RFP_PR9220__Attachment_D_Qualifications_Fillin_form_Draft.xls

XLS spreadsheet 44 KB Posted

Attached to
Asphalt and Concrete Services
Solicitation number
PR9220
Issued by
Orange County, Orlando City, Florida

About this file

This is a qualifications fill-in form for RFP PR9220 issued by OUC (Orlando Utilities Commission) in Florida for comprehensive asphalt and concrete services. The RFP requests proposals from qualified suppliers to furnish all necessary labor, supervision, materials, equipment, and expertise to complete various asphalt and concrete work including lime rock base installation, asphalt concrete surface work, Portland cement applications, concrete pavement and driveway construction, sidewalk creation, concrete curb restoration, debris removal, sod replacement, irrigation repair, roadway and parking surface maintenance, customer driveway repairs, milling, sealcoating, and support for location-specific projects across OUC facilities and service territory. The scope of work is broad and task assignments will be determined by the OUC Project Manager on an as-needed basis. Contractors must possess all required federal, state, and local licenses, permits, certifications, and approvals prior to commencing work.

The qualifications form requires bidders to provide comprehensive company background information including business details, primary contact information, and proof of proper licensing by the City, County, State of Florida, and/or Federal government. Bidders must demonstrate familiarity with FDOT Standard Specifications, MUTCD, and local permitting requirements. Insurance requirements include General Liability of $2 Million, Auto Liability of $1 Million with MCS-90 Endorsement, statutory Worker's Compensation, and Pollution Liability Coverage of $2 Million, with policies allowing for additional insured status and waiver of subrogation. Bidders must submit financial information including Dun and Bradstreet numbers and annual dollar volumes for the past four years, health and safety program documentation, OSHA metrics, drug-free workplace policies, and employee screening procedures including criminal background checks, workers compensation history review, driver's license verification, and pre-employment physicals. Three verifiable references for similar asphalt and concrete work performed in Florida are required, along with management and personnel information, resumes for assigned superintendents and foremen, and disclosure of any planned subcontractor use. All required compliance forms including Exceptions Form, Addendums Acknowledgement, Public Entity Crimes Form, Disputes Disclosure Form, Form W-9, and proof of insurance must be enclosed.

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General Background

RFP PR9220 - Asphalt and Concrete Services
Attachment D - Qualifications Fill In Form
Supplier Response
1Company Background Data
1.1Name of Firm
1.2Name of Parent Company
1.3Complete Business Address
1.4State of Incorporation
1.5Number of years in business
2Company Primary Contact Information:
2.1Name
2.2Email Address
2.3Office Phone Number
2.4Mobile Phone Number
2.5Telefax Number
3Licenses
3.1Potential Bidders shall be properly licensed by the City, County, State of Florida and /or Federal government to perform the type of services requested. Provide a copy of all applicable licenses including but not limited to occupational Licenses and General Contractor’s License.(State of Florida, Division of Professional Regulation, Constuction Industries Licensing Board and licenses by other federal, state, regional, county or minicipal agencies)
3.2Describe your firms familiarity with FDOT Standard Specifications.
3.3Describe your firms familiarity with MUTCD.
3.4Describe your firms familiarity with City/County permitting and code requirements.
4Insurance
4.1Potential Bidders shall be properly insured in accordance with the Minimum specified OUC insurance requirements. Provide a sample copy of your firms insurance certificates.
4.2General Liability $2 Million
4.3Auto Liability $1 Million including MCS-90 Endorsement Coverage
4.4Worker Comp (Statutory)
4.5Polution Liability Coverage $ 2 Million
4.5Does Policy allow for additioinal insured for GL and waiver of subrogation for Buying firm?
5Company Financial
5.1Dunn and Bradstreet Number
5.2Firms annual dollar volume for the last four years specific to the division of the firm to provide the services requested.2025
2024
2023
2022
6Company Health and Safety Programs and RecordIf your firm utilizes third party carrier services please include the infomration for items 9.1 to 9.5 for both your firm and your third party carrier(s).
6.1Provided a copy of your firm’s Health & Safety Manual on CD. (YES OR NO)
6.1aFirms Workman's Comp Exp Mod rating last 3 yrs.2025:
2024:
2023:
6.1bOSHA Incidence Rate for the last 3 years2025:
2024:
2023:
6.1cOSHA Frequency Rate for the last 3 years2025:
2024:
2023:
6.1dOSHA Severity Rate for the last 3 years2025:
2024:
2023:
6.2Has you firm had any incidents resulting in loss of life within the past 5 years related to the production, supply or delivery for any of the products being proposed.
6.2aIf response to 8.2 is yes please provide explanation
6.3Does your firm have a comprehensive employee and vehicle safety program that includes hazardous material response training, ongoing driver safety training, formal incident investigation with root cause analysis, and equipment and vehicle inspection?
6.3aIf Yes to 8.3 please provide a summary of these programs or otherwise specify the specific sections of your firms Health and Safety Manual this is covered by.
6.4Does your company have a program to ensure that all federal, state and local regulations are followed in the handling, storage and disposal of hazardous material?
6.4aIf yes to Item 9.4, please provide brief outline of program
6.5Has your company ever been issued a warning or violation by a regulatory agency for non-compliance with federal or state regulations?
6.5aIf yes to Item 8.5, please describe and include date of violation or warning.
6.6Does your company have a Drug Free Work Place policy?
6.6aIf yes, please provide an outline of your Drug Free Work Place policy Table of Contents.
7Please indicate below if your firm conducts the following screening and testing.If your firm utilizes third party carrier services please include the information for items 10.1 to 10.4 for both your firm and your third party carrier(s).
7.1Pre-Employment Criminal Background Checks? (YES or NO)
7.2Workers Compensation History Review? (YES or NO)
7.3Driver License Verification (YES or NO)
7.4Pre-employment Physical Exam (YES or NO)
7.5Provide outline of your firms emergency response programs and capabilities in support of your customers.
7.6Provide any additional information you feel will assist OUC in determining your firm’s qualifications. You may include any related services your company could provide.
8Qualifications
8.1Provide a narrative describing your firm’s capabilities in regards to the scope of work/services being requested in the RFP for Asphalt and Concrete Sercices. Include the overall approach and specific methodology to provide the specified services.
8.2Number of Years your firm has been in buisness supplying Asphalt and Concrete Sercices work in Florida.
8.3List the number of projects (with similar scope and size) that the bidding organization has completed and are in progress.
9REFERENCESProvide three (3) verifiable references for Asphalt and Concrete Sercices. under this RFP. All references are requested to be for work performed in State of Florda by your firm for Asphalt and Concrete Sercices.
Ref # 1
Name of company or organization the service was provided for.
Name of facility and its location
Description of Product/Service provided
Cost Method used and Dollar Value
Crew Size and Make up
Types of Equipment Used
Dates of contract term
Contact: Name, phone number, and e-mail address. Contact must be someone familiar with the details of the actual performance of the contract who can comment on the contractor’s performance from an operations and maintenance perspective.
List the scope of services provided in detail
Describe any unusual operating conditions, requirements, or circumstances that may serve to distinguish your firm’s qualifications.
Ref # 2
Name of company or organization the service was provided for.
Name of facility and its location
Description of Product/Service provided
Cost Method used and Dollar Value
Crew Size and Make up
Types of Equipment Used
Dates of contract term
Contact: Name, phone number, and e-mail address. Contact must be someone familiar with the details of the actual performance of the contract who can comment on the contractor’s performance from an operations and maintenance perspective.
List the scope of services provided in detail
Describe any unusual operating conditions, requirements, or circumstances that may serve to distinguish your firm’s qualifications.
Ref # 3
Name of company or organization the service was provided for.
Name of facility and its location
Description of Product/Service provided
Cost Method used and Dollar Value
Crew Size and Make up
Types of Equipment Used
Dates of contract term
Contact: Name, phone number, and e-mail address. Contact must be someone familiar with the details of the actual performance of the contract who can comment on the contractor’s performance from an operations and maintenance perspective.
List the scope of services provided in detail
Describe any unusual operating conditions, requirements, or circumstances that may serve to distinguish your firm’s qualifications.
10Management, Personnel, Facilties, Resources, and Other
Location of the local service office with in OUC's service territory.
Locatons of any other facilties that may be utilized in support of a contract resulting from this RFP.
Provide a brief description of current technical and management capabilities and availability to perform the work.
For staff who would be assigned to the contract, provide the following:
List names phone and email for the following within your firm responsible for the Asphalt and Concrete Services.President:
Vice President
Outside Sales/Account Manager:
Provide Resumes for Superintendents and Foreman that would be assigned to peform work under a resulting contract.
Provide outline of your firms emergency response programs and capabilities in support of your customers for the specified services.
Describe any training and or other value added support services your firm provides/offers to its customers pertainig to the specified services
Does your firm plan on using subcontractors for any part of the scope of this solicitation? (Yes or No)
11Required/Compliance Forms
1Exceptions Form Enclosed (YES or NO) & Exceptions Taken (YES or NO)
2ADDENDUMS Acknowledgement Form Enclosed (YES or NO)
3PUBLIC ENTITY CRIMES FORM Enclosed (YES or NO)
3.1Entity Crimes Noted (YES or NO)
4Disputes Disclosure Form Enclosed (YES or NO)
4.1Disputes Noted (YES or NO)
5Form W-9 Enclosed (YES or NO)
6Copy of Insurance Certificate Enclosed (YES or NO)

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