FREDERICK COUNTY PUBLIC SCHOOLS

PURCHASING DEPARTMENT

33 THOMAS JOHNSON DRIVE

FREDERICK, MARYLAND 21702

PHONE NUMBER: 301-644-5219

FAX NUMBER:  301-644-5213

 

CONTRACTOR’S QUESTIONNAIRE FOR NEW CONSTRUCTION, RENOVATION, AND/OR MAJOR REPAIR PROJECTS FOR THE PERIOD ENDING

AUGUST 31, 2008

 

                                                                                    Phone #: _______________________________

                                                                                    Fax #: _________________________________

                                                                                    E-Mail: ________________________________

                                                                                    Federal I.D. # ___________________________

 

1.  General:

     (A)  Legal Title and Address of Organization            (B)      Maryland Representative’s Name, Title

                                                                  and Address:

 

      ____________________________________            ________________________________

      ____________________________________            ________________________________

      ____________________________________            ________________________________

 

      (C) ___  Corporation       ___  Partnership      ____  Individual         (Check One)

                                           

 

      (D) If a Corporation, state: Date of Incorporation:  _____________________

                                       State in which Incorporated:  _____________________

 

      Name and Title of Principal Officers:                             Date of Assuming Position

 

      ________________________________________________            _______________________

      ________________________________________________            _______________________

      ________________________________________________            _______________________

 

      (E) If Partnership, state:  Date of Organization:  _________________________________

 

            Nature of Partnership (General, Limited or Association):  _____________________________

 

            Names and Addresses of Partners:

 

      _________________________________________________________________________________

      _________________________________________________________________________________

      _________________________________________________________________________________

 

      (F)  If Individual:  State:  Full Name and Address of Owner: ________________________________

           _________________________________________________________________________________

     

 

 

      (G) Is your company affiliated in any way with any construction management companies/general

           contractors?  If so, please list below:

 

            Company Name: ________________________________________________________________

            Address: ______________________________________________________________________

            Affiliation:_____________________________________________________________________

 

      (H) Has this company ever operated under another name? ____ If yes, list the previous name (s)

             __________________________________________________________________________

 

(I)     Has your company ever filed for bankruptcy? ______________

      If yes, please explain___________________________________________________________

      ____________________________________________________________________________

 

(J)    Has your organization previously worked for Frederick County Public Schools?  If yes please list

      projects: _______________________________________________________________________

             ______________________________________________________________________________

 

      (K)  Is any member of your organization employed by the State of Maryland, a member of any State

             Institution’s Board of Managers or Trustees, or any way officially connected with the State

              Government or Board of Education of Frederick County? _____________________

 

      (L) How many full time equivalent employees do you employ? ___________________

 

      (M)      Is your company debarred from any city/county governments or any school districts?  ______                        If yes,  please list below:  ______________________________________________________

            ___________________________________________________________________________

 

      (N) Has your company ever been terminated by an Owner or General Contractor?  If yes explain:

            ___________________________________________________________________________

            ___________________________________________________________________________

 

      (O) Give name and data about any projects you have failed to complete (use separate sheet if

            necessary):  ____________________________________________________________________

            ______________________________________________________________________________

           

      (P) Has your organization ever been party to any criminal litigation as a result of construction or

            operating methods, costs, etc.? _______

            If yes, explain: __________________________________________________________________

            ______________________________________________________________________________

 

      (Q)  Please list below the address that you would like all bidding information sent:

            ______________________________________________________________________________

            ______________________________________________________________________________

            ______________________________________________________________________________

 

2.   Minority Business Enterprise Information:

 

      (A) Is the company a certified Minority Business Enterprise (MBE) with documented certification

             from the Maryland State Department of Transportation (MDOT)?   _______

             If yes, provide certification number ____________________

 

3.  Financial

 

      (A) Give values of current and total assets of organization: __________________________________

 

      (B)  Give values of current and total liabilities of organization: _______________________________

            (The dept to equity ratio of assets to liabilities helps determine financial stability.)

 

      (C)  Give total contract value of work accomplished by your organization in each of the last three (3)

              years:

 

             _______________ - _________         _______________ - _________   ______________ - ________

                   (Value)                   (Date)              (Value)                  (Date)            (Value)                   (Date)

 

      (D) On a separate sheet list all work presently being accomplished by, or pending award to your 

             organization:

 

      (E) Give value of any judgements or liens outstanding against your organization: ______________

                         ____________________________________________________________________________

 

      (F)  Has any bonding company refused to write you a bond on any work? _____  If yes, explain

                         ____________________________________________________________________________

             ____________________________________________________________________________

      (G) Give maximum value of contract work for which you could obtain bond during the fiscal year:

                $ _________________________  (Individual Project)

                $ _________________________  (Aggregate)

              Contractor Bonding Company (Not Agent) _________________________________________

               Rating as listed by the A.M. Best rating: _________________________

               (Information available from website: www.ambest.com)     

 

      (H) Does your company carry both general liability and comprehensive automobile liability

             insurance coverage for a minimum of one million dollars each? _____  If not, explain why:

            ______________________________________________________________________________

            ______________________________________________________________________________

 

4.Safety

 

(A)  Do you have a Written Safety Program (including Hazard Communications)?  _____________

 

(B)  What is your EMR (Experience Modification Rate) for the last 3 years?

 

The Experience Modification Rate (EMR) is the rate by which insurance companies base the amount charged to contractors.  The industry Average is 1.0; the EMR for contractors will either

Increase or decrease based on the number of accidents vs. the number of man-hours logged

company-wide.  EMR rates can be obtained by contacting the firm’s insurance company.

 

                                                                             2004 ______________________

                                                                             2003 ______________________

                                                                             2002 ______________________

 

 

(C)  Please list your company’s Safety Director or other safety contact:

 

4.   Experience:

 

      (A)  Indicate type of contracting undertaken by your company and years experience (under present

             company name):  If General Prime contractor, list only work that your company performs.

           

                  Category #      Category (Please Check if Applicable):      Company’s Years Experience

 

                  912       Concrete                 _____        ______________

                  927       Conveying Systems                  _____              ______________

                  913       Doors & Windows                _____              ______________

                  914       Electrical                _____        ______________

                  915       Equipment               _____        ______________

                  916       Finishes                  _____        ______________

                  917       Furnishings              _____        ______________

                  911A                General Prime                     _____              ______________

                                                    ($250,000 to $5,000,000)

                  911B                General Prime                     _____              ______________

                                    ($250,000 to $20,000,000)

                  911C                General Prime                     _____              ______________

                                    ($250,000 to $40,000,000 and

                                    over)

                  918       Masonry                 _____        ______________

                  919       Mechanical             _____        ______________

                  920       Metals                          _____              ______________

                  921       Roofing                   _____        ______________

                  922       Sitework                 _____        ______________

                  923       Special Construction            _____              ______________

                  924       Specialties               _____        ______________

                  925       Wood and Plastics       _____              ______________

 

            (B) List experience of principal members of your organization:

 

Name                                          Title      Exp. (Yrs.)   Type of Work    In What Capacity

 

___________________________  __________   ______            _____________  ______________

 

___________________________  __________   ______            _____________  ______________

 

___________________________  __________   ______            _____________  ______________

 

___________________________  __________   ______            _____________  ______________

 

___________________________  __________   ______            _____________  ______________

                                 

 

      (C)  Give any special qualifications of firm members (Registered Engineer, Surveyor, etc.):

__________________________________________________________________________________________________________________________________________________________________

 

      (D)  List minimum of four (4) projects completed by your organization under current company

       name.  You must list a minimum of four (4) projects for each trade your company is

       applying for pre-qualification.  At least three of the references should be over $250,000.00.

       (School projects are preferred, but are not required).  These projects must be within the last

       three years.  

            

CATEGORY:  _____________________________________________

 

NAME OF                  CONTRACT    YEAR     NAME OF         COMPANY/

PROJECT                  VALUE                      CONTACT        ADDRESS

 

1. ______________________  $____________   ______  ___________   __________________________

                                                                              __________________________

Phone No. _______________________                                __________________________

 

2. ______________________  $____________   ______  ___________   __________________________

                                                                              __________________________

Phone No. _______________________                                       __________________________

 

3. ______________________  $____________   ______  ___________   __________________________

                                                                              __________________________

Phone No. _______________________                                       __________________________

 

4. ______________________  $____________   ______  ___________   __________________________

                                                                              __________________________

Phone No. _______________________                                       __________________________

 

                         

CATEGORY:  _____________________________________________

 

NAME OF                  CONTRACT    YEAR     NAME OF         COMPANY/

PROJECT                  VALUE                      CONTACT        ADDRESS

 

1. ______________________  $____________   ______  ___________   __________________________

                                                                              __________________________

Phone No. _______________________                                __________________________

 

2. ______________________  $____________   ______  ___________   __________________________

                                                                              __________________________

Phone No. _______________________                                       __________________________

 

3. ______________________  $____________   ______  ___________   __________________________

                                                                              __________________________

Phone No. _______________________                                       __________________________

 

4. ______________________  $____________   ______  ___________   __________________________

                                                                              __________________________

Phone No. _______________________                                       __________________________

 

 

For additional trades please use a separate sheet.

 

      (E)  List all projects completed in the last three years (on a separate sheet of paper)

 

(F)  1.  What is the money value of the largest project accomplished by your organization:

            $______________________

            2.  Maximum value you prefer to undertake:    $_____________________

             3.  Price range of work your organization is deemed best adapted to undertake:

                  $___________________

 

      (G)  List the local, state and/or federal authorities with whom your organization is licensed and

              submit copies of these licenses with this application to avoid delay in approval.  Bidder must

               be at least licensed as a general contractor in the State of Maryland.

 

Licensing Authority      Issue Date        Expiration Date           License Number       License Title

 

________________      _________      _____________          _____________          ____________

 

________________      _________      _____________          _____________          ____________

 

________________      _________      _____________          _____________          ____________

 

________________      _________      _____________          _____________          ____________

 

I/WE CERTIFY UNDER PENALTIES THAT THE INFORMATION SUBMITTED IS CORRECT AND CURRENT.  I/WE FURTHER UNDERSTAND THAT IF THE INFORMATION IS FOUND TO BE INCORRECT, IT COULD BE GROUNDS FOR DENIAL OR PRE-QUALIFICATION OR AWARD.  WE HEREBY AUTHORIZE THE BOARD OF EDUCATION OF FREDERICK COUNTY TO CONTACT REFERENCES.

 

                                                      _______________________________________

                                                      Please Print- Name/Title of Officer, Partner, Etc.

 

Date: ______________________          _____________________________________________

                                                                                (Signature)

 

 

 

 

           

ADDITIONAL PRE-QUALIFICATION FOR ROOFING CONTRACTORS

 

CONTINUATION OF CONTRACTOR’S QUESTIONNAIRE FOR NEW SCHOOL CONSTRUCTION, RENOVATION, AND/OR MAJOR REPAIR PROJECTS FOR THE PERIOD ENDING AUGUST 31, 2008

1.  How many years has your company been in business primarily as a roofing contractor under

     current name.  _____

 

2.  What kind of roofing work does your company perform?  Check all that apply.

 

____ Built-up                            ____ Shakes                          ____ Slate

____ Cold Process                        ____ Sheet Metal                  ____ Spray Polyurethane Foam

____ Metal                               ____ Shingles                                    ____ Tile

____ Modified Bitumen                        ____ Single-ply                                  ____ Waterproofing

____ Roof Deck

 

3.  Do your company’s work crews perform the roofing work?  ______yes   ______no

     If no, please explain. __________________________________________________________

     ___________________________________________________________________________

 

4.  What is your company policy concerning on-site supervision of work and internal quality

     control procedures? ___________________________________________________________

     ___________________________________________________________________________

 

5.  Within the last five years, has any officer or partner of your company ever been an officer or

     partner of any other company when it failed to complete a roofing contract? ___yes ___no.

     If yes, please explain. _________________________________________________________
     ___________________________________________________________________________

 

6.  Have your company ever filed for bankruptcy?  _____yes _____no

     If yes, please explain __________________________________________________________
     ____________________________________________________________________________

 

7.  What is your company’s experience modification rate (EMR) for workers’ compensation

      insurance over the last three years?

 

     EMR last year _____________________________  State _________________________

     EMR previous year _________________________    State _________________________

     EMR previous year _________________________          State _________________________

 

8.  Does your company handle projects involving the removal of asbestos- containing roofing

     materials?  ___ yes  ___ no          Installation?  ___ yes  ___ no

 

9.  Is your company currently involved in litigation?  ___ yes  ___ no If yes, please explain.

     ____________________________________________________________________________

     ____________________________________________________________________________

 

10. Please list manufacturers with which your firm has licensed applicator agreements and level of

      certification of approval.

      ___________________________________________________________________________

      ___________________________________________________________________________