MMSD 2025 Prequalification Forms.pdf

PRE-QUALIFICATION APPLICATION

THE CONTENTS OF THIS QUESTIONNAIRE SHALL BE CONFIDENTIAL FOR THE EXCLUSIVE USE OF THE

CONTRACTING AGENCY AND SHALL NOT BE MADE PUBLIC EXCEPT BY WRITTEN PERMISSION OF

THE PROSPECTIVE BIDDER.

INFORMATION / INSTRUCTIONS

1) To be submitted by all prime bidders. All others to submit as required by the bidding documents.

2) Must be received by The District prior to deadline stated in bidding documents. Additional information, if necessary, may be requested by the District.

3) Fill out and send questionnaire (IN PDF FORMAT) to: Prequalifications@madsewer.org

4) Bidder’s Statement of Request for Pre-Qualification (Green Sheet) must be filled out for every project.

5) Statement of Qualifications (Blue Sheets) are valid for the current calendar year only.

(EXAMPLE: project bid in June, statement of qualifications valid until 12/31)

6) Submission of the Blue Sheets section of the application does not grant automatic approval for all projects advertised by the District in the current calendar year. Qualifications are still reviewed project to project by project engineer.

PREQUALIFICATION STATEMENT

There is submitted herewith for your consideration, pursuant to Section 66.0901(2), Wisconsin Statutes, a statement of qualifications of the undersigned to furnish the necessary labor, materials, and skills required to enter upon and complete contracts for Madison Metropolitan Sewerage District.

BIDDER’S STATEMENT OF REQUEST FOR PRE-QUALIFICATION

IDENTIFICATION

1. Firm’s Name:_________________________________________________________________

Mailing Address: ______________________________________________________________

Telephone: ____________________________

E-Mail: _____________________________________________________________________

□ Individual Owner

Number of years in business under present name: __________

Is the business a: □ □ Corporation (includes LLC and S) Partnership

If a Corporation: Year incorporated: ______________

State incorporated: ___________________

Contact information regarding questions related to this form:

Name: ______________________________________________

Telephone Number: ____________________________________

Email Address: _______________________________________

2. The above-named Bidder requests to be pre-qualified for construction of the following project/contract:

Prime Contractor Subcontractor Which do you wish to qualify as (select all that apply):

Please specify trade(s) : ______________________________________________

Bidder HAS NOT submitted a Statement of Qualifications within the current calendar year. Documentation is required. Proceed to following page, complete forms and attach documentation.

Bidder HAS submitted a Statement of Qualifications within the current calendar year. A new Statement of Qualifications is not required. Bidder acknowledges his/her intent to be pre-qualified for the above-named project(s) by signing and dating this form below and by returning this form to the District prior to the deadline stated in the bidding documents.

Firm Name

Signature

Title

Date

BIDDER’S STATEMENT OF QUALIFICATIONS

EXPERIENCE

I - PERSONNEL

What is the experience of the principal individuals, including officers, superintendents and/or foremen/women, of your organization? Provide information similar to the table below:

Name Present Position/Title Years of Experience Description of Duties

(1) (3) (3) (4)

Average number of employees during the last 12 months:

Office: Skilled: Unskilled:

II - PROJECTS COMPLETED

Provide a list of work performed on any projects pertinent to the type of work for which pre-qualification is desired.

Provide information similar to the table below. Under "Capacity", state whether the work was as a Prime Contractor, Subcontractor, etc.

Year Finished

Project Name

Type of Work Capacity Contract

Amount ($) Reference

Name Reference City, State

Reference Phone #

Reference Email

(1) (2) (3) (4) (5) (6) (7) (8) (9)

III - CURRENT CONTRACTS

Attach information related to current contracts. Highlight contracts that are for work similar to the type of work for which pre-qualification is desired. Provide information similar to the table below:

Project Name Owner %

Complete Contract

Amount ($) Completion

Date Type of Work

Reference Name

Reference City, State

Reference Phone #

Reference Email

(1) (2) (3) (4) (5) (6) (7) (8) (9) (10)

IV - EQUIPMENT

Provide a list of major pieces of equipment owned and available when needed for proposed work. Provide information similar to the table below:

No. of Each Description Model/Size Capacity Year

(1) (2) (3) (4) (5)

CONTRACTUAL RESPONSIBILITY

Answering "yes" to any of the following questions may not directly disqualify a company from becoming approved to bid by the District. However, failure to answer truthfully will likely result in disqualification.

If response is “Yes”, please attach a description of particulars (date, parties involved, type of work, amount of contract, cause, resolution).

1) Has your firm or any officer or partner of your firm ever been debarred, suspended, disapproved, or not pre-qualified by the State of Wisconsin or any government entity in the past ten (10) years?

[ ] Yes [ ] No

2) Has your firm or any officer or partner of your firm had any type of business, contracting, or trade license, certification, or registration revoked or suspended in the past ten (10) years?

[ ] Yes [ ] No

3) Does your firm or any officer or partner of your firm have an open or ongoing investigation or been cited in a violation of federal, state, or local government safety or environmental laws? This includes, but is not limited to, any OSHA, EPA, or WDNR violations.

[ ] Yes [ ] No

If Yes, include in description the OSHA reportable incidents and citations.

4) Has your firm or any officer or partner of your firm ever declared bankruptcy while performing work on a contract or work awarded to it in the past ten (10) years?

[ ] Yes [ ] No

5) Has your firm ever defaulted on or failed to complete any contract or work awarded to it in the past ten (10) years?

[ ] Yes [ ] No

6) Has your firm or any officer or partner of your firm asked to be relieved from a bid submitted by it to a public awarding authority in the past ten (10) years?

[ ] Yes [ ] No

7) Has your firm or any officer or partner of your firm ever been charged with or convicted of a violation of any Davis Bacon federal wage rates?

[ ] Yes [ ] No

8) Has your firm; any of its owners; a subsidiary or corporate parent; or any officer, director, or partner thereof, been convicted of violating Section 133.03 Wisconsin Statutes (Unlawful Contracts: Conspiracies) in the last ten (10) years?

[ ] Yes [ ] No

2) Attach a dated, recent financial statement, no later than the previous calendar year, showing breakdown of your firm’s assets, liabilities, and net worth.

COMMITMENT TO SAFETY

A safe work environment is always the top priority of the District, and this priority extends to all contractors and subcontractors on work of any capacity. Please attach a description of your company’s commitment to safety (including but not limited to safety programs, safety personnel, and leadership commitment)

BONDING RESPONSIBILITY

Current Bonding Company

Bonding Company Name:________________________________________________________________

Mailing Address: ______________________________________________________________

Telephone: ____________________________ E-Mail:

Firm's current performance and payment bond limit for a single job:

Firm's current performance and payment bond limit for aggregate jobs:

CONTRACTOR’S FINANCIAL STATEMENT

1) Attach a bank letter, no later than the previous calendar year, indicating credit available.

AFFIDAVIT

I certify that all above statements and attachments hereto are true and correct and are made on behalf of

Firm Name

Officer/Owner Name

Signature

Title

Sworn and Subscribed to before me this _____ day of _________________________, 20___.

____________________________________ Notary Public.

My commission expires .