8Th & Filbert Sts Transformation Project

Philadelphia Parking Authority July 2013

8th & Filbert Sts Transformation Project

Application For Prequalification

□ General Construction □ Mechanical/Plumbing □ Electrical

□ Hazardous Materials/Demolition □ Façade Structural Steel and Glass Package

Bidder: ______

PRE-QUALIFICATION FORMS

For: 8th & Filbert Sts Transformation Project

General Construction; including Architectural, Civil, Structural

Construction plus other Construction Operations

Façade Structural Steel and Glass Package

Mechanical/Plumbing Work:

Electrical Work:

Hazardous Materials/Demolition:

□ GENERAL CONSTRUCTION WORK

□ FAÇADE STRUCTURAL STEEL & GLASS PACKAGE

□ HAZARDOUS MATERIALS/DEMOLITION WORK

□ MECHANICAL/PLUMBING WORK

□ ELECTRICAL WORK

Date Submitted:
______/ Contractor Federal EIN No.:
______ / City Business Tax ID No.:
______/ PA License No.: ______
Exp. Date: ______
Submitted by: / Individual □ / Corporation □ / Partnership □
Principal Office Street Address (Address cannot be a PO Box):
Number: ______
Street Address: ______
Suite No.: ______
City: ______
State: ______
Zip Code: ______ / Principal Office Telephone No.: ______
Principal Office Fax No.: ______
Principal Office Email Address: ______
______
Principal Office Web Address: ______
______
Number of Full Time Employees:
Check One Under 25 □ Under 50 □ Under 100 □ Over 100 □
CORPORATION / PARTNERSHIP
Date of Incorporation:
______/ State:
_____ / Capitalization:
______ / Date of Organization:
______ / Type:
General □ Limited □
Other □
If other, state Partnership Type: ___
OFFICER / PARTNERS
President:
Name: ______
Address: ______
______/ Name: ______
Address: ______
______
Vice President:
Name: ______
Address: ______
______/ Name: ______
Address: ______
______
Secretary:
Name: ______
Address: ______
______/ Name: ______
Address: ______
______
Treasurer:
Name: : ______
Address: ______
______/ Name:
Address: ______
______
EXPERIENCE AND EQUIPMENT
1a. Number of years your organization has been in business as a contractor under its present business name: ___ yrs
1b. List all other business names under which your organization has been in business as a construction contractor over the last 10 years:
1. ______2. ______
3. ______4. ______
5. ______6. ______
2.a Number of years of experience your organization has as a prime contractor in the type of construction work for which you are seeking Pre-Qualification: _____ yrs
2.b. Provide Name, Address and Contact Working Phone Number for at least six Project Owners for which you performed work as a prime contractor:
1.  Project: ______
Owner Name: ______Address: ______
Year Work was performed: ____ Contact Phone No.: ______
2.  Project: ______
Owner Name: ______Address: ______
Year Work was performed: ____ Contact Phone No.: ______
3.  Project: ______
Owner Name: ______Address: ______
Year Work was performed: ____ Contact Phone No.: ______
4.  Project: ______
Owner Name: ______Address: ______
Year Work was performed: ____ Contact Phone No.: ______
5.  Project: ______
Owner Name: ______Address: ______
Year Work was performed: ____ Contact Phone No.: ______
6.  Project: ______
Owner Name: ______Address: ______
Year Work was performed: ____ Contact Phone No.: ______
3.a Number of years of experience your organization has as a sub-contractor in the type of construction work for which you are seeking Pre-Qualification: ____ yrs
3.b. Provide Name, Address and Contact Working Phone Number for at least six Projects for which you performed work as a sub- contractor:
1. Project: ______
Prime Contractor: ______Prime Contractor’s Address: ______
______
______
Year Work was performed: ____ Contact Phone No.: ______
2.  Project: ______
Prime Contractor: ______Prime Contractor’s Address: ______
______
______
Year Work was performed: ____ Contact Phone No.: ______
3.  Project: ______
Prime Contractor: ______Prime Contractor’s Address: ______
______
______
Year Work was performed: ____ Contact Phone No.: ______
4. Project: ______
Prime Contractor: ______Prime Contractor’s Address: ______
______
______
Year Work was performed: ____ Contact Phone No.: ______
5.  Project: ______
Prime Contractor: ______Prime Contractor’s Address: ______
______
______
Year Work was performed: ____ Contact Phone No.: ______
6.  Project: ______
Prime Contractor: ______Prime Contractor’s Address: ______
______
Year Work was performed: ____ Contact Phone No.: ______
4. Dollar amount your organization has done each year during the last six years as:
1. a prime contractor: Year 1: $ ______Year 2: $ ______Year 3: $ ______
Year 4: $ ______Year 5: $ ______Year 6: $ ______
2. a sub-contractor: Year 1: $ ______Year 2: $ ______Year 3: $ ______
Year 4: $ ______Year 5: $ ______Year 6: $ ______
5. Description of the construction experience of the principal officers and managers (including superintendents) of your organization:
1. Name: ______Position/Office: ______
Type of work in which individual has experience: ______
Years of construction experience: ______Size of project worked on: ______
Names of organizations worked for: ______Position held: ______
______Position held: ______
______Position held: ______
______Position held: ______
2. Name: ______Position/Office: ______
Type of work in which individua l has experience: ______
Years of construction experience: ______Size of project worked on: ______
Names of organizations worked for: ______Position held: ______
______Position held: ______
______Position held: ______
______Position held: ______
______Position held: ______
3. Name: ______Position/Office: ______
Type of work in which individual has experience: ______
Years of construction experience: ______Size of project worked on: ______
Names of organizations worked for: ______Position held: ______
______Position held: ______
______Position held: ______
______Position held: ______
______Position held: ______
4. Name: ______Position/Office: ______
Type of work in which individual has experience: ______
Years of construction experience: ______Size of project worked on: ______
Names of organizations worked for: ______Position held: ______
______Position held: ______
______Position held: ______
______Position held: ______
______Position held: ______
5. Name: ______Position/Office: ______
Type of work in which individual has experience: ______
Years of construction experience: ______Size of project worked on: ______
Names of organizations worked for: ______Position held: ______
______Position held: ______
______Position held: ______
______Position held: ______
______Position held: ______
6a.1 Has your organization within the last five years performed work for the Philadelphia Parking Authority: YES □ NO □
Has any of your work not been finally accepted by the Philadelphia Parking Authority: YES □ NO □
If the answer to above question is yes, please state:
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the non-acceptance: ______
______
______
Has any of your work with the Philadelphia Parking Authority been the subject of a Claim: YES □ NO □
If the answer to above question is yes, please state:
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the Claim: ______
______
______
Description of Final Resolution of the Claim: ______
______
______
6a.2 Has your organization within the last five years performed work for the City of Philadelphia: YES □ NO □
Has any of your work not been finally accepted by the City of Philadelphia: YES □ NO □
If the answer to above question is yes, please state:
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the non-acceptance: ______
______
______
Has any of your work with the City of Philadelphia been the subject of a Claim: YES □ NO □
If the answer to above question is yes, please state:
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the Claim: ______
______
______
Description of Final Resolution of the Claim: ______
______
______
6a.3 Has your organization within the last 5 years performed work for the Commonwealth of Pennsylvania: YES □ NO □
Has any of your work not been finally accepted by the Commonwealth of Pennsylvania: YES □ NO □
If the answer to above question is yes, please state:
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the non-acceptance: ______
______
______
Has any of your work with the Commonwealth of Pennsylvania been the subject of a Claim: YES □ NO □
If the answer to above question is yes, please state:
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the Claim: ______
______
______
Description of Final Resolution of the Claim: ______
______
______
6b.1 Has any officer, partner or other person active in the management of your organization, within the last five years, been an Officer, partner, manager, or sole proprietor of another organization which performed work for the Philadelphia Parking Authority: YES □ NO □
Has any of that work not been finally accepted by the Philadelphia Parking Authority: YES □ NO □
If the answer to above question is yes, please state:
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the non-acceptance: ______
______
______
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the non-acceptance: ______
______
______
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the non-acceptance: ______
______
______
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the non-acceptance: ______
______
______
6b.2 Has any officer, partner or other person active in the management of your organization, within the last five years, been an Officer, partner, manager, or sole proprietor of another organization which performed work for the City of Philadelphia: YES □ NO □
Has any of that work not been finally accepted by the City of Philadelphia: YES □ NO □
If the answer to above question is yes, please state:
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the non-acceptance: ______
______
______
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the non-acceptance: ______
______
______
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the non-acceptance: ______
______
______
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the non-acceptance: ______
______
______
6b.3 Has any officer, partner or other person active in the management of your organization, within the last five years, been an Officer, partner, manager, or sole proprietor of another organization which performed work for the Commonwealth of
Pennsylvania: YES □ NO □
Has any of that work not been finally accepted by the Commonwealth of Pennsylvania: YES □ NO □
If the answer to above question is yes, please state:
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the non-acceptance: ______
______
______
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the non-acceptance: ______
______
______
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the non-acceptance: ______
______
______
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the non-acceptance: ______
______
______
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the non-acceptance: ______
______
______
7a. Has the Philadelphia Parking Authority, within the past five years, declared your organization in default of a Philadelphia Parking Authority contract or otherwise terminated the contract? YES □ NO □
If the answer to above question is yes, please state:
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the default: ______
______
______
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the default: ______
______
______
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the default: ______
______
______
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the default: ______
______
______
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the default: ______
______
______
7b. Has the City of Philadelphia, within the past five years, declared your organization in default of a City of Philadelphia contract or otherwise terminated the contract? YES □ NO □
If the answer to above question is yes, please state:
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the default: ______
______
______
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the default: ______
______
______
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the default: ______
______
______
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the default: ______
______
______
7c. Has the Commonwealth of Pennsylvania, within the past five years, declared your organization in default of a Commonwealth of Pennsylvania contract or otherwise terminated the contract? YES □ NO □
If the answer to above question is yes, please state:
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the default: ______
______
______
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the default: ______
______
______
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the default: ______
______
______
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the default: ______
______
______
Contract number : ______
Project name: ______
Explanation of the circumstances surrounding the default: ______
______
______
8a.1 Has a commercial surety for your organization, within the past five years, been called upon to complete any work on a
contract with the Philadelphia Parking Authority? YES □ NO □
If the answer to above question is yes, please state:
Contract number for which the surety was called upon to complete the work: ______
Project name for the Contract which the surety was called upon to complete the work: ______
______
Explanation of the circumstances surrounding the event: ______
______
______
Contract number for which the surety was called upon to complete the work: ______
Project name for the Contract which the surety was called upon to complete the work: ______
______
Explanation of the circumstances surrounding the event: ______
______
______
Contract number for which the surety was called upon to complete the work: ______
Project name for the Contract which the surety was called upon to complete the work: ______
______
Explanation of the circumstances surrounding the event: ______
______
______
Contract number for which the surety was called upon to complete the work: ______