ESBD_442575_1754077337796_SUBMISSION FORM-QUALIFICATIONS STATEMENT.pdf

ALL FORM FIELDS REQUIRED, MARK N/A IF NOT APPLICABLE.

FAILURE TO COMPLETE, SIGN AND SUBMIT WITH BID MAY BE CAUSE FOR REJECTION OF BID.

SECTION 1. COMPANY INFORMATION

Legal Name of the Company

Principal Place of Business (Corporate Headquarters)

Address:

City, State, Zip:

Physical Address of Office Providing Services (if different from above)

Address:

City, State, Zip:

Mailing Address (if different from above)

Address:

City, State, Zip:

Include name, address, email, and telephone number of the person in your organization authorized to negotiate contract terms and render binding decisions on contractual matters.

Name & Title:

Address:

City, State, Zip:

Email:

Phone:

Does any relationship exist by relative, business associate, capital funding agreement, or any other such kinship between your firm and any Owner employee, officer or member of the Texas Parks and Wildlife Commission? If so, please explain.

Firm History: List firm history below including any other business names used.

From: To: Firm Name:

From: To: Firm Name:

From: To: Firm Name:

Total Number of Years in Business:

Entity Classification

YES NO

Select the Appropriate Ownership Type for your business:

Individual Recipient (not owning a business) Texas Corporation

Sole Ownership (Individual owning a business) Professional Association

Partnership Professional Corporation

Texas Limited Partnership Out of State Corporation*

Other*:

*If Bidder is an out of state entity, bidder shall provide a copy of the Certificate of Authority to do business in Texas with the bid.

Owner reserves the right to request documentation of Bidder signed by an authorized representative of the

Bidder clearly indicating the legal name, entity status and capacity and authority of the person signing on behalf of Bidder.

Documentation requests may include but are not limited to, articles and bylaws, certificate of organization, articles of organization and regulations, joint venture agreements, partnership agreements and certificates of limited partnership and documentation for partner.

END SECTION 1

SECTION 2. FINANCIAL CAPABILITY

Bidder must provide evidence of financial capability and stability.

Bidder

ALL FORM FIELDS REQUIRED, MARK N/A IF NOT APPLICABLE

Indicate if your company or any of its subsidiaries filed or met criteria for bankruptcy within the last five years.

__ NO __ YES If yes, explain.

Identify if your firm is currently in default on any loan agreement or financing agreement with any bank, financial institution, or other entity? If so, specify date(s), details, circumstances, and prospects for resolution.

__ NO __ YES If yes, explain.

Identify if your firm is currently for sale or involved in any transaction to expand or to become acquired by another business entity? If so, please explain the impacts, financial, organizational and company direction.

__ NO __ YES If yes, explain.

BONDING INFORMATION: Indicate the Agency/Surety through which bonding will be obtained.

AGENCY COMPANY

Agent Company Name:

Agent Name:

Agent Address:

Agent Email:

Agent Phone No.:

BONDING COMPANY (UNDERWRITER)

Bonding Company Name:

Bonding Agent Name:

Bonding Agent Address:

Bonding Agent Email:

Bonding Agent Phone:

DISCLOSURE OF OUTSIDE FINANCIAL RESOURCES: Identify outside financial resources available to firm to enable performance under the awarded contract.

CONSTRUCTION CAPABILITIES

Firms Average Annual Construction Volume $

Building % Mech.-HVAC % Hwy/Roads % Other %

Electrical % Utility Lines % Earthwork % Other %

Plumbing % Utility Plants % Site Work % Other %

END SECTION 2

SECTION 3. LITIGATION HISTORY

Bidders involved in litigation, depending upon the circumstances, may be disqualified.

Provide details of litigation or claims filed against bidder for the past ten years, including any pending litigation or claims.

Has firm, under its current or former name(s) ever failed to complete a project, defaulted on a contract, or been terminated from a construction contract?

__ NO __ YES If yes, explain.

END SECTION 3

SECTION 4. RELATED PROJECT EXPERIENCE

Bidder must provide history of successful completion of projects with similar size, scope, and complexity.

MINIMUM EXPERIENCE REQUIREMENTS

BIDDER MUST SHOW EVIDENCE OF THREE (3) SUCCESSFUL CONSTRUCTION PROJECTS TO BE

ELIGIBLE FOR AWARD OF THIS CONTRACT. PROJECTS PUT FORWARD AS EVIDENCE OF

EXPERIENCE MUST BE SIMILAR TO THIS PROJECT AND MUST HAVE OCCURRED WITHIN THE

PAST FIVE (5) YEARS, MEASURED BACKWARDS FROM THE ISSUE DATE OF THIS SOLICITATION.

A SUCCESSFUL CONSTRUCTION PROJECT IS ONE THAT WAS COMPLETED ON TIME, WITHIN

BUDGET AND IN COMPLIANCE WITH THE DESIGN AND SPECIFICATIONS.

THE OWNER REGARDS SIMILAR WORK AS CONSTRUCTION WORK OF A COMPARABLE TYPE,

SCOPE AND SIZE TO THIS OPPORTUNITY. COMPARABLE TYPE TO THIS PROJECT IS

CONSIDERED TO BE CIVIL CONSTRUCTION. The documentation shall be presented in sufficient detail to demonstrate that that the Bidder is qualified to manage and construct the type of project being solicited.

PROJECT EXPERIENCE INFORMATION

size and scope to the project of this solicitation.

REFERENCES FOR EACH INCLUDED PROJECT

Provide current contact information on the Project Experience forms for each project owner. References will be contacted by the designated TPWD Contract Manager via email to substantiate the Project Experience provided.

Negative responses or no responses from project reference owners and/or A/E firms that are familiar with Bidder performance, depending on problems encountered, may be ground for disqualification.

Information requested may include any combination of the following:

Owner Name Project Title & Location Initial Contract Amount Final Contract Amount Start Date Completion Date Statement on Quality of Work Statement on Job Coordination/Supervision Statement on Timeliness Statement on Change Order Pricing Additional Information (if any)

PROJECT EXPERIENCE FORM - #1

Project Name:

Project Location:

Project Owner Company Name:

Representative Phone:

Project A/E Company Name:

Project A/E Contact Name:

Project A/E Phone & Email Address:

Original Contract Amount: $

Final Contract Amount: $

Describe Change Orders or other amendments that modified the contract amount.

Project Start Date:

Project Completion Date:

Original Construction Duration:

Final Construction Duration:

Provide a brief explanation for variances and time extensions granted.

Key Personnel for this project, including Project Superintendent

NAME TITLE

YEARS W/

BIDDER

TOTAL YEARS

EXPERIENCE

Major Subcontractors for this Project

NAME COMPANY NAME

YEARS W/

BIDDER

TOTAL YEARS

Brief Description of the Work

Describe how this Project is comparable to the Work required for this Project

PROJECT EXPERIENCE FORM - #2

Project Name:

Project Location:

Project Owner Company Name:

e:

Project A/E Company Name:

Project A/E Contact Name:

Project A/E Phone & Email Address:

Original Contract Amount: $

Final Contract Amount: $

Describe Change Orders or other amendments that modified the contract amount.

Project Start Date:

Project Completion Date:

Original Construction Duration:

Final Construction Duration:

Provide a brief explanation for variances and time extensions granted.

Key Personnel for this project, including Project Superintendent

NAME TITLE

YEARS W/

BIDDER

TOTAL

YEARS

YEARS W/

BIDDER

TOTAL

PROJECT EXPERIENCE FORM - #3

Project Name:

Project Location:

Project Owner Company Name:

e:

Project A/E Company Name:

Project A/E Contact Name:

Project A/E Phone & Email Address:

Original Contract Amount: $

Final Contract Amount: $

Describe Change Orders or other amendments that modified the contract amount.

Project Start Date:

Project Completion Date:

Original Construction Duration:

Final Construction Duration:

Provide a brief explanation for variances and time extensions granted.

Key Personnel for this project, including Project Superintendent

NAME TITLE

YEARS W/

BIDDER

TOTAL

YEARS W/

BIDDER

TOTAL

REQUIRED SUBMITTALS: Submittal shall be one .pdf file uploaded to the appropriate field within the bid portal. Bid Portal file name should not exceed ten characters. Include the following:

Qualifications Statement

Certificate of Authority for Out of State Contractor, Section 1 (if applicable)

BIDDER I hereby certify that all information provided with the bid, above and attached is true and correct. Furthermore, I hereby authorize Texas Parks and Wildlife Department to contact the references listed and authorize release of information from such references to Texas Parks and Wildlife Department. I certify that my firm is not debarred or suspended from performing work for the U.S.A. or the State of Texas.

BIDDER BID WITH A FALSE STATEMENT OR MATERIAL MISREPRESENTATIONS

MADE DURING THE PERFORMANCE OF A CONTRACT IS A MATERIAL BREACH OF CONTRACT AND SHALL VOID

THE SUBMITTED BID OR ANY RESULTING CONTRACTS.

Name of Contracting Firm Authorized Signature Date

Street Address Printed Name

City State Zip Code Title

Office Phone Number Direct Phone Number

Email Address Cell Phone Number

Texas Identification Number (TIN) Federal Employers Identification Number (FEIN)

A FULLY EXECUTED COPY OF THIS FORM IN ITS ENTIRETY ALONG WITH THE REQUESTED DOCUMENTS AS

LISTED HEREON AND IN IFB SECTION 3.13, MUST BE UPLOADED INTO BID PORTAL