City of St. Petersburg

City of St. Petersburg

Contractor’s Pre-Qualification

Statement and Questionnaire

Project: Neighborhood Stabilization Program, Single Family Dwelling Rehabilitation

Owner: City of St. Petersburg______

Contractor: ______

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I.  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. Responses to Items II-VII shall be tabbed individually and separately. All other requested information (Form A, Licenses and Insurance, Comments, Certification and Affidavits) may be submitted as one tabbed Section. The City of St. Petersburg may reject any questionnaire that does not meet the following criteria.

e.  The City reserves the right to request additional information if required.

f.  If there are any questions concerning the completion of this form, contractors are encouraged to contact Michael Schlesinger, CPPB, Procurement Analyst at (727) 893-7223 or .

II.  General Background
Company Name / Company Phone/Fax No.
D/B/A (if applicable) / Contact Name/Title 1/ E-mail
Company Address 1 / Contact Name/Title 2/ E-mail
Company Address 2 / Federal Id No.
City/State/Zip / License Number

1.  Type of Organization

Please indicate business type below by placing a √ in the space provided.

Corporation / Organization Date:
Sole Proprietorship / State of Incorporation:
Partnership
General
Limited
Limited Liability
Limited Liability Company
Affiliates and/or Subsidiaries
Other / (specify)

2.  Personnel

a.  Administrative

Principal Officers / Position and Function / Years With Company /

b.  Construction (Supervisory Field Personnel)

Name / Title / Years of Experience /

3.  How many years has your organization been in business in Florida as a licensed general/building/residential contractor under your present name and license number? ______

4.  Number of full-time, permanent employees: _____ office _____field

5.  Previous name, address and license number of Contractor, if any:

______

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III.  Financial Status

a.  Financial Statements

Attach your latest financial statement, including the Contractor’s latest balance sheet and income statement or federal tax return showing the following items:

1.  Current assets, i.e., cash, joint venture account, accounts receivable, notes receivable, accrued income, deposits, materials inventory, and prepaid expenses.

2.  Net fixed assets.

3.  Other assets.

4.  Current liabilities, i.e., accounts payable, notes payable, accrued expenses, provision for income taxes, advances, accrued salaries, and accrued payroll taxes.

5.  Other liabilities, capital, capital stock, authorized and outstanding shares par values, earned surplus, and retained earnings.

6.  Name of firm preparing financial statement and date thereof.

b.  Present net worth of firm $ ______

c.  Annual dollar sales (each of the last three years)

200__ $ ______200__ $ ______200__ $ ______

d.  Bidding Limits:

Minimum: / $ / Maximum: / $

e.  Banking Reference:

Bank
Address
Telephone No.
Contact

f.  Bonding:

Limit, Aggregate / $
Limit, Single Project / $
Bonding Company
Bonding Company Address
Phone Number
Contact Person(s)

g.  Bankruptcy Proceedings:

1. Has Contractor, or any of its parents or subsidiaries ever had a Bankruptcy Petition filed in its name, voluntarily or involuntarily? If so, specify date, circumstances, and resolution. Include case information.

2. Has any owner, shareholder owning 20% or more of the issued stock of the corporation or a partner of the partnership ever had a Bankruptcy Petition filed in his or her name, voluntarily or involuntarily? If so, list the owner, shareholder or partner and specify date, circumstances, and resolution. Include case information.

h. Liquidated Damages

At any time in the last five years, has your firm been assessed and paid liquidated damages associated with the completion of a project, under a construction contract with either a public or private owner? If yes, identify the owner, the project, the year and the amount of liquidated damages paid/withheld.

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i. Loans

Is this Contractor currently in default of any loan agreement or financing agreement with any bank, financial institution, or other entity? If yes, specify details, circumstances and prospects for resolution.

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IV.  Capabilities

a.  Classes of work Contractor is qualified to perform with its own forces:

iii. 
iii. 
iii. 
iii. 
iii. 

b.  Work normally subcontracted to others:

i.
ii.
iii.
iv.
v.
$ / Yr.

c.  Largest contract completed to date:

d.  List Contractor’s major material supply houses/credit references:

Name / Location / Contact/ Phone

e.  Equipment: List your major equipment that is available, including description, number of units, capacity and condition of equipment.

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V.  Proposed Project Personnel

a.  Personnel Commitment:

1.  By submitting these names for consideration, the Contractor is committing these people to the City of St. Petersburg for this project’s duration if awarded the project. No personnel changes will be permitted without written authorization from the City.

2.  Higher consideration will be given if the Project Executive, Project Manager, and Field Superintendent have experience in the construction and renovation of affordable housing projects.

3.  Higher consideration will be given if the Project Executive, Project Manager, and Field Superintendent have worked together on previous successful projects.

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).

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2.  List the last five affordable housing projects regardless of size that the proposed Project Executive has supervised for the contractor, or for any other company. Include contact names and phone numbers.

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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).

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2.  List the last five affordable housing projects regardless of size that the proposed Project Manager has supervised for the Contractor, or for any other company. Include contact names and phone numbers.

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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 the last five (5) years and provide resume.

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2.  List the last five affordable housing projects regardless of size that the proposed Field Superintendent has supervised for the Contractor, or for any other company. Include contact names and phone numbers.

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VI.  Insurance and Bonding

a.  Insurance

1.  Provide a current certificate of insurance that summarizes the current Commercial General Liability, Automobile Liability and Worker’s Compensation insurance coverages maintained by your office.

2.  In the last five years, has any insurance carrier, for any form of insurance, refused to renew the insurance policy for your firm? If yes, identify the insurance carrier and the year in which such refusal occurred.

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3.  Within the last five years, has there ever been a period when Contractor had employees but was without workers’ compensation insurance or state-approved self-insurance? ______If Yes, explain below.

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b.  Bonding

1.  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? ______

2.  If the answer to 1 is yes, please describe the claim(s), the name of the company or person making the claim, and the resolution of the claim(s).

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3.  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).

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4.  Is your firm capable of achieving the following criteria for bonds and insurance? “Best’s Insurance Guide” rating of “Excellent” (A, A-) or better with an asset rating of “V” (in excess of $10 million).

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VII.  Lead Based Paint Removal Certification

a.  Is Contractor currently certified to perform lead based paint removal in accordance with the requirements of 40 CFR 745 as amended? ______If yes, include a copy of the certification(s) maintained by Contractor.

b.  List those persons employed by Contractor that are currently certified to perform lead based paint removal services in accordance with 40 CFR 745, as amended. Include a copy of each certification maintained by each named individual.

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c.  Does Contractor intend to hire a certified licensed contractor as a subcontractor to perform lead based paint removal services for rehabilitation properties awarded to Contractor? ______If yes, identify the lead based paint removal contractor by name and include a copy of its current certification.

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d.  List the last five projects regardless of size, that the lead based paint removal contractor named in answer 3 above has performed such services for the Contractor. Include contact names and phone numbers.

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VIII.  Company Experience - Similar Projects

a.  List all projects of reasonably similar nature, scope and duration performed by Contractor in the last five years. Complete the forms in this questionnaire with the requested information for each project. Preference will be given to projects, both private and public, that include affordable housing related scope or work.

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b.  On Form “A” Projects Under Construction, (add additional sheets if required) list major construction projects your organization has in process, giving the name of project, owner, architect, contract amount, percent complete, and scheduled completion date.

c.  On Form “B” Completed Single family rehabilitation projects over $40,000 that your organization has completed in the past five (5) years, giving the name of the project, owner, architect, contract amount, date of completion and percentage of the cost of work performed with your own forces.

d.  Has Contractor had a contract for similar services terminated prior to completion in the past five years? Yes No

If yes, identify the project, the owner, owner’s representative and the reason for termination.

IX.  Legal Proceedings:

a.  Arbitration

List all construction arbitration demands filed by, or against, the Contractor in the last five years. Identify the nature of the claim, the amount in dispute, the parties and the ultimate resolution of the proceeding.

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b.  Litigation

List all construction-related lawsuits (including but not limited to personal injury litigation) filed by, or against, the Contractor in the last five years. Identify the nature of the claim, the amount in dispute, the parties, and the ultimate resolution of the lawsuit.

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c.  Other Proceedings

1.  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.

2.  Identify any lawsuits, administrative proceedings, or hearings initiated by the National Labor Relations Board or similar state agency in the past five years concerning any labor practices of the Contractor. Identify the nature of any proceeding and its ultimate resolution.

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3.  Identify any lawsuits, administrative proceedings, or hearings initiated by the Occupational Safety and Health Administration (OSHA) concerning the project safety practices of the Contractor in the last five years. Identify the nature of any proceeding and its ultimate resolution.

Note: If you have filed an appeal of a citation and the Occupational Safety and Health Appeals Board has not yet ruled on your appeal, you need not include information about it.

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4.  Identify below and/or submit a listing of any OSHA citations and/or fines that may have been imposed on your company or organization in the past five years. If Contractor is a joint venture or partnership, list citation for both firms.

Note: If you have filed an appeal of a citation and the appropriate appeals Board has not yet ruled on your appeal, you need not include information about it.

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5.  Has the EPA or any Air Quality Management District or any Regional Water Quality Control Board cited and assessed penalties against either your firm or the owner of a project on which your firm was the contractor, in the past five years?

Note: If you have filed an appeal of a citation and the Appeals Board has not yet ruled on your appeal, or if there is a court appeal pending, you need not include information about the citation.

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