J8 Contractor_Responsibility_Questionair_-_New.rtf

CONTRACTOR’S RESPONSIBILITY QUESTIONNAIRE

THESE DOCUMENTS SHALL BE TREATED BY THE GOVERNMENT AS CONFIDENTIAL.

CONSTRUCTION CONTRACTOR EXPERIENCE DATA

DATE:

Firm Name and Telephone Number Main Office Address (Street, City, and State) Branch Offices Services Rendered Construction Design Consultant Organization

Date Organized Date Incorporated:

State:

Names of Officers and Other Key Personnel I – PRESENT PAYROLL PERSONNEL (List Number of Each Category Below) Partners: Officers: Other Key:

Remainder:

Subtotal Permanent:

Maximum Personnel at Any Time: Date:

Total:

II—EQUIPMENT OWNED

III—FINANCIAL DATA AS OF (DATE):

Present Value ($)

Current Assets:

Acquisition Cost ($) Current Liabilities:

Net Worth:

IV—TOTAL VALUE OF CONSTRUCTION AND DEMOLITION WORK IN PAST 6 YRS EXCLUSIVE OF JOINT VENTURE (LIST MOST RECENT FIRST)

V—LARGEST JOB EVER CONTRACTED

(If Other Than in Past Six Years)

LARGEST JOB IN PAST 6 YRS

Contract Amount: Date: Description:

Owner:

Contract Amount: Date: Description:

Owner:

Avg. Annual Income

VI—TYPE OF WORK IN WHICH FIRM SPECIALIZES

NAME AND POSITION/TITLE OF PERSON SIGNING

SIGNATURE

NOTE: Use reverse side for explanations or detailed description of item(s) reported above.

SCHEDULE A

CONSTRUCTION CONTRACTOR EXPERIENCE DATA

EXISTING COMMITMENTS: List below ongoing Construction project or projects including those on which you are presently the low bidder but have not received an award.

CONTRACT NUMBER: AMOUNT:

DESCRIPTION OF WORK/LOCATION:

*FOR WHOM PERFORMED: PERCENT COMPLETE:

* PROVIDE NAME OF ORGANIZATION, POINT OF CONTACT AND TELEPHONE NUMBER FOR CONTACT.

SCHEDULE B

EXPERIENCE DATA: List below similar scoped projects your firm has completed within the past six (6) years.

CONTRACT NUMBER: AMOUNT:

DESCRIPTION OF WORK/LOCATION: COTACT PERSON/PHONE NUMBER:

SCHEDULE C

CONSTRUCTION AND/OR TECHNICAL EOUIPMENT: List total equipment and facilities owned for performing the work and present status as to whether or not it is committed to existing contracts.

DESCRIPTION: QUANTITY: CONDITION:

YEARS OF PRESENT SERVICE STATUS: