CONTRACTOR QUALIFICATION STATEMENT/APPLICATION PACKAGE
Greene County Satellite EMS Station
Qualified Bidder shall complete Contractor’s Qualification Statement/Application Package. Failure to answer all of the following questions may result in disqualification. If you have any questions, you may contact the Greene County Managerlisted below. Greene County reserves the unqualified right to reject any or all proposals and to wave informalities. Please note the following:
- Qualified applicants shall have satisfactorily completed at least (4) fourconstruction projects for a municipal agency of at least Three hundred thousand Dollars ($300,000) in the past (3) threeyears.
- The completed Contractor’s Qualification Statement/Application Statement and the required supplemental information must be sufficient and detailed to be verifiable by Greene County.
- Greene County will consider other information from any other source it may deem relevant to the contractor’s qualifications for the performance of the required work.
- In determining the contractor’s qualifications, Greene County will take into consideration the past performance of the contractor on construction and renovation contracts for the state, federal government or municipal agencywith particular concern given to completion times, quality of work, cooperation with other contractors and cooperation with the Designer and Owner.
- The contractor must have been in business, under the present business name, as a general contractor doing commercial and or institutional work for a period of not less than (5) five years.
- Failure to provide the requested information may disqualify the applicant.
- Greene County reserves the option to contact applicants to seek clarifying information from those who submit Contractor Qualification Statement/Application Package.
DUE DATE:April 24, 2018 NO LATER THAN 12 Noon
SUBMITTED TO:Kyle DeHaven
Greene County Manager
229 Kingold Boulevard
Suite D
Snow Hill, NC 28580
CONTACT INFORMATION:Kyle DeHaven
252-747-3446
PROJECT TITLE:Greene County Satellite EMS Station
PROJECT DESCRIPTION: The project consists of site grading and construction of 2,400 square feet to include the following: In Ground Septic, two Ambulance bays, two sleeping quarters, two bathrooms with showers, a setting room, and kitchen. The site will consist of paved, lighted and landscaped parking area with two access roads and appropriate signage. Work will be performed under a Single Prime General Construction Contract
PROJECT ESTIMATED CONSTRUCTION BUDGET: Three Hundred Thousand ($300,000)
PROJECT ESTIMATED CONSTRUCTION SCHEDULE: Approximately 180 calendar day (6 months) duration once Notice to Proceed is given.
SUBMITTED BY:
NAME:
ADDRESS:
PRINCIPAL OFFICE:
TYPE OF COMPANY
CorporationPartnership
IndividualJoint Venture
Other (Please specify):
TYPE OF WORK (file separately for each classification of work):
General ConstructionHVAC
PlumbingElectrical
Other (Please specify):
I. ORGANIZATION
1.1Years in business as a Contractor under name listed above?
1.2Under what former names has your organization operated?
Please list NONE if there are not others.
1.3If your organization is a corporation, answer the following:
1.3.1Date of incorporation:
1.3.2State of Incorporation:
1.3.3President’s name:
1.3.4Vice-President’s name:
1.3.5Secretary’s name:
1.3.6Treasurer’s name:
1.3.7Register’s Agent:
1.3.8Address of Register’s Agent:
1.4If your organization is a partnership, answer the following:
1.4.1Date of organization:
1.4.2Type of partnership (if applicable):
1.4.3Name(s) of general partners:
1.5If your organization is individually owned, answer the following:
1.5.1Date of organization:
1.5.2Name of owner:
1.6If the form of your organization is other than those listed above, describe it and name the principals:
1.7Proximity of your organization’s office to the project site referenced above:
1.8How many full-time permanent employees work for your organization?
1.8.1Attach an organizational chart/job descriptions and resumes of proposed key personnel that will be used on this project if awarded to your company.
1.9Attach a copy of your company’s safety program.
II. LICENSING
2.1List trade categories in which your organization is legally qualified to do business in the State of North Carolina, and indicate North Carolina registration and license numbers:
NOTE: ATTACH EVIDENCE OF AUTHORITY TO DO BUSINESS IN NORTH CAROLINA
III. WORK EXPERIENCE
3.1List the categories of work that your organization normally performs with its own forces and plans to on the above referenced project:
3.2Has your organization ever performed construction work for a North Carolina State Agency, Federal or Municipal Agency?
Yes No
If yes, on a separate sheet, list name of agency, name of project, owner/phone number, architect/phone number, contract amount, scheduled completion date and actual completion date.
3.3Claims and Suits: (if the answer to any of the questions below is yes, attach details)
3.3.1Has your organization ever failed to complete work awarded to it? Yes No
3.3.2Has your organization ever failed to substantially complete a project in a timely manner?
Yes No
3.3.3Are there any judgments, claims, arbitration proceedings or suits pending or outstanding against your organization or its’ officers? Yes No
3.3.4Has your organization filed any claims with the North Carolina Office of State Construction within the last ten years? Yes No
3.4On a separate sheet, list the major construction projects your organization has in progress, giving the name of the project, owner/phone number, architect/phone number, contract amount, percent complete and scheduled completion date.
3.4.1State total worth of work in progress and under contract:$
3.5On a separate sheet, list the major projects your organization has completed in the past eight years, giving the name of the project, owner/phone number, architect/phone number, contract amount, date of completion and percentage of the cost of the work performed with your own forces.
3.5.1State the yearly average amount of construction work performed during the past five years: $
IV. BONDING
4.1Attach letter from your surety company or its agent licensed to do business in North Carolina, verifying your organization’s capacity of providing adequate performance and payment bonds for the above referenced project.
4.2Have any funds been expended by a surety company on your behalf? Yes No
If yes, explain circumstances:
4.3List all surety companies that have provided bonds for your company for the past ten years.
4.4 What is your current bonding capacity with regards to your current total worth of work in progress and under contract?
V. FINANCING
5.1Attach a financial statement, preferably audited, including your organization’s latest balance sheet and income statement showing the following items:
.1 Current Assets (e.g., cash, joint venture accounts, accounts receivable, notes receivable, accrued income, deposits, materials inventory and prepaid expenses);
.2 Net Fixed Assets;
.3 Other Assets;
.4 Current Liabilities (e.g., accounts payable, notes payable, accrued expenses, provision for income taxes, advances, accrued salaries and accrued payroll taxes); and
.5 Other Liabilities (e.g., capital, capital stock, authorized and outstanding shares par values, earned surplus and retained earnings).
VI. SIGNATURE
6.1Dated at this day of:
Name of organization:
By: ______
Title:
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