VENDOR PREQUALIFICATION FORM

Transcription

1 VENDOR PREQUALIFICATION FORM Date: Please complete this form and return to Rockford Construction via or fax ( must include the 1-616). ALL AREAS OF THIS FORM MUST BE FILLED IN. IF NEEDED, WRITE NOT APPLICABLE Name of Organization: Address: City: State: Zip: Fax: Website: Type of Company: Corporation Partnership Sole Prop. LLC Check all that apply: Architect Engineer Subcontractor Supplier Other: List ALL states where you are able to perform work: Select areas that you are able to work in Michigan: West East Southeast North Trades That You Self-Perform (See attached CSI Code Breakdown): *If you perform sitework or paving, please attach a list of equipment you own or have access to. Firm certified as: MBE WBE OTHER NONE (attach a copy of all applicable certificates) Workforce: Union Merit Number of years in business under present name: Has your firm gone through an ownership change in the last 12 months? No Yes *If yes, please explain: Federal Employer ID#: Total number of office staff: Total number of field staff: Percentage of self-performed work: % List any Affiliated or Related Businesses & their relationship to Company listed above: COMPANY CONTACTS: Estimating Contact: Mobile address for bid invitations ( same as above): Accounting Contact: General Information Contact:

2 SAFETY INFORMATION: Provide Workers Compensation Experience Modification Rate (EMR) for the last (3) years: Current: Last Year: Two Years Prior: **If EMR is greater than 1.0, please include the following attachments: OSHA Logs for Last Three Years; Letter from Insurance Carrier Explaining Elevation; Copy of Organization s Safety Plan FINANCIAL INFORMATION: As a part of this submission, we require a recent balance sheet showing your current assets, current liabilities and equity to calculate your aggregate contractual threshold limit. All subcontractor prequalification questionnaires and balance sheets are held in strict confidence and are only reviewed by our VP of Finance Brian Wierenga. We will be happy to sign a confidentiality statement if requested. Dun & Bradstreet (D&B) Number: Historical Financial information last three (3) years: Year Ending Revenue Ending Backlog Current Year Projections: Revenue ($) Current Backlog ($) Current Number of Projects in Progress Average Contract Size Largest Contract in Past 36 Months Number of LEED Projects Completed Primary Financial Institution: Contact Person: Phone #: Bank Line of Credit: Unused Portion: Financial/Litigation: (Select all that apply to your company and submit details for each on a separate sheet) failed to complete a contract been involved in bankruptcy/reorganization pending judgments claims or suits against them SURETY AND BONDING: Surety Company (indicate if none): Surety Broker/Agent Name: Phone Number: Total Bonding Capacity: $ Bonding Capacity per Job: $ Value of Work Currently Bonded: $ **If bonding is not available, please explain: INSURANCE INFORMATION: *See attached Rockford Construction s Subcontractor Insurance requirements Does your Company s existing insurance policy meet the attached requirements? Yes No *if no, please explain: **Please provide a sample of your insurance certification as an attachment to this form

3 PROJECT EXPERIENCE: List three (3) projects completed in last five years. Include three (3) projects per trade that you self-perform (if multiple trades performed on one project, please separate the value for each different trade performed (i.e. Concrete $150,000; General Trades $200,000) TRADE REFERENCES: Project Trade Performed GC/CM Phone Number Contract Amount Year SUPPLIER REFERENCES: Project Trade Performed Supplier Name Phone Number Contract Amount Year ADDITIONAL INFORMATION: Please feel free to include any other information that you feel would be of interest to us. If you have regional offices in other locations besides the address listed on page one, please enter information below (attached additional sheets if necessary): Check here if none: REGIONAL OFFICE(s): Contact Person and Address: City: State: Zip: Fax: This form must be signed by an officer of your company or an individual authorized by the company: Signature: Name: Date: Title:

4 CSI CODE SPECIALTIES IDENTIFICATION 01 - GENERAL REQUIREMENTS 07 - THERMAL MOISTURE PROTECTION 10 - SPECIALTIES (continued) 26 - ELECTRICAL o Testing & Inspecting Services o Waterproofing o Wall & Corner Guards o Electrical Contractor o Temp Heat & Ventilation o Traffic Coatings o Toilet Accessories o Emergency Generator o Crane Service o Building Insulation o Manufactured Fireplaces o Lightning Protection o Tower Cranes & Skips o Spray Applied Insulation o Fire Extinguishers o Traffic Barricades o EIFS o Lockers 27 - COMMUNICATIONS o Surveying o Shingles o Postal Specialties o Technology Contractor o Final Cleaning o Shingle Roofing Supply o Storage Shelves o Communication/Data Equipment o Metal Wall Panels o Exterior Sun Control Devices o Sound Masking Equipment 28 - ELECTRONIC SAFETY & SECURITY 02 - EXISTING CONDITIONS o Siding o Awnings & Canopies o Haz-Mat Surveys & Analysis o Membrane Roofing o Flagpoles o Subsurface Investigation o Built Up Bituminous Roofing o Electronic Security Subcontractor o Selective Site Demolition o Sheet Metal Roofing 11 - EQUIPMENT o Selective Building Demolition o Applied Fireproofing o Vehicle Service Equipment 31 - EARTHWORK o Structure Raising (Total Demolition) o Fire Stopping o Parking Control Equipment o Earthwork o Hazardous Waste Removal o Joint Sealers o Loading Dock Equipment o Dewatering o Underground Tank Removal o Expansion Joint Covers o Teller and Service Equipment o Erosion Control o Haz-Mat & Asbestos Remediation o Prison Equipment o Soil Stabilization o Mold Remediation 08 - OPENINGS o Commercial Laundry Equipment o Shoring & Underpinning o Metal Door/Frame/Hardware o Darkroom Equipment o Helical Anchors 03 - CONCRETE o Install Doors & Hardware o Residential Appliances o Driven Piles o Ready Mix Supplier o Wood Doors o Food Service Equipment o Bored Piles o Concrete (Floor) Resurfacing o Access Doors o Library Equipment o Caissons o Concrete Rehabilitation o Coiling Doors & Grilles o Audio-visual Equipment o Concrete Formwork Subcontractor o Overhead Doors o Laboratory Equipment 32 - EXTERIOR IMPROVEMENTS o Concrete Formwork Suppliers o Elevator Smoke Doors o Paint Booths o Asphalt Paving o Concrete Accessories o Hanger Doors o Theater & Stage Equipment o Concrete Pavement o Rebar Supplier o Detention Doors & Frames o Athletic Equipment o Unit Pavers o Rebar Installer o Traffic Doors o Play Field Equip & Structures o Pavement Striping o Post-Tension Tendons o Entrances & Storefronts o Athletic & Recreational Surfaces o Concrete Subcontractor o Automatic Entrances 12 - FURNISHINGS o Fences & Gates o Architectural Concrete o Glazed Curtain Walls o Window Treatments o Highway Guardrails o Concrete Finishing Subcontractor o Translucent Wall & Roof Panels o Manufactured Casework o Modular Retaining Walls o Stamped/Stained Concrete Finish o Manufactured Aluminum Windows o Laboratory Casework o Irrigation System o Shot/Sandblast Concrete Finish o Wood Windows o Entrance Floor Mats & Frames o Planting o Concrete Floor Polishing o Glazing o Multiple Seating o Concrete Pumping o Telescoping Stands 33 - UTILITIES o Precast Structural Concrete 09 - FINISHES o Site Furnishings o Utility Subcontractors o Precast Wall Panels o Drywall o Architectural Precast o Plaster & Stucco 13 - SPECIAL CONSTRUCTION 34 - TRANSPORTATION o Tilt-Up Site Cast Panels o Tile o Swimming Pools o Railroad Work o Cementitious Underlayment o Acoustical Ceilings o Ice Rinks o Concrete Sawing o Wood Flooring o Pre-Engineered Metal Buildings PROCESS EQUIPMENT SUBGROUP o Resilient Flooring (Vinyl) o 4XXXX-X Process Equipment o Terrazzo 14 - CONVEYING EQUIPMENT o 04 - MASONRY o Masonry Subcontractor o Fluid Applied Flooring o Elevators o o Masonry Restoration o Carpet o Wheelchair Lifts o o Masonry Suppliers o Access Flooring o Vehicle Lifts o Cut Stone o Wall Covering o Scaffolding o Fabricated Stone Panels o Acoustical Wall Treatment o Trash Chutes o o Cast Stone o Paint & Coatings o Pneumatic Bulk Handling Systems o o Simulated Stone o Access Flooring o o Wall Covering' 21 - FIRE SUPPRESSION o 05 - METALS o Acoustical Wall Treatment o Fire Sprinkler Subcontractor o o Structural Steel Supplier o Paint and Coatings o o Steel Erectors 22 - PLUMBING o Metal Fabrications 10 - SPECIALTIES o Plumbing & Piping o Visual Display Boards o Mechanical Contractor 06 - WOODS, PLASTICS & COMPOSITES o Display Cases o Duct & Pipe Insulation o Lumber Suppliers o Identification Devices o WTP/WWTP Process Piping Sub o Rough Carpentry Subcontractor o Panel Signage o Process Piping Fabricator o Wood Trusses o Traffic Signs and Signals o Glued-Laminated Construction o Toilet Compartments 23 - HVAC o Finish Carp & Cabinet Installation o Wire Mesh Partitions o HVAC Subcontractor o Architectural Woodwork o Demountable Partitions o Testing Adjusting & Balancing o FRP Fabrications - General o Operable Partitions o Controls & Instrumentation OTHER

5 Subcontractor Insurance Limits/Coverages/Requirements: To bid on Rockford Construction projects, the following are the standard required insurance limits and coverages. Owners may have additional requirements that are job specific. Failure of the Subcontractor to carry or secure the insurance coverages as specified herein may cause Subcontractor to be ineligible to bid on project. Minimum Required Insurance Limits (Coverage on an Occurrence Basis): 1. Commercial General Liability (CGL) with limits of insurance of not less than $1,000,000 each occurrence and $3,000,000 Annual Aggregate. a. CGL coverage shall be provided on an ISO Occurrence form CG or its equivalent, and include a per project aggregate, using ISO form CG , or its equivalent. b. Subcontractor shall maintain CGL coverage for itself and all additional insureds for the duration of the project and until paid in full and maintain Completed Operations coverage for itself and each additional insured for at least three years after completion of the Work. 2. Business Auto Policy a. Business Auto Policy with limits of at least $1,000,000 each accident. b. Business Auto coverage must include coverage for liability arising out of all owned, leased, hired and non-owned automobiles. 3. Commercial Umbrella a. Umbrella limits must be at least $2,000,000. b. Umbrella coverage must include as insureds all entities that are additional insured on the CGL. c. Umbrella coverage for such additional insureds shall apply as primary before any other insurance or selfinsurance, including any deductible, maintained by, or provided to, the additional insured other than the CGL, Business Auto Policy and Employers Liability coverages maintained by the Subcontractor. 4. Workers Compensation and Employers Liability a. Employers Liability Insurance limits of at least $500,000 each accident for bodily injury by accident, $500,000 each employee for injury by disease, and $500,000 aggregate limit. b. Where applicable, U.S. Longshore and Harborworkers Compensation Act Endorsement shall be attached to the policy. c. Where applicable, The Maritime Coverage Endorsement shall be attached to the policy. Waiver of Subrogation: Subcontractor waivers all rights against Contractor, Owner, and Architect and their agents, officers, directors, and employees for recovery of damages to the extent these damages are covered by commercial general liability, commercial umbrella liability, business auto liability or workers compensation and employer s liability insurances maintained per requirements stated above. Subcontractor shall have current Certificates of Insurance on file with Rockford Construction before a contract can be issued and any Work is to be performed. Insurance required is: Worker's Compensation, Auto, Umbrella and General Liability, naming Rockford Construction Co. and its subsidiaries as an additional insured with respect to the General Liability coverage. Subcontractor insurance shall be primary and non-contributory with a 30-day notice of cancellation, completed operations coverage for itself and each additional insured for at least three (3) years after completion of work and a waiver of subrogation favoring Rockford. Subcontractor shall provide Rockford with Certificates of Insurance reflecting the requirements described herein.

6 Subcontractor's obligation to endorse the above-described insurance policies to name Rockford as an additional insured shall also extend to any person or entity that Rockford agreed to make additional insured(s) on Rockford's insurance policies in Rockford's contract with the project owner. Subcontractor shall provide Rockford with a copy of each such endorsement. Subcontractor's failure to comply with this provision would be deemed a breach of contract. Insurance must be kept current until final payment is made, no funds will be released to Subcontractor without a valid certificate of insurance. Subcontractor shall keep in force without interruption during the course of contract, policies of insurance covering subcontractor for Worker's Compensation, Commercial General Liability insurance and a Business Auto Policy (including hired and non-owned automobile liability) with minimum limits set forth with an insurer or insurers either licensed/admitted/authorized or eligible by the state's insurance regulatory authority to operate in the state where the work is to be performed and except for worker's compensation and the business auto policy, subcontractors shall cause such policies to be endorsed to name Rockford as Additional Insured on such policies with respect to the project identified herein.