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.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| RFP_PR9220__Addendum_No_2_Final.pdf | ||
| RFP_PR9220_Attachment_B__Asphalt_and_Concrete_Services_Rev_1.xlsx | XLSX spreadsheet | |
| RFP_PR9220__Addendum_No_1_Final.pdf | ||
| RFP_PR9220__Asphalt_and_Concrete_Services_Final_81826.pdf | ||
| RFP_PR9220_Attachment_B__Asphalt_and_Concrete_Services_Final.xlsx | XLSX spreadsheet |
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Text version
General Background
| RFP PR9220 - Asphalt and Concrete Services | ||
| Attachment D - Qualifications Fill In Form | ||
| Supplier Response | ||
| 1 | Company Background Data | |
| 1.1 | Name of Firm | |
| 1.2 | Name of Parent Company | |
| 1.3 | Complete Business Address | |
| 1.4 | State of Incorporation | |
| 1.5 | Number of years in business | |
| 2 | Company Primary Contact Information: | |
| 2.1 | Name | |
| 2.2 | Email Address | |
| 2.3 | Office Phone Number | |
| 2.4 | Mobile Phone Number | |
| 2.5 | Telefax Number | |
| 3 | Licenses | |
| 3.1 | Potential 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) | |
| 3.2 | Describe your firms familiarity with FDOT Standard Specifications. | |
| 3.3 | Describe your firms familiarity with MUTCD. | |
| 3.4 | Describe your firms familiarity with City/County permitting and code requirements. | |
| 4 | Insurance | |
| 4.1 | Potential Bidders shall be properly insured in accordance with the Minimum specified OUC insurance requirements. Provide a sample copy of your firms insurance certificates. | |
| 4.2 | General Liability $2 Million | |
| 4.3 | Auto Liability $1 Million including MCS-90 Endorsement Coverage | |
| 4.4 | Worker Comp (Statutory) | |
| 4.5 | Polution Liability Coverage $ 2 Million | |
| 4.5 | Does Policy allow for additioinal insured for GL and waiver of subrogation for Buying firm? | |
| 5 | Company Financial | |
| 5.1 | Dunn and Bradstreet Number | |
| 5.2 | Firms annual dollar volume for the last four years specific to the division of the firm to provide the services requested. | 2025 |
| 2024 | ||
| 2023 | ||
| 2022 | ||
| 6 | Company Health and Safety Programs and Record | If 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). |
| 6.1 | Provided a copy of your firm’s Health & Safety Manual on CD. (YES OR NO) | |
| 6.1a | Firms Workman's Comp Exp Mod rating last 3 yrs. | 2025: |
| 2024: | ||
| 2023: | ||
| 6.1b | OSHA Incidence Rate for the last 3 years | 2025: |
| 2024: | ||
| 2023: | ||
| 6.1c | OSHA Frequency Rate for the last 3 years | 2025: |
| 2024: | ||
| 2023: | ||
| 6.1d | OSHA Severity Rate for the last 3 years | 2025: |
| 2024: | ||
| 2023: | ||
| 6.2 | Has 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. | |
| 6.2a | If response to 8.2 is yes please provide explanation | |
| 6.3 | Does 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? | |
| 6.3a | If 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. | |
| 6.4 | Does 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? | |
| 6.4a | If yes to Item 9.4, please provide brief outline of program | |
| 6.5 | Has your company ever been issued a warning or violation by a regulatory agency for non-compliance with federal or state regulations? | |
| 6.5a | If yes to Item 8.5, please describe and include date of violation or warning. | |
| 6.6 | Does your company have a Drug Free Work Place policy? | |
| 6.6a | If yes, please provide an outline of your Drug Free Work Place policy Table of Contents. | |
| 7 | Please 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). |
| 7.1 | Pre-Employment Criminal Background Checks? (YES or NO) | |
| 7.2 | Workers Compensation History Review? (YES or NO) | |
| 7.3 | Driver License Verification (YES or NO) | |
| 7.4 | Pre-employment Physical Exam (YES or NO) | |
| 7.5 | Provide outline of your firms emergency response programs and capabilities in support of your customers. | |
| 7.6 | Provide any additional information you feel will assist OUC in determining your firm’s qualifications. You may include any related services your company could provide. | |
| 8 | Qualifications | |
| 8.1 | Provide 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. | |
| 8.2 | Number of Years your firm has been in buisness supplying Asphalt and Concrete Sercices work in Florida. | |
| 8.3 | List the number of projects (with similar scope and size) that the bidding organization has completed and are in progress. | |
| 9 | REFERENCES | Provide 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. | ||
| 10 | Management, 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) | ||
| 11 | Required/Compliance Forms | |
| 1 | Exceptions Form Enclosed (YES or NO) & Exceptions Taken (YES or NO) | |
| 2 | ADDENDUMS Acknowledgement Form Enclosed (YES or NO) | |
| 3 | PUBLIC ENTITY CRIMES FORM Enclosed (YES or NO) | |
| 3.1 | Entity Crimes Noted (YES or NO) | |
| 4 | Disputes Disclosure Form Enclosed (YES or NO) | |
| 4.1 | Disputes Noted (YES or NO) | |
| 5 | Form W-9 Enclosed (YES or NO) | |
| 6 | Copy of Insurance Certificate Enclosed (YES or NO) |
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