FOCUS DESIGN BUILDERS CONTRACTOR S QUALIFICATION STATEMENT

Transcription

1 FOCUS DESIGN BUILDERS CONTRACTOR S QUALIFICATION STATEMENT PROJECT (if applicable): Date: / / Up to what size single project do you want to be prequalified for? FIRM NAME: Address: City: State: Zip: Phone: ( ) Fax: ( ) Primary Business Contact: Telephone: Fax: Person to receive bid invitations: Title: Telephone: Fax: Trade Licenses: (if Applicable) Please include all states in which the company is licensed in: MANAGEMENT AND KEY EMPLOYEES: Name Title % Ownership Position/Duties Years Exp in This Business Are owners personally active in business? How many years in business under present ownership? STAFF: Total number of permanent staff presently employed by firm: The above-referenced permanent staff employment includes the following # of people: Management # Superintendents # Engineers/Arch. # Foremen # Draftsmen # Skilled Craftsmen # Project Managers # Unskilled Labor # Project Engineers # Other # Estimators # Other # PROJECT PERSONNEL: (if applicable): Submit names, project experience and business references of personnel who will be directly responsible for this project s delivery: a. Corporate responsibility with project names and references. b. Field responsibility with project names and references. (may submit alternate names for a. & b.) Page 1 of 6

2 PROJECT SIZE PREFERENCE: List the minimum job value in which you prefer to bid/perform work List the maximum job value in which you prefer to bid/preform work List the name of the largest project you have ever completed, the Contractor you worked for, its value and the year it was completed AREAS THAT YOUR FIRM PURSUES WORK List geographic area that firm pursues work TYPE OF WORK: (list types of work firm is interested in): 1. General Construction 2. HVAC 3. Electrical 4. Plumbing 5. Other (Specify) EXPERIENCE ATTACH a listing of the major construction projects your organization has in progress. Include the; Name of the Project, Owner, Architect, Gross Contract Amount, % Complete and Scheduled Completion Date. ATTACH a listing of the major construction projects your organization has completed over the past five years. Include the Name of the Project, Owner, Architect, Gross Contract Amount, and Completion Date. Largest Contract Completed: Amount: Year: Project Name: Scope: Largest Job Your Company Expects to do during this Year: Amount: Year: Project Name: Scope: The Expected Annual Volume This Year: Amount: Number of Projects: Percentage of Work Normally Subcontracted: % On which projects size are you most competitive? Under $100,000 $3,000,000 - $6,000,000 $100,000 - $200,000 $6,000,000 - $9,000,000 $200,000 - $500,000 $10,000,000 - $15,000,000 $500,000 - $1,000,000 Over $15,000,000 $1,000,000 - $3,000,000 All Building Types on which your company has worked: Commercial Industrial Building Hotels/Motels High Tech/Laboratories Healthcare Correctional Facilities Page 2 of 6

3 Residential Design/Build Design Assist Sports/Entertainment Interior Fit-out LIST THREE TRADE REFERENCES (or attach a list of trade references with this response) Reference 1: Company: Contact: Phone: ( ) Reference 2: Company: Contact: Phone: ( ) Reference 3: Company: Contact: Phone: ( ) LIST THREE OWNERS, GENERAL CONTRACTORS, OR CONSTRUCTION MANAGERS YOU HAVE WORKED FOR WITHIN THE PAST TWO YEARS: Reference 1: Company: Contact: Phone: ( ) Project: Reference 2: Company: Contact: Phone: ( ) Project: Reference 3: Company: Contact: Phone: ( ) Project: LIST THREE OF YOUR MAJOR SUPPLIERS: Supplier 1: Company: Address: Types of Supplies: Contact: Phone: ( ) Supplier 2: Company: Address: Types of Supplies: Contact: Phone: ( ) Supplier 3: Company: Address: Contact: Phone: ( ) Page 3 of 6

4 MINORITY CLASSIFICATION List all classifications that apply to your organization. ATTACH documentation from any local, state or federal agency that certifies your firm as such. African American Owned Business Hispanic Owned Business American Indian Owned Business Woman Owned Business Asian American Owned Business Small Disadvantaged Business (SDB) None of These Apply BONDING: Can your company supply a payment and performance bond if needed? ** If yes, list your surety company s full and proper name: Present Bonding Capacity Aggregate: $ Bonding Capacity Per Project Limit: $ INSURANCE: Insurance Company: Agent Company: Agent Contact: Phone: ( ) *Attach sample certificate of insurance evidencing all lines of insurance currently in place. SAFETY: YEAR Workers Compensation Experience Modification Rate for last three years. NOTE: If EMR Average for last three years is over 1.0, you must submit an OSHA 200 log for each year with this response. Have you had any OSHA fines within the last three years? Have you had any jobsite fatalities within the last three years? YES NO YES NO If you have answered YES to either of the above two questions, you MUST submit on separate sheet the details describing the circumstances surrounding each incident. FIELD PERSONNEL CERTIFICATIONS: (Please include all project personnel certifications ie: OSHA 10 or 30, fork lift, first aid, CPR and AED, trade certifications or license, etc: GENERAL: Years in business under present name (minimum of three years required): Years performing work specialty (minimum of five years required): Current Cost to Complete Backlog: $ Annual Revenue Last Year: $ Average Annual Revenue Over Last Three Years: $ Page 4 of 6

5 What trades of work do you usually perform with your own forces: % of work performed by own forces: % BANK REFERENCES, CREDIT REFERENCES: Bank Name: Contact: Phone: ( ) Line of Credit Amount: Expiration: Amount of Line Currently Available: Has firm: - Failed to complete a contract YES NO - Been involved in bankruptcy or reorganization YES NO - Pending judgment claims or suits against firm YES NO (If answer to above is yes, submit details on separate sheet.) FINANCING Financial Statement Attach a financial statement, preferably audited, including your organization s latest balance sheet and income statement showing the following items: Current Assets (e.g., cash, joint venture accounts, accounts receivables, notes receivable, accrued income, deposits, materials inventory and prepaid expenses); Net Fixed Assets; Other Assets; Current Liabilities (e.g., accounts payable, notes payable, accrued expenses, provision for income taxes, advances, accrued salaries and accrued payroll taxes); Other Liabilities (e.g., capital, capital stock, authorized and outstanding shares par values, earned surplus and retained earnings). Name and address of firm preparing attached financial statement, and date thereof: Is the attached financial statement for the identical organization named on page one? Yes No If not, explain the relationship and financial responsibility of the organization whose financial statement is provided (e.g., parent-subsidiary). Will the organization whose financial statement is attached act as guarantor of the contract for construction? Yes No LEGAL INFORMATION Has your Company or any of its principals ever petitioned for bankruptcy, failed in business, defaulted or been terminated on a contract awarded to you? Page 5 of 6

6 Yes No (If yes, please attach statement) Has any of the Owners, officers or major stockholders of your Company ever been indicated or convicted of any felony or other criminal conduct? Has your Company ever been disbarred or otherwise precluded from pursuing public work or ever been found to be non-responsive by a public agency? Has your Company ever had a claim made against it for improper, delayed, defective or non-compliant work or failure to meet warranty obligations? Is your Company or any of its owners, officers or major shareholders currently involved in any arbitration or litigation? Does your Company have any outstanding judgments or claims against it? Please list any litigation brought against your Company in the past five (5) years asserting that you failed to make payments to anyone: I hereby certify that the above information is true and complete to the best of my knowledge. Signature: Name: Title: Date: (Officer of the Firm) Type of Firm Corporation Partnership LLC Sole Proprietor Page 6 of 6