Contractor s Statement of Qualifications for (Insert Project Name) (Insert Owners Name Here) (Insert Owners City and State Here) This form must be returned to (Insert Architect s Name and Address here) by PM,, 2013. The form must be in a sealed envelope addressed to (Insert Owners Name and Address Here). Unless otherwise requested, do not send promotional literature, brochures, etc. PROJECT DESCRIPTION: 1. General Information 1.1 Name of Firm: : Mailing Address: (If different from street address) Area Code & Phone No.: ( ) Facsimile No.: ( ) Persons to : 1.2 a. Date your firm was organized or started: b. Legal Form of Business Corporation: Individual: Partnership: Joint Venture: Other: c. If a Corporation: State of Incorporation: Date of Incorporation: Federal I.D. #: 1.3 a. Subsidiary of another company? Yes No b. Parent Company Name c. Sister Company in Related Business? Yes No d. Sister Company Name
1.4 a. In what states are you licensed to do business? b. Alabama Contractor s License Number : 1.5 Names of officers, owners, partners, and principals. Identify relationship of each to firm and if active in firm: 1.6 Other than persons listed above, number of full-time office employees: 1.7 Number of full-time, permanent field employees: 1.8 If yes to any of the following questions, please attach a brief explanation and include the names, addresses, and phone numbers of persons who might be contacted for additional information. a. Are there any claims, judgments, arbitration proceedings or suits pending against your organization? Yes No b. Within the last five years, has your organization filed any law suits or requested arbitration related to construction contracts? Yes No c. Within the last five years, has your organization ever failed to complete any work awarded to it? Yes No d. Has your organization ever been adjudged a bankrupt or filed a petition in bankruptcy? Yes No e. Within the last five years, has your organization been assessed liquidated damages for failure to complete a project by the contracted date? Yes No f. Has your organization, in the last three years, received a final order for willful and/or repeated violation(s) issued by the United States Occupational Safety and Health Administration (OSHA) or by the Alabama Department of Labor or any other government agency? Yes No g. Have any Performance or Payment Bond claims ever been paid by any surety on behalf of your organization? Yes No 2. Contractor s Experience 2.1 a. Number of years of doing similar work for which you are pre-qualifying: b. Number of projects that your organization has completed that are similar to work for which you are pre-qualifying:
2.2 Attach a list of major and/or similar projects completed within the last five years. Include cost of construction and date completed. 2.3 Attach a list of major projects in progress. Include cost of construction and anticipated completion date. 2.4 On a separate page, briefly describe your approach to project scheduling, monitoring, and control to ensure timely completion. Include how your firm will keep the owner abreast of any concerns related to the schedule (1 page or less). 2.5 a. What percent of the contract amount do you typically perform with your own forces? b. Identify work normally performed with your own forces on projects similar to the one for which your firm is pre-qualifying. 2.6 a. Does your firm have a written quality control program? Yes No b. Is a copy available upon request? Yes No 3. Contractor s Financial Status 3.1 Enclose your latest audited financial statement or a current letter of reference from your bank or primary lending institution indicating good financial standing. 3.2 a. Who is your bonding company? b. Who is your bonding agent? c. Has your bonding company changed in the last three (3) years? If so, why? d. Indicate your surety s A.M. Best rating: e. Does your surety have a license to do business in the State of Alabama? 3.3 a. What is the total bonding capacity of your firm? b. What is your current bond amount in use? c. What is the individual job bonding capacity of your firm? d. What is the maximum you have bonded on any single project? e. What is your average annual volume for the past five years? f. What is your organization s current backlog (total value of work in progress and work under current)? 3.4 What is your policy on bonding subcontractors?
4. Employee Qualifications 4.1 On a separate page, provide an organizational chart of project personnel for a project similar to the one for which you are pre-qualifying (1 page or less). 4.2 Include resumes of your key personnel who may staff this project. Provide at least three (3) project-related references for each proposed team member. Include a resume for the project field superintendent. 5. Safety 5.1 a. Indicate your Experience Modification Rate (EMR) for the past three years. b. EMR Anniversary Date: 5.2 a. Does your firm have a written safety program? Yes No b. Is a copy available upon request? Yes No 6. References 6.1 Does the Owner have concurrence of the Contractor to contact any and all references included? Yes No 6.2 OWNER / CLIENT (3 each) Owner / Client #1: Owner / Client #2:
Owner / Client #3: 6.6 LEGAL COUNSEL The undersigned certifies under oath that the information provided herein is true and sufficiently complete so as not to be misleading. Signature: Witness: Date: