or modify the application criteria, by way of an addendum, should such action be deemed in the best interest of Fairfax County.

Termination of the Prequalification process can occur, and the County reserves the right to do so when necessary. Applicants will be so notified in writing. If the process is terminated, no compensation will be made to any applicants regardless of the stage of completion of the process.

Please note that, by applying for prequalification, the applicant acknowledges that the subject project requires Contractor-compliance with the responsibilities and reporting requirements shown in the Fairfax County Prevailing Wage Ordinance and Virginia Code 2.2-4321.3 (latest editions). Additional information on the Prevailing Wage Ordinance can be found at the following webpage:

https://www.fairfaxcounty.gov/topics/prevailing-wage-ordinance

This is not a request for proposal.

2. DESCRIPTION OF WORK

Crossroads is a residential substance abuse treatment and rehabilitation facility serving individuals with substance use disorders or co-occurring substance use and mental health disorders. The facility is currently vacant. The construction project scope includes full renovation of the Crossroads Facility along with two small one-story additions and sitework improvements within the property boundaries. The existing facility is housed in two separate two-story buildings with a combined interior floorspace totaling approximately 40,000 sf, located on the same parcel. The two existing buildings require full interior renovation with complete building systems upgrades as well as exterior renovations.

Expansion to the existing facility includes two single story building additions totaling approximately 4,800 sf of floor space with foundations supported by helical piles.

The interior renovations include demolition and reconfiguration of interior walls, finishes and equipment, elevator modernization, and the associated structural and MEP work. This interior work will consist of the relocation of offices, clinical offices, meeting rooms, and bathrooms; space conversions to accommodate 24/7 residential rooms that have anti-ligature, barricade-resistant, and ADA compliant design; kitchen renovation; and elevator modernization, and the incorporation of an energy efficient building envelope with upgraded HVAC and electrical system. Exterior renovations include the incorporation of an energy efficient building envelope through the upgrade of HVAC and electrical system, the addition of photovoltaic (PV) roof panels, and the replacement of windows, siding, insulation, and roofing. The minor expansion to the building footprint includes a fitness center, additional offices, a building connector, and a covered porch. Renovation and expansion of the building will require upgrades to the existing fire detection and suppression systems.

Site improvements include the addition of Electric Vehicle (EV) charging stations, asphalt repaving and marking, additional accessible parking spaces, signage, the addition of a concrete pad and pavilion, and an underground stormwater management (StormTech) system to replace an existing pond.

The project address is 6901 South Van Dorn St., Alexandria, VA 22315.

The General Contract for this project is anticipated to be advertised for bid in July 2026 with bid opening in September 2026. Contract Award and start of construction are anticipated to occur in Fall 2026. The overall construction duration is planned to be approximately 24 months. These are estimated dates, seasons, and durations which are subject to change. The construction cost for this project is estimated to be approximately

$25,000,000 (USD).

3. PREPARATION AND SUBMISSION OF PREQUALIFICATION APPLICATION

A. Applicants may choose one delivery method (hardcopy or electronic). Hardcopy Application Packages must be sealed. The sealed Application package must be clearly and legibly marked on the outside lower left corner as follows:

SEALED PREQUALIFICATION APPLICATION - DO NOT OPEN

FAIRFAX COUNTY CROSSROADS RENOVATION:

PROJECT NO. HS-000050-001

Sealed hardcopy application packages are to be post-marked on or before Friday, May 8, 2026 and delivered in a single sealed and legibly marked package, addressed to the Office of the Director, Building Design and Construction Division, Department of Public Works & Environmental Services, 12000 Government Center Parkway, Suite 449, Fairfax, Virginia. Sealed. The applicant’s full business name shall be clearly displayed on the outside of the envelope. Electronic submissions of prequalification application packages are to be transmitted on or before 2:00 PM on Friday, May 8, 2026, to the following email address: building@fairfaxcounty.gov. Late applications will not be accepted. The Applicant shall assume full responsibility for timely delivery of the Application.

B. The Prequalification Application Form must be typed or neatly printed. Hardcopy submissions are to be provided as one (1) original paper hardcopy in a suitable three-ring binder and shall not exceed 60 pages of data, (30 sheets printed front and back, or 60 sheets of single sided print) exclusive of any required financial documents. The information presented should be clear, complete, responsive, concise, truthful, and accurate. All attachments submitted shall be identified with the name of the applicant, project name, and project number. All pages are to be consecutively numbered. Complete full-color high-resolution searchable PDF files for all application packages are to be provided to the Owner upon request. Please note that emails sent to Fairfax County cannot have attachments with file sizes totaling more than 19MB. Sending up to three separate emails to cover one submission is acceptable. All email submissions for the same applicant must be transmitted on the same date. Incomplete packages will not satisfy timeliness requirements and will not be reviewed. Please submit any questions regarding this process to building@fairfaxcounty.gov.

Failure to submit a complete response using the official submittal forms provided herewith may be considered cause for rejection of the application. Unauthorized modification of any portion of the application may be cause for submission rejection. The Owner reserves the right to decide, at its sole discretion, whether to reject any or all applications, and any such decision shall be considered final.

C. Applicant shall provide all supplemental Information including any additional information requested in the Invitation or submitted as part of the Prequalification Application Form.

This information shall be typed or clearly printed on the Applicant’s letterhead in an organized, concise manner and should follow the same sequence as the Prequalification Application Form with the item numbers cross-referenced. County or assigned designee may, at their sole discretion, contact one or more Applicants during the evaluation process for clarification of any entries in the Prequalification Application and may request additional information. Such additional information must be submitted to the County prior to expiration of the submission period and no later than seven (7) calendar days after the receipt of the request by the Applicant, whichever comes first.

D. The County intends to contact all references listed in the application to establish Applicant’s performance in all aspects.

E. Applicants must provide prompt notice to the County if the Applicant experiences a substantial change in its financial condition, ownership, Fairfax County Safety Resolution compliance status, corporate structure, or personnel after the Prequalification Application Form and related information have been submitted and prior to completion of the bidding process.

Docusign Envelope ID: 115E7393-269D-4B87-A76F-57DCE5899122

Failure to notify the County of any substantial change in financial condition, Fairfax County Safety Resolution compliance, corporate structure, or personnel may constitute grounds for rescinding the Applicant's qualification to bid or for rejection of their bid proposal.

4. APPLICANT QUESTIONS, ADDENDA, AND INTERPRETATIONS

A. All requests for interpretation of the meaning of the Prequalification Instructions and Application Form must be made in writing addressed as indicated in the Invitation to Apply for Prequalification, and to be given consideration, such requests must be received at least seven (7) calendar days prior to the advertised deadline for submittal of the Prequalification Application.

B. Any and all such interpretations and any supplemental instructions or changes will be in the form of written addenda which, if issued, will be posted on-line not later than (3) three calendar days prior to the deadline for submittal of the Prequalification Application. Failure of any Applicant to receive any such addenda shall not relieve the Applicant from any obligation under this Prequalification Procedure. All addenda so issued shall become part of the Prequalification Application and acknowledgment of receipt must be indicated by all Applicants on the Prequalification Application Form on page 1.

5. EVALUATION OF PREQUALIFICATION APPLICATIONS

A. The County will determine whether applicants are either "qualified" or "not qualified” to bid on this Project. The County will notify all Applicants in writing whether or not they have been determined to be a prequalified contractor within thirty (30) calendar days after the deadline for receipt of the Prequalification Application. This decision shall be final and conclusive unless the Applicant appeals within ten (10) calendar days of receipt of the Notice by instituting legal action as provided in the Code of Virginia.

If, upon appeal, it is determined that the action taken by the County was arbitrary or capricious, or not in accordance with the Constitution of Virginia, statutes or regulations, the sole relief available to the Applicant shall be restoration of eligibility. The Applicant may not institute legal action until all statutory requirements have been met.

In determining whether an Applicant should be prequalified, the County, in its sole and absolute discretion, will decide whether the Applicant is capable of fully performing the contractual requirements for the Project, in all respects. The prequalification process is designed to determine the applicant's performance capability as well as its business integrity, safety record, and reliability.

B. Any unsatisfactory references may serve as a basis for disqualification of the Applicant.

Examples of unsatisfactory references include but are not limited to untimely performance, failure to properly schedule the work, failure to complete the work, defective work not corrected, failure to complete punch list work, lack of proper manpower to meet scheduled activities, poor workmanship, submission of unreasonable claims, failure to make prompt payments, inappropriate staffing, or any other documented evidence of noncompliance with the terms and conditions of prior construction contracts.

C. In evaluating each Application for Prequalification, the County will consider information provided in the Application for Prequalification and the following criteria:

1. The Applicant must have been established as a full-time construction contractor for a minimum of ten (10) years holding or eligible to hold a Virginia Class A contracting license.

2. The Applicant shall have acted as a General Contractor and have completed construction of at least three (3) similar construction projects for governmental, institutional or private owners, each with an original contract value of $15,000,000 (USD) or more within the past seven (7) years.

3. Satisfactory performance as a general contractor within the past ten (10) years on projects similar in size, complexity, and scope including the ability to meet scheduled completion dates.

4. Ability to obtain Performance and Payment Bonds in the amounts required for this project.

5. Possession of a valid Class A Virginia Contractor's license prior to bid submission.

D. Applications will be evaluated in accordance with the criteria listed in these Instructions.

An unsatisfactory rating in any one category may be considered sufficient cause to determine that an Applicant is “not qualified to bid”.

E. By submitting an Application, the Applicant agrees that the County and/or its representatives may research the information provided and contact entities associated with such information, at its discretion.

F. The County or its designee may deny prequalification to any Applicant if it finds any of the following (in addition to other criteria outlined in this Application):

1. Prequalification submittals that fail to conform to the requirements of the Prequalification Application may be considered non-responsive and the Applicant determined to be "not qualified to bid".

2. If any Applicant knowingly makes a misrepresentation in submitting information to the County, such misrepresentation may be sufficient grounds for denying prequalification to that Applicant or rescinding the Applicant's prequalification. Any such misrepresentation may also result in debarment of the Applicant by the County.

3. The Applicant does not have sufficient financial ability, including bonding capacity, to perform the contract.

4. Applicant does not meet minimum experience requirements.

5. The Applicant does not have the appropriate staff or experience to perform the work.

6. The Applicant (or any officer, director, or owner thereof) has had judgments entered against him/her within the past ten (10) years for the breach of contract for governmental or non-governmental projects, including but not limited to, construction, design-build or construction management contracts.

7. The Applicant has been in substantial non-compliance with the terms and conditions of prior construction contracts without good cause.

8. The Applicant (or any officer, director, owner, project manager, procurement manager, or chief financial official thereof) has been convicted within the past ten years of a crime related to construction or contracting.

9. The Applicant (or any officer, director, owner thereof) is currently debarred pursuant to an established debarment procedure from bidding or contracting by any public body, agency or another state, or agency of the Federal Government.

10. The Applicant fails to provide to the County any additional information requested by the County within time frames established in this solicitation.

6. APPLICATION REQUIREMENTS

Application Forms and Supplemental Information must be typed or printed clearly. Information presented therein shall be clear, complete and concise. Page 1 of the Application for Prequalification shall be the cover page for each copy of the Application submitted. The following forms and attachments comprise the Application for Pre-qualification:

A. Applicant's Prequalification Statement: The Applicant shall provide the information required. The form in Attachment A shall be used.

B. Project Experience: List construction projects currently being performed or performed during the past ten (10) years as outlined in Attachment B. Provide details on at least three of those projects completed within the past 7-years which are most similar in size, complexity, and scope to the proposed Project on the enclosed form Attachments B1, B2, B3, etc. to demonstrate conformance to minimum experience requirements described in Section 5C above.

C. Key Personnel: Information about the experience of the key personnel that the applicant plans to assign to this project.

D. Contractor's License: A statement of applicant's ability to acquire a Virginia Class A Contractor's License, if currently unlicensed, prior to bidding; and a commitment to require that all affected subcontractors obtain applicable Virginia licenses.

E. Surety Statement: Applicant's ability to acquire bid, performance, and payment bonds for this project.

F. Safety Program and History: Description of Applicant’s Safety Program, Safety Record and EMR, during the past three (3) years.

G. Fairfax County Construction Safety Resolution

H. Quality Control Program: Applicant shall outline its Quality Control Program and its implementation plan.

I. Affidavit of Accuracy: Certification that the information contained in the Application for Pre-qualification is true and accurate. The form in Attachment K shall be used.

7. PROJECT EXPERIENCE

The prequalification application shall demonstrate the experience of the Applicant as a general contractor of new multipurpose buildings. The Applicant shall describe their experience, specifically identifying and describing the following:

A. Minimum Experience Requirement:

1. The Applicant must have been established as a full-time construction contractor for a minimum of ten (10) years holding or eligible to hold a Virginia Class A contracting license.

2. The Applicant shall have acted as a General Contractor and have completed at least three (3) substantially similar projects for governmental, institutional or private owners, each with an original contract value of $15,000,000 (USD) or more within the past seven (7) years.

3. Debarment Status – By submitting an RFQ package, the applicant certifies that neither it nor any affiliated entity is currently debarred from submitting bids or has otherwise agreed not to submit bids on contracts with any federal, state, or local government or business entity. If the applicant experiences a material change in its debarment status after the RFQ submission is submitted and prior to the award of the contract for the Project, the applicant shall notify the Owner of the change in writing at the time the change occurs or as soon thereafter as is reasonably practicable. If at any time during the evaluation process the applicant is debarred as described above, it will be considered grounds to reject their application.

B. Satisfactory experience in the General Contracting of new building construction within the last ten (10) years. Provide the current status of projects in progress, including project duration and anticipated completion of each project. Explanations shall be given for any project that finished or is currently behind schedule.

C. Name, address and telephone number of individual(s) representing owners of each listed construction project who is familiar with the services provided by the Applicant. Fairfax County will contact the individual to verify the experience and satisfactory performance of services by the applicant.

8. KEY PERSONNEL / PROJECT TEAM

The Applicant must identify the Applicant's proposed key personnel including project executive, project manager, and field superintendent intended to be assigned to the project in the event award is made to the Applicant's firm.

Such personnel shall be, insofar as practical, assigned to the project for the duration of such project. The applicant must provide a detailed resume’ for each such individual. The Applicant shall describe in the application the individuals' responsibilities on previous projects and their proposed responsibility on this project. The application must demonstrate that the Applicant has the capability, in terms of both types and quantities of personnel, facilities and equipment required to accomplish the contract goals on schedule.

The Applicant's project management team must reflect at least ten (10) years of experience for each key person on similar type work and in similar capacity as proposed for this Contract.

Those key people who do not have ten years of experience will be removed from the proposed organization chart and the chart thus evaluated. If the Applicant does not propose a project management team meeting the minimum experience and qualification criteria, the Applicant may be considered "not qualified to bid". The successful Applicant must assign the proposed project manager to this project or replace them with individuals having equal or greater relevant construction experience.

Prequalification Application

FAIRFAX COUNTY

DEPARTMENT OF PUBLIC WORKS AND ENVIRONMENTAL SERVICES

APPLICATION FOR PREQUALIFICATION

FAIRFAX COUNTY CROSSROADS RENOVATION

PROJECT No. HS-000050-001

A. This page shall be the cover page for the Application submitted.

B. All required attachments and any additional information requested in this Solicitation must be attached herein.

Attachments:

A. Applicant's Prequalification Statement (Forms and Supplemental Information) B. Project Experience (Forms and Supplemental Information) C. Key Personnel D. Virginia Class A Contractor’s License Statement (by Applicant) E. Suggested Surety Statement F. Safety Program (Forms and Supplemental Information) G. Fairfax County Construction Safety Resolution H. Quality Control Program I. Affidavit of Accuracy (Form)

Acknowledge receipt of addendum below if applicable (initial and date):

Addendum No. 1 _______/________ Addendum No. 2 _______/________ initial date initial date

Submitted by:

Applicant Name: ____________________________________________________

Address: __________________________________________________________

City/State/Zip Code: _ ________________________________________________

Signed by: _________________________________________________________

Printed name and title: ________________________________________________

Telephone No: ______________________________________________________

Signing Applicant Representative Email: ___________________________________

Alternative Email Account (Monitored Daily): ________________________________

ATTACHMENT A

APPLICANT'S PREQUALIFICATION STATEMENT

CROSSROADS RENOVATION

Submitted By: ________________________________________________________

Applicant Name and Address: ____________________________________________

Applicant telephone No.: (____) _____________ Fax No.: (____) __________________

Applicant's Virginia Contractor's License Number: _________________ Class: _______

Tax ID No. (Soc. Sec. No. If Sole Proprietor): _____________________________ _

Person who can respond authoritatively to any questions about this statement:

Name: _________________________ Title: ______________ Tel.: ______________

Email:__________________________

Indicate if: Corporation Sole Proprietor Partnership

Joint Venture Other (Indicate) __________________

The Applicant may attach additional information deemed appropriate to respond. Do not attach additional information irrelevant to the response.

1. Organization

A. How many years has your organization been in business as a construction contractor? ____________

B. How many years has your organization been in business under its present business name? ____________

C. Under what other or former names has your organization operated?

D. If your organization is a corporation, please indicate:

Date of incorporation: ____________

State of incorporation: ____________

President's name: _______________________

Vice President's name(s): _______________________

Secretary's name: _______________________

Treasurer's name: _______________________

E. If your organization is a partnership, please indicate:

Date of organization: _______________________

Type of partnership (if applicable): _______________________

Name(s) of general partners: _______________________

F. If your organization is a sole proprietorship, please indicate:

Date of organization: ___________________________________

Name of owner: _______________________________________

G. If the form of your organization is other than those listed above, describe it and name the principals and date of commencement of business:

H. Submit a copy of the applicant's current organization chart showing numbers of employees by discipline and project and the names and titles down through Project Field Superintendent.

I. Provide proposed organizational chart for the project with names of key personnel.

J. Is the applicant related to another firm as a parent, subsidiary or affiliate?

Yes___ No___

If yes, give names and addresses of all affiliated parent and/or subsidiary companies. Indicate which companies are subsidiaries.

2. Judgments

A. Has the applicant or any officer, director or owner thereof had any judgments entered against him within the past ten years for breach of contracts for governmental or non-governmental construction, including, but not limited to, design-build or construction management?

If yes, provide details on any such judgment.

3. Contract Compliance

A. Has your firm been found to be in substantial noncompliance with the terms and conditions of prior construction contracts in the past 10 years?

Yes No ______

If yes, provide details on any such instance.

B. Has the Applicant ever failed to complete any work awarded to it? If yes, state date(s), project(s), owner or A/E reference(s), and reason(s).

Yes _____ No ______

C. Has the Applicant ever been party to a construction contract, which was terminated by the owner, for the owner’s convenience or otherwise? If yes, state date(s), project(s), owner or A/E reference(s), and reason(s).

Yes _____ No ______

D. Has the Applicant ever been declared to be in default or partial default on a construction contract or project? If yes, state date(s), project(s), owner or A/E reference(s), and reason(s).

Yes _____ No ______

E. Has the Owner or Owner’s Agent ever taken steps to complete contract work, which was the Applicants own responsibility? If yes, indicate date(s), project(s), owner or A/E references, and reason(s).

Yes _____ No ______

F. Has the Applicant ever been the subject of a stop work order on a construction project? If yes, state date(s), project (s), and reason(s).

Yes _____ No ______

G. Are there any judgments, claims, suites, arbitration proceedings, or other legal proceedings pending or outstanding to which the Applicant is a party? If yes, state date(s), project(s), and reason(s).

Yes _____ No ______

H. Has the Applicant filed or caused to be filed, any suits, arbitration requests or claims with regard to any construction contracts within the past five (5) years? If yes, state date(s), project (s), and reason(s).

Yes _____ No ______

I. Has the Applicant been assessed liquidated damages for failure to complete a project by contract date within the past ten (10) years? If yes, state date(s), project (s), and reason(s).

Yes _____ No ______

J. Has the Applicant ever failed to complete punch list work on time.

Yes _____ No ______

4. Convictions

Has the applicant or any officer, director or owner thereof been convicted within the past ten (10) years of a crime related to governmental or non-governmental construction or contracting, including, but not limited to, violation of (i) Ethics in Public Contracting (Article 4 - § 11-72 et seq.), (ii) the Virginia Governmental Government (Chapter 4.2 - § 59.1 - 68.6 et seq.) of Title 59.1), or (iv) any substantially similar law of the United States or another state? If yes, provide details on any such convictions on a separate sheet.

Yes _____ No ______

5. Debarment

Is the applicant or any officer, director or owner thereof currently debarred pursuant to an established debarment procedure from bidding or contracting by any public body, agency of another state or agency of the federal government?

Yes _____ No ______

If yes, provide details:

6. References (Provide at least five (5) references in each category and include for each reference its name, address, telephone number, and name of contact person.)

A. ENGINEERS/ARCHITECTS:

1. _____________________________________________________________

2. _____________________________________________________________

3. _____________________________________________________________

4. _____________________________________________________________

5. _____________________________________________________________

B. MAJOR SUBCONTRACTORS:

1. _____________________________________________________________

2. _____________________________________________________________

3. _____________________________________________________________

4. _____________________________________________________________

5. _____________________________________________________________

C. OWNERS:

1. _____________________________________________________________

2. _____________________________________________________________

3. _____________________________________________________________

4. _____________________________________________________________

5. _____________________________________________________________

7. Financial

A. Does any individual, company or corporation own a 10% or more interest in the outstanding shares of the capital stock of the Applicant?

Yes _____ No ______

If yes, list the name and percent interest of ownership held in the Applicant.

B. Audited financial statements for the Applicant’s previous three fiscal years may be required. These financial statements, if requested, shall include a complete report of Applicant’s financial resources, liabilities, equipment, and personnel.

C. Is the Applicant currently a debtor in any bankruptcy case or has been in bankruptcy at anytime during the previous five (5) years? If yes, state date(s), and reason(s).

Yes _____ No ______

8. Workers Compensation Experience

List your Experience Modification Rate (EMR) for workers compensation and OSHA incidence rate for the past three years:

EMR Incidence Rate

9. Surety and Insurance

A. Provide documentation from your Surety identifying Applicant’s total bonding capacity, individual job bonding capacity, and maximum the Applicant can be bonded on a single project. Provide Surety Statement as outlined in Attachment E.

B. List all other sureties (name and address) that have written bonds for the Applicant during the last five years.

C. Provide the following information:

Average annual contract volume for the past 5 years $ _____________

Total value of work in progress or under contract $ _____________

D. Has any surety company made a payment on Applicant’s behalf as a result of default, to satisfy any claims made against a performance or payment bond in connection with any construction project during the previous five (5) years? If yes, state date(s), project(s), and reasons.

Yes _____ No ______

E. Has any insurance carrier, for any form of insurance, refused to renew insurance policy for your firm? If yes, state date(s), and reason(s).

Yes _____ No ______

10. Confidential and Proprietary Information

Initial here ____ if the applicant requests that all information submitted as part of this prequalification process be considered a trade secret or as proprietary information subject to the provisions of subsection D of § 11-52, Code of Virginia.

ATTACHMENT B

PROJECT EXPERIENCE

Applicant shall demonstrate conformance to the experience requirements of this solicitation and provide the following:

1. On a separate sheet(s), list all construction projects your organization has in progress, giving the name of project, scope, owner, design engineer/architect, contract amount, percent complete and scheduled completion date.

2. On a separate sheet(s), list all projects similar to the work herein being performed or performed during the past ten (10) years, giving the name of project, owner, design engineer/architect, contract amount, and date of completion and project scope description. Please verify prior to submission that all contact information is accurate and current.

3. Provide on the following pages (attachments B1, B2, B3, etc.) the details of at least three (3) similar construction projects for governmental, institutional, or private owners for which the Applicant has acted as a General Contractor and completed within the past seven (7) years with original contract values of $15,000,000 (USD) or more.

ATTACHMENT B1

SIMILAR PROJECTS

PROJECT 1

DETAILS OF PROJECT

1. Applicant Name: _____________________________________________

Project Manager Name: __________________________________

Superintendent Name: ___________________________________

2. Name of Project: ________________________ Contract No. Project Number ______________

3. Owner Name: __________________________ Address: _____________________________________________ Contact Person: ________________________________________

Telephone Number: ( )

4. Engineer/Architect: ___________________________________________

Address: ______________________________________________

Contact Person: ________________________________________

Telephone Number: ( )

5. Contract Dates - Attach additional information if project was not on schedule.

Started: __________

Original Contractual Completion:

Final Contractual Completion:

Actual Completion:

6. Description of the project: ___________________________________________

7. Original Contract Value $

Final Contract Value $

Value of Change Orders to Date $

Value of Outstanding Claims to Date $

8. Name of Bonding Company ____________

Address:

Contact Person:

Telephone Number: ( )

9. Major Subcontractor{s} Name:

Address:

Contact Person:

Telephone Number: ( ) Role In Project:

Name:

Address:

Contact Person:

Telephone Number ( ) Role In Project:

Name:

Address:

Contact Person:

Telephone Number ( ) Role in Project:

ATTACHMENT B2

SIMILAR PROJECTS

PROJECT 2

DETAILS OF PROJECT

1. Applicant Name: _____________________________________________

Project Manager Name: __________________________________

Superintendent Name: ___________________________________

2. Name of Project: ________________________ Contract No. Project Number ______________

3. Owner Name: ______________________________ Address: ______________________________________________

Contact Person: ________________________________________ Telephone Number: ( )

4. Engineer/Architect: ___________________________________________

Address: ______________________________________________

Contact Person: ________________________________________

Telephone Number: ( )

5. Contract Dates - Attach additional information if project was not on schedule.

Started: __________

Original Contractual Completion:

Final Contractual Completion:

Actual Completion:

6. Description of the project: ___________________________________________

7. Original Contract Value $

Final Contract Value $

Value of Change Orders to Date $

Value of Outstanding Claims to Date $

8. Name of Bonding Company

Address:

Contact Person:

Telephone Number: ( )

9. Major Subcontractor{s} Name:

Address:

Contact Person:

Telephone Number ( ) Role In Project:

Name:

Address:

Contact Person:

Telephone Number ( ) Role In Project:

Name:

Address:

Contact Person:

Telephone Number ( )

ATTACHMENT B3

SIMILAR PROJECTS

PROJECT 3

DETAILS OF PROJECT

1. Applicant Name: _____________________________________________

Project Manager Name: __________________________________

Superintendent Name: __________________________________

2. Name of Project: ________________________ Contract No. Project Number ______________

3. Owner Name: ______________________________ Address: _____________________________________________

Contact Person: ________________________________________

Telephone Number: ( )

4. Engineer/Architect: ___________________________________________

Address: ______________________________________________

Contact Person:

Telephone Number ( )

5. Contract Dates - Attach additional information if project was not on schedule.

Started: __________

Original Contractual Completion:

Final Contractual Completion:

Actual Completion:

6. Description of the project: ___________________________________________

7. Original Contract Value $

Final Contract Value $

Value of Change Orders to Date $

Value of Outstanding Claims to Date $

8. Name of Bonding Company

Address:

Contact Person:

Telephone Number ( )

9. Major Subcontractor{s} Name:

Address:

Contact Person:

Telephone Number ( ) Role In Project:

Name:

Address:

Contact Person:

Telephone Number ( ) Role In Project:

Name:

Address:

Contact Person:

Telephone Number ( )

ATTACHMENT C

KEY PERSONNEL

1. Provide information about the experience of key personnel of the Applicant that will be associated with this project. The information shall include name, title, intended assignment, years of construction experience, last employer, last position, and experience on similar projects.

2. Applicant must also provide the percentage of time the key personnel will dedicate to the project.

ATTACHMENT D

VIRGINIA CLASS A CONTRACTOR’S LICENSE STATEMENT

Provide a Statement of applicant's ability to possess a Virginia Class A Contractor's License prior to bidding, and a commitment to ensure that affected subcontractors obtain applicable Virginia Contractor's Licenses.

ATTACHMENT E

SUGGESTED SURETY STATEMENT

REFERENCE: APPLICATION FOR PRE-QUALIFICATION

CROSSROADS RENOVATION

(Name of Applicant) has been a client of (name of Surety Company) for over (______) years. During that time, we have supported this firm in their pursuit of projects in the $________ range and total programs in excess of $_____________. We are prepared to provide Bid, Performance, and Payment Bonds on the aforementioned project, provided (name of Applicant) is awarded the contract.

We also possess certificates of authority as an acceptable surety authorized to do business in the Commonwealth of Virginia as published annually in the Federal Register, Department of Treasurer, Fiscal Service, Department Circular 570.

Sincerely, Attorney-In-Fact (Name of Surety Company)

Name of Surety

Signature

Typed Signature

Date

Address

Telephone

ATTACHMENT F

SAFETY PROGRAM and HISTORY

A. Does your firm have a written safety program?

Yes No _____

If yes, provide detail of your safety program on separate sheet.

B. Does the firm incorporate safety and health related issues into their new employee orientation programs?

Yes No _____

C. Does the firm include work safety as a part of an employee's performance evaluation?

Yes No _____

D. To what degree does senior/corporate management support safety related matters? Does the firm have a safety policy statement signed by a member of senior/corporate management?

Provide detail on separate sheet.

E. Does the firm have a full time Safety Manager? Does this person report to a high level, authoritative position within the Company?

Yes No _____

If yes, provide detail on separate sheet.

F. Are safety inspections conducted at work sites? If so, how often and by whom?

Provide detail on separate sheet.

G. Are safety training programs conducted for employees? If so, how often and by whom?

Provide detail on separate sheet.

H. Are safety "tailgate meetings" and “toolbox meetings” conducted by the firm? If so, how frequently?

Provide detail on separate sheet.

Pre-Qualification Application

I. Does the firm have a visibly active safety committee? If so, how often does it meet? Who serves on the committee?

Provide detail on separate sheet.

J. Is the firm an active member of a recognized construction safety organization in the Washington Metropolitan area, or in the state of contractor's domicile?

Yes No _____

K. What is the firm's Workers Compensation Experience Modification Factor?

Are there any evident trends?

Provide detail on separate sheet.

L. In the previous three years has your firm been cited for a serious violation, willful violation, violation for failure to abate or repeated violation (as defined by OSHA)? See attachment G, Fairfax County Construction Safety Resolution.

Yes No _____

If yes, provide detail on separate sheet.

M. Attach OSHA form 300 and OSHA form 300A with a summary of occupation injuries and illness for the last thirty-six (36) months.

ATTACHMENT G

All bidders will be required to meet Fairfax County Safety Resolution at the time of bid. The current Fairfax County Safety Resolution is provided below.

FAIRFAX COUNTY CONSTRUCTION SAFETY RESOLUTION

The Contractor shall comply with the resolution adopted by the Fairfax County Board of Supervisors on December 8, 2003, as amended:

A. It shall be required that each bid submitted to the County for a contract for construction, alteration, and/or repairs, including painting or decorating of a building, highway, street, bridge, sidewalk, culvert, sewer, excavation, grading, or any other construction, include a list of all the following actions which have become final in the three years prior to the bid submission:

1. Willful violations, violations for failure to abate, or repeated violations, for which the bidder was cited by (a) the United States Occupational Safety and Health Administration; (b) the Virginia Occupational Safety and Health Administration; or (c) the occupational safety and health plan for any other public jurisdiction; or

2. Three (3) or more serious construction safety violations for which the bidder was cited by the (a) United States Occupational Safety and Health Administration; or (b) the Virginia Occupational Safety and Health Administration; or (c) the occupational safety and health plan from any other public jurisdiction.

3. Termination of a contract between the contractor and any public entity by their purchasing agent or his designee for safety violations.

B. If the bidder has not received or been the subject of any such violations referenced in paragraph A in the three (3) years prior to the bid submission, then the bidder shall so indicate by certification on the bid form entitled Certification of Safety Violations. The bidder will also indicate on this form each state in which work was performed in the three (3) years prior to the bid submission.

C. No bidder or contractor may bid on a County construction contract who has been the subject of any citations for the type and number of violations listed in aforementioned paragraph A, which have become final within the three (3) years prior to the bid submission.

1. Notwithstanding the language of paragraph C, above, any bidder or contractor who has been the subject of a violation, as described in paragraph A.1, which has become final in the three (3) years prior to the bid submission, may bid, if the bidder or contractor meets the eligibility criteria set forth in paragraph E, below.

2. Notwithstanding the language of paragraph C, above, any bidder or contractor who has been the subject of the type and number of violations as described in paragraph A.2, which have become final within three (3) years prior to bid submission, may bid, if the bidder or contractor meets the eligibility criteria in paragraph E, below.

3. Notwithstanding the language of paragraph C, above, any bidder or contractor who has previously been terminated from a public contract, as described in paragraph A.3, within three (3) years prior to the bid submission, may bid, if the bidder or contractor meets the eligibility criteria in paragraph E, below.

D. Prior to bidding on a project, under the provisions of paragraph C above, a contractor may request that a determination be made by the County's Purchasing Agent or designee, regarding their eligibility to submit a bid on a contract under the terms of this resolution. However, this request for determination and any subsequent adjudication process must be completed prior to submitting a bid on any project and the request for determination must be received by the County's Purchasing Agent or designee no later than twenty-one (21) days before bids are due unless otherwise stated in the…