City of St. Petersburg Contractor Pre-Qualification Questionnaire Procurement & Supply Management
Project: Three Welcome Signs for the Skyway Marina District
1. Instructions
a. All questions are to be answered in full, without exception. If copies of other documents will answer the question completely, they may be attached and clearly labeled. If additional space is needed, additional pages may be attached and clearly labeled. b. The City of St. Petersburg shall be entitled to contact each and every reference listed in response to this questionnaire, and each entity referenced in any response to any question in this questionnaire. The Contractor, by completing this questionnaire, expressly agrees that any information concerning the Contractor in possession of said entities and references may be made available to the City. c. The Contractor shall provide only complete and accurate information. The Contractor hereby warrants that, to the best of its knowledge and belief, the responses contained herein are true, accurate, and complete. The Contractor also acknowledges that the City is relying on the truth and accuracy of the responses contained herein. If it is later discovered that the Contractor provided any material information given in response to a question, knowing it was false, it shall constitute grounds for immediate disqualification, termination, or rescission by the City of any subsequent agreement between the City and the Contractor. d. The contractor’s response should be in the same sequence as the criteria listed below so that they can be easily identified and compared to other responses. e. The City of St. Petersburg may reject any offer that does not meet the following criteria. f. The City reserves the right to request additional information if required. g. If there are any questions concerning the completion of this form, contractors are encouraged to contact Don Enge, CPPB, Procurement Analyst at (727) 893-7030 or [email protected].
2. Company and Contact Person
Company Name Company Phone/Fax No.
D/B/A (if applicable) Contact Name/Title 1/ Email
Company Address 1 Contact Name/Title 2/ Email
Company Address 2 Federal Id No.
City/State/Zip Authorized Signature
Contractor License No.
3. Type of Organization
Please indicate business type below by placing a √ in the space provided.
Corporation Organization Date: Sole Proprietorship State of Incorporation: Partnership Other
4. General Background
a. Has your firm changed its name recently? If so, please provide previous name of the company and previous Federal ID No.?
Response:
b. Name of current President or Chief Executive Officer of your firm?
Response: Years in that position:
c. Number of full-time, permanent employees?
Response: Full-Time - Office - Field -
d. How many years has your organization been in business in Florida as a general/building contractor under your present name and license number?
Response:
e. If a Corporation answer the following: (1) Date of Incorporation: (2) State of Incorporation: (3) President’s name: (4) Vice-President’s name: (5) Secretary’s name: (6) Treasurer’s name:
f. If other than a Corporation or Partnership, describe organization and name principals?
Response:
j. Names and addresses of current affiliated companies (parent, subsidiary, divisions)?
Response:
2 5. Financial Status, Bonding
a. What is the Contractor’s current bonding capacity with a contract surety company for a single project? $ In the aggregate? $
b. Please identify the Contractor’s surety company and the current line of bonding credit that company has extended to Contractor?
Response:
c. Please provide the name, address, and telephone number of current surety agent or underwriting contact?
Response:
d. Have Performance or Payment Bond claims ever been made to a surety for this Contractor on any project, past or present? If the answer is yes, how many claims have been made?
Response:
e. If the answer to (d) is yes, please describe the claim, the name of the company or person making the claim, and the resolution of the claim?
Response:
f. During the last five years, has your firm ever been denied bond credit by a surety in place during a public construction project when one was required? (If answer is yes, specify the reasons given for that refusal, and the name and address of the surety company that refused to bond)?
Response:
g. In the past five (5) years, has any surety company refused to bond the Contractor’s parent, or subsidiaries, on any project? (If answer is yes, please specify the reasons given for that refusal, and the name, address and telephone number of the surety company)?
Response:
h. Is your firm capable of achieving the following criteria for bonds and insurance? “Best’s Insurance Guide” rating of “Excellent” (A, A-)
Response:
6. Proposed Project Personnel
a. Personnel Commitment
3 (1) By submitting these names for consideration, the Offeror is committing the key personnel listed below to the City for this project’s duration if awarded the project. No personnel changes will be permitted without written authorization from the City?
Response:
(2) Higher consideration will be given if the Project Executive, Project Manager, and Field Superintendent who have experience in similar projects?
Response: b. Proposed Project Executive
(1) List the name, qualifications, and background of your proposed Project Executive for this project. (Include the names and addresses of companies he/she has been affiliated with in the last five (5) years and provide resume)?
Response:
(2) List at least comparable projects, by size, type, and duration that the proposed Project Executive has supervised in the last five (5) years for the Contractor, or for any other company. Include contact names and phone numbers?
Response: c. Proposed Project Manager
(1) List the name, qualifications, and background of your proposed Project Manager for this project. (Include the names and addresses of companies he/she has been affiliated with in the last five (5) years and provide resume)?
Response:
(2) List comparable projects by size, type, and duration that the proposed Project Manager has supervised in the last five (5) years for the Contractor, or for any other company. Include contact names and phone numbers?
Response: d. Proposed Field Superintendent
(1) List the qualifications and background of your proposed Field Superintendent (if different than the project manager) and include the names and addresses of any companies he/she has been affiliated within
4 the last five (5) years and provide resume?
Response:
(2) List comparable projects by size, type, and duration that the proposed Field Superintendent has supervised in the last five years, for the Contractor, or for any other company?
Response:
7. Project Approach
a. Provide a brief, overall description of the approach your firm would take if awarded this project. This description of how this work will be done should include, but not be limited to, the following factors: proposed design, methods for fabrication and installation?
Response:
b. Utilize the provided illustrations to select one (1) aspect of this project which your team finds to be the most challenging and provide the following:
A description of this one (1) aspect and why your team finds it to be the most challenging, A description of how your firm would address this issue, and What your recommendations might be.
Response:
8. Company Experience, Similar Projects
a. List all projects of reasonably similar nature, scope and duration performed by your company in the last five years, giving the name of project, owner, architect, contract amount, date of completion, and percentage of the cost of work performed with your own forces?
Response:
b. Of the projects listed in “a” above, identify any that was the subject of claim or lawsuit by or against the Contractor. Identify in your response the nature of such claim or lawsuit, the court in which the case was filed, and the details of its resolution?
Response:
c. Identify what work Contractor typically performs with its own forces?
Response:
d. The following sub-contractors are generally used by Contractor to perform the following types of work: (provide contractor names)?
5 Response:
e. Equipment: List your major equipment that is available, including description, number of units, capacity and condition of equipment?
Response:
f. Has Contractor ever failed to complete work awarded to it? If so, identify the project, the name and telephone number of the owner and explain the circumstances under which this occurred?
Response:
g. In the past five (5) years has your firm, or any firm with which any of your company’s owners, officers or partners was associated, been debarred, disqualified, removed or otherwise prevented from bidding on, or completing, any government agency or public works project for any reason? If so, attach a separate sheet of explanation.
NOTE: “Associated with” refers to another construction firm in which an owner, partner or officer of your firm held a similar position.
Response:
h. In the past five (5) years, has your firm been denied an award of construction of a public building or a public works contract based on a finding by a public agency that your company was not a responsible bidder? If so, provide details.
NOTE: The following two questions refer only to disputes between your firm and the owner of a project. You need not include information about disputes between your firm and a supplier, another contractor, or subcontractor. You need not include information about “pass-through” disputes in which the actual dispute is between a subcontractor and a project owner.
Response:
i. In the past five (5) years, has any claim against your firm concerning your firm’s work on a construction project, been filed in court or arbitration? If yes, provide details.
Response:
j. List major construction projects your organization has in process, giving the name of project, owner, architect, contract amount, percent complete, and scheduled completion date.
Response:
9. Licenses and Insurance
6 Please enclose copies of Contractor’s Florida General/Building Contractor’s License, Certificate of Competency, Current Certificates of Insurance for general liability, builder’s risk, automobile liability, and worker’s compensation insurance and the name of your surety company.
10. Comments
Please list any additional information that you believe would assist the City in evaluating the possibility of using the Contractor on this Project.
Response:
7 FORM A
PROJECTS UNDER CONSTRUCTION (Duplicate this form for additional projects.)
Project #:
Name:
Location:
Contract Price:
Is project on budget? If not, please explain.
Estimated Date of Completion:
Is project on schedule? If not, please explain.
Type of Construction:
Approximate Square Footage:
Description of Project:
Type of Contract (GMP, Lump Sum, etc.):
Project Manager/Superintendent:
Owner:
Address:
Owner’s Project Manager/Phone:
Architect/Engineer:
Comments:
8 CERTIFICATION OF INFORMATION PROVIDED
I certify that the information and responses provided on this Questionnaire are true, accurate and complete. The Owner of the Project or its representatives may contact any entity or reference listed in this Questionnaire. Each entity or reference may make any information concerning the Contractor available to the Owner.
Dated ______, 2014
Contractor:
______(Contractor Name)
______(Signature)
By: ______(Typed Name)
Its: ______(Title)
Sworn to and subscribed before me this ______day of ______, 2014.
______(Notary Public)
______(My Commission Expires) AFFIDAVIT FOR CORPORATION
State of Florida County of______
______(Name) is ______(Title) of the ______(corporation described herein) being duly sworn, deposes and says that he/she is familiar with the books of the said corporation showing its financial position; that the foregoing statements are a true and accurate statement of the financial position of said corporation as of the date hereof; and that the statements and answers to the interrogatories of the foregoing experience questionnaire are correct and true as of the date of this affidavit; and that he/she understands that intentional inclusion of false, deceptive or fraudulent statements on this application constitutes fraud; and that the City of St. Petersburg considers such action on the part of the applicant to constitute good cause for denial, suspension or revocation of a existing work or contracts being performed by the Contractor for the City of St. Petersburg.
______(Officer must also sign here)
Sworn to before me this _____ day of ______, 2014, by ______(name of corporate officer). He/she is personally known to me or has produced ______(type of identification) as identification.
______(Notary) SEAL
2 AFFIDAVIT FOR INDIVIDUAL
State of Florida County of______
______being duly sworn, deposes and says that the foregoing financial statements are a true and accurate statement of the financial position as of the date thereof and that the answers and information provided in reply to the questions contained therein are true; and, that the statements and answers to the questions in the foregoing Statement and Questionnaire are correct and true as of the date of this affidavit; and, that he understands that intentional inclusion of false, deceptive or fraudulent statements on this application constitutes fraud; and that the City considers such action on the part of the applicant to constitute good cause for denial for bidding on City construction projects or the suspension or revocation of a existing work or contracts being performed by the Contractor for the City of St. Petersburg, Florida.
______(Individual must also sign here)
Sworn to before me this ______day of ______, 2014, by ______(name of corporate officer). He/she is personally known to me or has produced ______(type of identification) as identification.
______(Notary)
SEAL AFFIDAVIT FOR CO-PARTNERSHIP
State of Florida County of______
______being duly sworn, deposes and says that the foregoing financial statements are a true and accurate statement of the financial position of said firm as of the date thereof, and that the answers and information provided in reply to the questions contained therein are true; and, that the statements and answers to the questions in the foregoing Statement and Questionnaire are correct and true as of the date of this affidavit; and, that he/she understands that intentional inclusion of false, deceptive or fraudulent statements on this application constitutes fraud; and that the City considers such action on the part of the applicant to constitute good cause for denial for bidding on City construction projects or the suspension or revocation of existing work or contracts being performed by the Contractor for the City of St. Petersburg, Florida.
______(Member of Firm)
Sworn to before me this ______day of ______, 2014, by ______(name of applicant). He/she is personally known to me or has produced ______(type of identification) as identification.
______(Notary)
SEAL