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FORM A FIRM BACKGROUND

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FORM A FIRM BACKGROUND
Shared by: RyanTannehill
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views:
9
posted:
8/21/2009
language:
English
pages:
4
Quotation Number:



University of Cincinnati

Division of Administration and Finance

Facilities and Construction Services



RESPONSIBLE BIDDER INFORMATION FORM

(Attach additional pages as needed. Photo copy pages as needed.)



SHALL BE SUBMITTED WITH THE BID OR WITHIN THREE (3) BUSINESS DAYS

OF REQUEST, OR BID WILL BE REJECTED.



University Project No. University Project Name:



SECTION A: COMPANY BACKGROUND



COMPANY NAME:





PHYSICAL ADDRESS:



TELEPHONE NUMBER: (w/ Area Code) ( ) DATE:



FAX NUMBER: ( )



EMAIL ADDRESS:



AUTHORIZED OFFICIAL: TITLE:



(Authorized official must have authority to contractually bind the company)



Provide the following information:



a) Bidder’s overall experience in performing the type of construction or work specified, including number of years

in performing the type of construction or work specified under present and former business names;









b) Provide information regarding your company assets that would enable the performance of the specified work

(i.e. scheduling software, machinery/equipment, inventory, etc.);









c) Indicate the percentage and type of work that will be performed with your work force.







The apparent low Bidder shall submit upon request of the University either:



a) An annual financial statement prepared within the twelve (12) months prior to the Bid by an

independent licensed accounting firm, and the name, address, contact person and phone number of the

bank normally used by the Bidder for its primary banking; or,



b) A financial report generated within 30 days prior to the Bid from Standard and Poors, Dun and

Bradstreet, or a similar company acceptable to the University documenting the financial condition of

the Bidder, and the name, address, contact person and phone number of the bank normally used by the

Bidder for its primary banking.







RBI-1 of 4 Lead Contractor Project October 15, 2005

Quotation Number:

This information is not a public record under section 149.43, ORC; and will remain confidential, except

under proper order of a court.

SECTION B: LIST OF PROJECTS



COMPANY NAME:



• List all ongoing work, or work completed for the University of Cincinnati in the past four (4) years:



Title of project Completion Date University Project Manager









• Lead Contractors to identify projects completed in the last four (4) years, similar in size, cost and complexity and

carrying the Responsibility and Authority of the Lead Contractor (GC 4.2). Lead Contractor to show total amount

of contracts for the project indicated. (Attach separate sheet.)



• Other Contractors to identify all ongoing projects and projects completed in the last four (4) years, of

scope and complexity similar to the project being bid. (Attach separate sheet.)



• Project

• Scope of Work

• Location

• Client / Contact/ Phone No.

• Contract

• Total amount of contracts (for Lead Contractor).









• Has your company experienced any of the following within the last four (4) years:



Liquidated Damages Yes No Barred from Federal, State, or Local work. Yes No

Litigation Yes No Contract Termination Yes No

Arbitration/ADR Yes No Surety Take-over or Contract Abandonment Yes No

EPA/OSHA violations Yes No Prevailing Wage violations or judgements Yes No

Filed Bankruptcy Yes No Affirmative Action Violations Yes No



If YES to any of the above, explain below. (Provide attachment if necessary.)







• Indicate your firm’s “Experience Modification Rate” (EMR) for the past four (4) years

Rating/Year _____/_____, _____/_____, _____/_____, _____/_____



Notice Regarding EMR:

- Attach document(s) to support annual rating noted above.









RBI-2 of 4 Lead Contractor Project October 15, 2005

Quotation Number:





SECTION C: MANAGEMENT TEAM



COMPANY NAME:





IDENTIFY THE FOLLOWING INDIVIDUALS PERFORMING ON THIS CONTRACT (as applicable):



Principal: Years with this Firm: Total Exp.



Project Manager: Years with this Firm: Total Exp.





Field Superintendent: Years with this Firm: Total Exp.





Office Field Engineer: Years with this Firm: Total Exp.





CPM Scheduler: Years with this Firm: Total Exp.



Attach Resume including experience, accomplishments and professional background for the persons listed

above.







SECTION D: CERTIFICATION



I hereby certify that the information provided in this entire Responsible Bidder Information Form, including any and

all attachments and referenced information, is factual and complete.









COMPANY NAME







AUTHORIZED OFFICIAL (Please print or type)







SIGNATURE OF AUTHORIZED OFFICIAL DATE









RBI-3 of 4 Lead Contractor Project October 15, 2005

Quotation Number:



EDGE PARTICIPATION

Certified Statement of Intent To Contract and To Perform

Bidder: Submit one fully-completed form for each EDGE Business Enterprise



University Project No.:



Project Name:





A. Bidder Company Name:



B. Certified EDGE Business Enterprise information (for project contract at ANY tier)



Mark all that apply:



Bidder Subcontractor Material Supplier Professional Services Goods/Services



EDGE Business Name:



EDGE Business Address:



EDGE Business Federal Tax I.D. email:



Contact Person: Phone: ( )



Insert a brief description of materials, supplies, labor, etc., to be provided (may use industry codes).









C. Certification of Intent

By signing below, Bidder certifies that it intends to contract with the certified EDGE Business Enterprise for the

portion of the contract described above related to this project contract and for the estimated cost shown below. By

signing below, the certified EDGE Business Enterprise certifies that it intends to contract with the Bidder and

intends to provide the portion of the contract described above related to this project contract for the estimated cost

of:





and /100 dollars ($ ).







In the event the named Bidder is NOT the successful bidder, this Statement shall be null and void.



EDGE Business Enterprise Bidder









Authorized representative name, title (print or type) Authorized representative name, title (print or type)









Signature of authorized representative Signature of authorized representative









RBI-4 of 4 Lead Contractor Project October 15, 2005


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