<p> 1. THE PORT AUTHORITY OF NEW YORK AND NEW JERSEY</p><p>2. CONTRACTOR’S QUALIFICATION STATEMENT FOR CONTRACT SWF-164.039 STEWART INTERNATIONAL AIRPORT– REHABILITATE RUNWAYS 9-27 AND 16-34</p><p>3. AUGUST 2012</p><p>4. PLEASE TYPE OR PRINT CLEARLY </p><p>A. Contractor’s General Business Information</p><p>1* Statement submitted by:</p><p>1* Name of Firm: ______2* Name of Individual: ______3* Title: ______4* Business Address: ______5* E-mail Address ______</p><p>______6* Telephone No.: ______7* Name & Telephone No. ______of Contact Person if ______other than above: ______</p><p>2* Check how bid will be submitted:</p><p>Single Entity Joint Venture </p><p>If a Joint Venture, each participant in such Joint Venture must submit all the information that is required for a single entity. </p><p> Indicate if Firm has performed the Contract construction cost range.</p><p>Yes, $60,000,000.00-$90,000,000.00 range performed.</p><p>No, maximum range performed ______Indicate the type of work generally performed with your own work force.</p><p>______</p><p>______</p><p>3* Indicate which part of the work indicated in paragraph IIA of the attached Request to Qualify (“RTQ”) you plan on performing with your own forces and what work you plan to sub-contract to another firm.</p><p>8* Work to be performed with own forces:</p><p>______</p><p>______</p><p>______</p><p>9* Work to be performed by sub-contractors:</p><p>______</p><p>______</p><p>______</p><p>B. Relevant Experience and Past Performance:</p><p> On Schedule A, attached, list construction Contracts completed by your firm, which document that your firm meets the requirements indicated in paragraph III.A.1. If a joint venture, list each joint venture partner’s projects separately. Indicate if the contract was performed by your firm’s own forces or by a sub-contractor. </p><p> On Schedule B, attached, list the name and qualifications of the individual who will function as the Project Manger and Superintendent that meet the requirements in paragraph III.A.2 as well as those of any other key construction supervision personnel to be assigned to the Contract along with the anticipated function and relevant experience of each person.</p><p> On Schedule C, attached, list current projects currently under construction (work on hand) by your firm. If a joint venture, list each joint venture partner’s projects separately.  On Schedule D, attached, include narrative demonstration how you will satisfy pavement smoothness criteria as required by Specification No. 02561- ASPHALT CONCRETE PAVING (FAA)</p><p>Does your firm have the required certification(s) and/or license(s) as per paragraph III.B.2, if required?</p><p>Yes No Not Applicable</p><p>10* If No, indicate how you plan on meeting this requirement:</p><p>______</p><p>______</p><p>11* Submit documentation of required certification(s) and/or license(s) </p><p>4* Has your firm ever failed to complete any construction contract awarded it?</p><p>Yes No</p><p>If yes, describe the circumstances on a separate piece of paper.</p><p>5* In the last five years, has your firm ever failed to substantially complete a contract in a timely manner?</p><p>Yes No</p><p>If yes, describe the circumstances on a separate piece of paper.</p><p>6* Identify prior contracts that contained stated goals for M/WBE participation and how such goals were met or exceeded:</p><p>Contract Stated Goals Actual % Comments Obtained Financial Information:</p><p>7* Can your Firm provide a Performance And Payment Bond for the full amount required?</p><p>Yes No</p><p>8* Indicate approximate total bonding capacity: ______</p><p>9* Indicate name of your proposed surety company and name, address and phone number of agent:</p><p>12* Agent’s Name: ______</p><p>13* Company Name: ______</p><p>14* Address: ______</p><p>15* Telephone No. ______</p><p>10* Submit letter from your surety documenting your ability to submit the required Bond.</p><p>D. Certification </p><p>I hereby certify that the information submitted herewith, including attachments, is true to the best of my knowledge and belief.</p><p>______(Type or print business name of Firm)</p><p>By: ______(Signature of officer of Firm)</p><p>______(Type or print name of officer of Firm)</p><p>______(Type or print title of officer of Firm)</p><p>______(Type or print date)</p><p>***************** 5. SCHEDULE A </p><p>CONTRACTS COMPLETED</p><p>FIRM: ______Percent of Work Performed By Own Project Name, Location and Description Owner * Design Engineer * Date Cont Forces Completed ract Price **</p><p>Notes: * Include Name, Address and Phone No. of Reference Contact **Indicate amount of Firm’s contract and whether work was done as a general contractor SCHEDULE B KEY CONSTRUCTION SUPERVISION PERSONNEL</p><p>FIRM: ______</p><p>Date started Date started Name Position with this in Prior positions and experience in construction organization construction SCHEDULE C WORK ON HAND / BIDS SUBMITTED 6. FIRM: ______WORK ON HAND: Scheduled Completion Date Project Name, Location and Description Owner * Design Engineer * Co ntr act Pri ce **</p><p>BIDS SUBMITTED: Anticipated Award Date/ Contract Project Name, Location and Description Owner * Design Engineer * Bid Price ** Low Duration Bidd er (Yes or No) Notes: * Include Name, Address and Phone No. of Reference Contact **Indicate amount of Firm’s contract and whether work was done as a general contractor</p><p>SCHEDULE D 7. NARRATIVE DEMONSTRATION HOW PAVEMENT SMOOTHNESS CRITERIA CAN BE MET</p><p>8. FIRM: ______</p><p>______</p>