Part Two: Statement of Qualifications(SOQ)

Application Forms/Schedules

(to be completed by General Contractor)

RFQ Interest Form

GC RFQ Form 1

Instructions: If your firm is interested in responding to the RFQ for Prequalification of General Contractors for this Project then this RFQ Interest Form GC RFQ Form 1 MUST be submitted to the Awarding Authority BEFORE submitting the Statement of Qualifications (“SOQ”) Application GC RFQ Form 2.

Project Name:The Chancery-AnnexBuilding Renovation

Project Location:1617 Massachusetts Avenue NW

WashingtonDC20036

Awarding Authority:The Embassy of the Republic of the Philippines

Mail or Fax* this RFQ Interest Form to:

Shiena Escoto – Tesorero

Embassy of the Philippines

1600 Massachusetts Avenue NW

WashingtonDC

Fax: (202) 467-9417*

By submitting this RFQ Interest Form the below identified firm is expressing its interest in the above-referencedpublic building construction project and is requesting that it be added to the list of firms thatwill receive any addenda to the RFQ on the Project. The Awarding Authority assumes noresponsibility for a firm’s failure to receive any addenda or other correspondence related to thisRFQ due to the firm’s failure to submit an RFQ Interest Form as directed above or for any otherreason.

General Contractor Firm Name:
General Contractor Mailing Address:
General Contractor Telephone: / () - ext.
General Contractor Facsimile: / () -
General Contractor Contact (Person/Title):

By:Date:

(Signature of Authorized Representative)

*Please note that the Statement of Qualifications (“SOQ”) application form (GC RFQ Form 2) and accompanyingSchedules A through J, submitted in response to this RFQ MAY NOT BE FAXED.

Statement of Qualifications (SOQ)

Application for General Contractors

GC RFQ Form 2

Note: See Sections IV, V and VI of Part One, Request for Qualificationsfor this Project,for instructions on completing this Statement of Qualifications and accompanying Schedules A through J. This Statement of Qualifications (“SOQ”) application form (GC RFQ Form 2) and accompanying Schedules A through JMUST MAILED or DELIVERED TO the Awarding Authority’s Authorized Representative and MAY NOT BE FAXED.

Project Name:The Chancery-AnnexBuilding Renovation

Project Location:1617 Massachusetts Avenue NW

WashingtonDC20036

Awarding Authority:The Embassy of the Republic of the Philippines

General Contractor Firm Name:
General Contractor Mailing Address: /
General Contractor Street Address:
(if different than Mailing Address)
General Contractor Telephone: / ( ) - ext.
General Contractor Facsimile: / ( ) -
General Contractor Contact (Person/Title):
Required Schedules and Information

The following schedules and information must accompany this Statement of QualificationsGC RFQ Form 2 evaluation sub-category:

  1. Management Experience
  2. Business Owners:Interested General Contractors MUST COMPLETE Schedule A for each and every business owner of your firm as set forth in Section IV(C)(1)(a) of Part One, the RFQ for this Project.
  3. Management Personnel: Interested General ContractorsMUST COMPLETE Schedule B foreach and every person who will have any management responsibility,direct or indirect, for the Project, including, but not limited to, projectexecutives, project managers, field superintendents and field engineers,as set forth in Section IV(C)(1)(b) of Part One, the RFQ for this Project.
  4. Similar Project Experience:Interested GeneralContractors MUST COMPLETE Schedule C and list similar projects.List all past projects in Schedule CPart 1 and all ongoing projects in Schedule CPart 2. Foreach project, you must include the information listed in SectionIV(C)(1)(c) of Part One, the RFQ for this Project.
  5. LEEDTM Project Experience: Interested General Contractors MUST INCLUDE WITHIN Schedule C every LEEDTM rated project and associated information listed in SectionIV(C)(1)(d) of Part One, the RFQ for this Project.
  6. Terminations:Interested General Contractors MUST COMPLETE Schedule D and list each and every project on which yourfirm was terminated or failed to complete the work as set forth in SectionIV(C)(1)(e) of Part One, the RFQ for this Project.
  7. Legal Proceedings:Interested General Contractors MUST COMPLETE Schedule E and all information listing in Section IV(C)(1)(f) of Part One, the RFQ for this Project.
  8. Safety Record: Interested General Contractors MUST COMPLETE Schedule F with the history and supporting documentation as set forth in Section IV(C)(1(g) of Part One, the RFQ for this Project. You MUST ATTACH the supporting documentation to Schedule F.
  9. MBE/WBE and Workforce Compliance Record:Interested General Contractors MUST COMPLETE Schedule G and provide the information and evidence as set fort in Section IV(C)(1)(h) of Part One, the RFQ for this Project. General Contractors MUST ATTACH documentation supporting the actual participation and inclusion amounts reported in Schedule G.
  1. References
  2. Project References:Interested General Contractors MUST COMPLETE Schedule H and provide project references and information as required in Section IV(C)(2)(a) of Part One, the RFQ for this Project.
  3. Credit References:Interested General Contractors MUST COMPLETE Schedule I and provide credit references as required in Section IV(C)(2)(b) of Part One, the RFQ for this Project.
  1. Capacity to Complete Projects
  2. Computation of Net Financial Contracting Capacity: Interested General Contractors MUSTSUBMIT a computation of Net Financial Contracting Capacity (NFCC) as defined in Section IV(C)(3)(a) of Part One, the RFQ for this Project.
  3. Audited Financial Statement: Interested General Contractors MUST ATTACH to the GC RFQ Form 2 an audited financial statement as set forth in Section IV(C)(3)(b) of Part One, the RFQ for this Project. The audited financial statement may be submitted in a sealed envelope. (Note: whether submitted in a sealed envelope or not, such audited financial statement shall not be considered public records).
  4. Revenue: Interested General Contractors MUST COMPLETE Schedule Jand list revenue as set forth in Section IV(C)(3)(c) of Part One, the RFQ for this Project. Such financial information shall not be considered public records.
  1. Mandatory Requirements
  2. Bonding Capacity:Interested General Contractors MUST ATTACH to the GC RFQ Form 2 a commitment letter as set forth in Section IV(C)(4)(a) of Part One, the RFQ for this Project.
  3. Registration Certificate:Interested General Contractors MUST SUBMIT the registration certificate as set forth in Section IV(C)(4)(b) of Part One, the RFQ for this Project.
  4. Business License:Interested General Contractors MUST PROVIDE a copy of the license or permit as set forth in Section IV(C)(4)(c) of Part One, the RFQ for this Project.
  5. Joint Ventures: If applicable, Interested General Contractors MUST SUBMITa valid Joint Venture Agreement as set forth in Section IV(C)(4)(d) of Part One, the RFQ for this Project.
  6. Omnibus Sworn Statement:Interested General Contractors MUST SUBMIT a notarized affidavit executed by the authorized representative of the bidder with the declarations stated in Section IV(C)(4)(e) of Part One, the RFQ for this Project.
Execution Requirements
  1. RFQ Response Checklist: Before signing and submitting its SOQ application package for this Project, interested General Contractors are advised to carefully review the RFQ Response Checklist – GC RFQ Form 3.
  1. Acknowledgement of Addenda. By signing below, the interested General Contractor acknowledges receipt of the following addenda to this RFQ: Insert Addenda #
  1. Incomplete or Inaccurate Information:Failure to accurately and completely provide the information requested may result in the disqualification.
  1. Authorization to Sign: This form MUST be signed by an officer of the firm or an individual so authorized by an officer of the firm who has personal knowledge regarding the information contained herein.

SIGNED UNDER THE PAINS AND PENALTIES OF PERJURY:

By:Date:

(Signature of Authorized Representative)

Print Name:

Title:

Telephone:() - ext.

The Embassy of the Philippines Chancery-Annex

RFQ for General ContractorWashingtonDCSeptember 30, 2013

SCHEDULE A – BUSINESS OWNERS

Interested General ContractorsMUSTprovide the following information for each and every business owner of the firm in accordance with Section IV(C)(1)(a) of Part One, the RFQ for this Project.

NAME / TITLE / ROLE/JOB RESPONSIBILITIES / EDUCATION / CONSTRUCTION EXPERIENCE / PROFESSIONAL AFFILIATIONS / NUMBER OF YEARS WITH FIRM

SCHEDULE B – MANAGEMENT PERSONNEL

Interested General Contractors MUSTprovide the following information for each and every person who will have any direct or indirect management responsibility for the Project in accordance with Section IV(C)(1)(b) of Part One, the RFQ for this Project.

NAME / TITLE / ROLE/JOB RESPONSIBILITIES / EDUCATION / CONSTRUCTION EXPERIENCE / PROFESSIONAL AFFILIATIONS / NUMBER OF YEARS WITH FIRM

The Embassy of the Philippines Chancery-Annex

RFQ for General ContractorWashingtonDCSeptember 30, 2013

SCHEDULE C - SIMILAR PROJECT EXPERIENCE

Part 1: Past Projects

Interested General Contractors MUSTlist all similar projects your firm has completed as defined bySections IV(C)(1)(c)&(d)of Part One, the RFQ for this Project. List all past projects in Part 1 and all ongoing projects in Part 2.

PROJECT NAME / LOCATION / SIZE
(square footage and number of stories) / SCOPE OF WORK PERFORMED / ORIGINAL CONTRACT SUM / FINAL CONTRACT SUM (provide explanations in a separate attachment) / DATE OF COMPLETION
(M/D/YYYY) / LEEDTM RATING ACHEIVED
(if appl.)

SCHEDULE C - SIMILAR PROJECT EXPERIENCE

Part 2: Ongoing Projects

PROJECT NAME / LOCATION / SIZE
(square footage and number of stories) / SCOPE OF WORK / ORIGINAL CONTRACT SUM / DATE AWARDED / STARTED
(M/D/YYYY) / TARGET DATE OF COMPLETION
(M/D/YYYY) / PERCENTAGEAND VALUE OFOUTSTANDING WORK / TARGETED
LEEDTM RATING
(if appl.)

The Embassy of the Philippines Chancery-Annex

RFQ for General ContractorWashingtonDCSeptember 30, 2013

SCHEDULE D - TERMINATIONS

Interested General Contractors MUSTlist all similar projects your firm has completed as defined bySection IV(C)(1)(e) of Part One, the RFQ for this Project.

PROJECT NAME / LOCATION / SCOPE OF WORK PERFORMED / START DATE
(M/D/YYYY) / END DATE
(M/D/YYYY) / ESTIMATED CONTRACT AMOUNT / PERCENT COMPLETE / REASON FOR TERMINATION

The Embassy of the Philippines Chancery-Annex

RFQ for General ContractorWashingtonDCSeptember 30, 2013

SCHEDULE E - LEGAL PROCEEDINGS

Interested General Contractors MUSTlist all legal proceeding, administrative proceeding and arbitration in accordance with Section IV(C)(1)(f) of Part One, the RFQ for this Project.

PROJECT NAME / LOCATION / DESCRIPTION OF LEGAL PROCEEDING (include caption of case, parties, location of proceeding, description of the dispute or enforcement action and status and/or outcome)

The Embassy of the Philippines Chancery-Annex

RFQ for General ContractorWashingtonDCSeptember 30, 2013

SCHEDULE F - SAFETY RECORD

Interested General Contractors MUST provide the history and supporting documentation as set forth in Section IV(C)(1)(g) of Part One, the RFQ for this Project.

YEAR / YEAR WORKERS’ COMP. EXPERIENCE MODIFIER / EXPERIENCE MODIFIER COMMENTS

The Embassy of the Philippines Chancery-Annex

RFQ for General ContractorWashingtonDCSeptember 30, 2013

SCHEDULE G - MBE/WBE and WORKFORCE COMPLIANCE RECORDS

Interested General Contractors MUSTprovide the information and evidence as set fort in Section IV(C)(1)(h) of Part One, the RFQ for this Project.

PROJECT NAME / LOCATION / AWARDING AUTHORITY / CONTRACT SUM / MBE GOAL / ACTUAL MBE PARTIC. / WBE GOAL / ACTUAL WBE PARTIC. / WORK FORCE GOAL / ACTUAL WORK FORCE PARTIC. / PHILIPP.
VENDOR PARTIC.

The Embassy of the Philippines Chancery-Annex

RFQ for General ContractorWashingtonDCSeptember 30, 2013

SCHEDULE H - PROJECT REFERENCES

Interested General Contractors MUST list references for prior work as set forth in Section IV(C)(2)(a) of Part One, the RFQ for this Project.

PROJECT NAME / AWARDING AUTHORITY/ OWNER / CONTRACT PERSON / ADDRESS / TELEPHONE NUMBER / FAX NUMBER
() - ext. / () -
() - ext. / () -
() - ext. / () -
() - ext. / () -
() - ext. / () -

The Embassy of the Philippines Chancery-Annex

RFQ for General ContractorWashingtonDCSeptember 30, 2013

SCHEDULE I - CREDIT REFERENCES

Interested General Contractors MUST provide credit references as required in Section IV(C)(2)(b) of Part One, the RFQ for this Project.

CHECK ONE / COMPANY NAME / CONTRACT PERSON / TELEPHONE NUMBER / FAX NUMBER
BANK
SUPPLIER
VENDOR / () - ext. / () -
BANK
SUPPLIER
VENDOR / () - ext. / () -
BANK
SUPPLIER
VENDOR / () - ext. / () -
BANK
SUPPLIER
VENDOR / () - ext. / () -
BANK
SUPPLIER
VENDOR / () - ext. / () -

The Embassy of the Philippines Chancery-Annex

RFQ for General ContractorWashingtonDCSeptember 30, 2013

SCHEDULE J - REVENUE UNDER CONTRACT

Interested General Contractors MUST list revenue as set forth in Section IV(C)(3)(c) of Part One, the RFQ for this Project.

YEAR / REVENUE UNDER CONTRACT

OMNIBUS SWORN STATEMENT

GC RFQ Form 3

UNITED STATES OF AMERICA)

______) S.S.

AFFIDAVIT

I, [Name of Affiant], of legal age, [Civil Status], [Nationality], and residing at[Address of Affiant], after having been duly sworn in accordance with law, do hereby depose and state that:

  1. Select one:

If a sole proprietorship: I am the sole proprietor of with office address at;

If a partnership, corporation, cooperative, or joint venture: I am the duly authorized and designated representative of with office address at ;

  1. Select one:

If a sole proprietorship: As the owner and sole proprietor of , I have full power and authority to do, execute and perform any and all acts necessary to represent it in the bidding for The Chancery-Annex Building Renovation of The Embassy of the Republic of the Philippines;

If a partnership, corporation, cooperative, or joint venture: I am granted full power and authority to do, execute and perform any and all acts necessary and/or to represent the in the bidding as shown in the attached[state title of attached document showing proof of authorization (e.g., duly notarized Secretary’s Certificate issued by the corporation or the members of the joint venture)];

  1. is not “blacklisted” or barred from bidding by the Government of the Philippines or any of its agencies, offices, corporations, or Local Government Units, foreign government/foreign or international financing institution whose blacklisting rules have been recognized by the Government Procurement Policy Board;
  1. Each of the documents submitted in satisfaction of the pre-qualification requirements is an authentic copy of the original, complete, and all statements and information provided therein are true and correct;
  1. is authorizing the Head of the Procuring Entity or its duly authorized representative(s) to verify all the documents submitted;
  1. Select one:

If a sole proprietorship: I am not related to the Head of the Procuring Entity, members of the Bids and Awards Committee (BAC), the Technical Working Group, and the BAC Secretariat, the head of the Project Management Office or the end-user unit, and the project consultants by consanguinity or affinity up to the third civil degree;

If a partnership or cooperative: None of the officers and members of is related to the Head of the Procuring Entity, members of the Bids and Awards Committee (BAC), the Technical Working Group, and the BAC Secretariat, the head of the Project Management Office or the end-user unit, and the project consultants by consanguinity or affinity up to the third civil degree;

If a corporation or joint venture: None of the officers, directors, and controlling stockholders of is related to the Head of the Procuring Entity, members of the Bids and Awards Committee (BAC), the Technical Working Group, and the BAC Secretariat, the head of the Project Management Office or the end-user unit, and the project consultants by consanguinity or affinity up to the third civil degree; and

  1. complies with existing labor laws and standards.

IN WITNESS WHEREOF, I have hereunto set my hand this day of , 20 at [City, State, Country].

______

Bidder’s Representative/Authorized Signatory

[JURAT]

RFQ RESPONSE CHECKLIST

GC RFQ Form 4

Late applications for prequalification will not be considered. Therefore, before submitting a response to this RFQ, please review the following:

Did you fax or mail the RFQ Interest Form (GC RFQ Form 1) to the Awarding Authority?

Did you complete the entire SOQ Form (GC RFQ Form 2)?

Did you fully complete Schedules A through J?

Did you attach the required documentation from your insurance company supporting the workers’ compensation modifier history you reported in Schedule F?

Did you attach the required documentation supporting the MBE/WBE and Workforce Compliance record you reported in Schedule G?

Do you have the current contact information for all of the references you reported in Schedule H, and Schedule I?

Did you attach a computation of Net Financial Contracting Capacity (NFCC) as required in Section IV(C)(3)(a) of Part One, the RFQ for this Project?

Did you attach an audited financial statement as required in Section IV(C)(3)(b) of Part One, the RFQ for this Project?

Did you attach a commitment letter for payment and performance bondsas required in Section IV(C)(4)(a) of Part One, the RFQ for this Project?

Did you attach a notarized Omnibus Sworn Statement(GC RFQ Form 3) executed by the authorized representative of the bidder with the declarations stated in Section IV(C)(4)(e) of Part One, the RFQ for this Project?

Did you include the original and all required copies of your entire SOQapplication package?

Did you address the SOQ envelop correctly (i.e. to reference the Projectand other required information set forth herein)?

Did you review all of the Execution Requirements before signing the SOQapplication form?

Is the person who signed the SOQ application form authorized to do soand did his or her correct and current contact information?

The Embassy of the Philippines Chancery-Annex

RFQ for General ContractorWashingtonDCSeptember 30, 2013