VIEWS: 5 PAGES: 19 POSTED ON: 5/5/2011
Prequalification Surveys and all supporting documentation must be completed by an Authorized Representative of the company. The undersigned certifies that the information provided herein is a clear and accurate representation of this organization. Signed by: ___________________________ _________________________ Print Name Title _______________________________ _________________________ Signature Date 8802 North Meridian Street • Indianapolis, IN 46260 • 317.842.2616 phone • www.BowenEngineering.com Contractor Financial Pre-qualification Survey Company’s Legal Name: Street Address: City, State, and Zip: Controller: Telephone: Fax: Email Address: Additional Financial Contact: Telephone: Fax: E-Mail Address: Title: Company’s Web Address: Select One: State of Formation: Date Founded: Corporation Partnership Select (if applicable): Individual MBE SB SD-VOSB SDB Joint Venture WBE VOSB HUBZone WOSB Other DBE SDB List the company’s Key Officers and Members legally authorized to execute documents. Name: Title: Name: Title: Name: Title: Name: Title: Name: Title: Name: Title: A-1 Attachment A 1. Has the company ever failed to complete any work awarded to it? Yes No If yes, please explain: 2. Is the company’s Labor force? Union Non-Union 3. Has the company or any of its principals ever petitioned for bankruptcy, failed in business, defaulted, or been terminated on a contract awarded? Yes No a. If yes, please explain. 4. Have any of the owners, officers or major stockholders of the company ever been indicted or convicted of any felony or other criminal conduct? Yes No a. If yes, please explain. 5. Has the company or any of the owners, officers or major stockholders ever been suspended, disbarred or otherwise precluded from pursuing public work or ever been found to be non-responsive to a public agency? Yes No a. If yes, please explain. 6. Has the company ever had a claim made against it for improper, delayed, defective or non-compliant work or failure to meet warranty obligations? Yes No a. If yes, please explain. 7. Is the company or any of the owners, officers or major stockholders currently involved in any arbitration or litigation? Yes No a. If yes, please explain. 8. Does the company have any outstanding judgments or claims against it? Yes No a. If yes, please explain. 9. Has the company or any of the owners, officers or major stockholders ever been investigated for, or charged with, alleged labor law violations including alleged violations of Immigration Control and Reform Act; state or local laws regarding employment of immigrants; prevailing wage laws; wage and hour laws or other federal, local or state labor laws? Yes No a. If yes, please explain. 10. Please provide the following information for the last three years and current year-to-date. DEBT TO EQUITY NET # OF CURRENT RATIO 2010 YEAR REVENUE RATIO WORKING EMPLOYEES (Current Assets/Current (Total Liabilities/Total BACKLOG CAPITAL Liabilities) Equity) 2010 YTD $ $ $ 2009 $ $ N/A 2008 $ $ N/A 2007 $ $ N/A Trade References: Please provide contact information for three vendors with whom the company does business. A-2 Attachment A a.) Vendor: Contact Name: Telephone: Fax: b.) Vendor: Contact Name: Telephone: Fax: c.) Vendor: Contact Name: Telephone: Fax: Project References: Please provide contact information for six projects performed within the past year. a.) Largest Project Ever Project Name: General Contractor: Contract Amount: Project Completion Date: Contact Name: Telephone: Fax: b.) Largest Project This Year Project Name: General Contractor: Contract Amount: Project Completion Date: Contact Name: Telephone: Fax: c.) Largest Project Last Year Project Name: General Contractor: Contract Amount: Project Completion Date: Contact Name: Telephone: Fax: Preferred Project Size: Please indicate the company’s top five preferred project size categories using a scale of 1-5, with 1 being most preferred. Under $50K $3M - $6M $50K - $100K $6M - $10M $100K - $200K $10M - $15M $200K - $500K $15 - $25M $500K - $1M $25M - $50M $1M - $3M Over $50M Insurance Information Insurance Company: Address: City, State, and Zip: Local Agent: Telephone: Fax: Bonding Information Bonding Company: Address: City, State, and Zip: Local Agent: Telephone: Fax: A-3 Attachment A AM Best Rating: Total Bonding Capacity: $ Current Available Bonding Capacity: $ 11. Select the Industry or Industries that the company routinely performs work in. Ethanol Food/Food Processing Manufacturing Type(s): Power – Industrial Power – Solar Power – Wind Power - Other Type(s): Refinery Type(s): Water Waste Water Other Industry Not Listed Other Industry Not Listed Other Industry Not Listed Other Industry Not Listed Other Industry Not Listed 12. Select the Scope of Work Sections that the company performs. 1000 CONSULTANTS 2000 SITE CONSTRUCTION (CONTINUED) 1000 Construction Estimating Consultants 2955 Lawn Maintenance Services 1100 Geotech/Enviro/NDE/NDT Consultants 2970 Fountains 1200 Landscaping Consultants Other 1300 Architectural Consultants 1400 Engineering/Structural Consultants 3000 CONCRETE Other 3000 Building Concrete Sub’s 3030 Tilt-Up Concrete Sub’s 2000 SITE CONSTRUCTION 3050 Site Concrete Sub’s 2000 Site Demolition Work 3070 Redi-mix Concrete Suppliers 2020 Concrete Saw-cut/Core Drilling 3080 Concrete Accessories 2030 Hazard. Matl Remediation/Abatement 3090 Concrete Lifting 2070 Erosion/Sedimentation Control 3100 Concrete Formwork 2080 Lime Stabilization Subs 3150 Concrete Pumping Services 2100 Dewatering 3200 Concrete Reinforcement 2120 Tree Trimming/Cutting/Removal 3350 Shotcrete 2200 Earthwork & Excavating Subs 3370 Gunite & Epoxy Ejection 2220 Rock Removal/Drilling/Blasting 3380 Post-Tensioned Concrete 2270 Soil Termite Treatment 3400 Structural Precast Concrete 2300 Piles & Caissons 3425 Architectural Precast Concrete 2330 Gabions 3430 Precast Thin Brick/Conc Panels 2350 Shoring & Underpinning 3450 Precast Parking Structures 2470 Asphalt Paving & Striping 3475 Precast Plans 2500 Water Wells & Well Drilling 3490 Precast Erection 2550 Fuel & Steam Distribution 3500 Cementitious Decks & Toppings 2660 Site Utility Work Sub’s 3550 Decorative Concrete Finishes 2650 Site Utility Equip/Matl Suppliers 3570 Floor Hardeners & Sealing 2660 Ponds & Reservoirs 3900 Concrete Restoration/Cleaning A-4 Attachment A 2810 Walk/Rd/Parking Appurtenances Other 2830 Fences & Gates 2850 Unit Pavers/Retaining Walls 4000 MASONRY 2900 Landscaping & Seeding 4000 Masonry Sub’s 2950 Lawn Irrigation Systems 4020 Masonry Material Suppliers 4000 MASONRY (CONTINUED) 7000 THERMAL AND MOIST. PROT. (CONT’D) 4050 Masonry Accessories 7200 Building Insulation/Vapor Retarder 4150 Masonry Insulation Systems 7210 Pre-Eng. Building Insulation 4180 Masonry Reinforcing 7220 Foamed-in-place Insulation 4220 Concrete Unit Masonry Supplier 7250 E.I.F.S. 4270 Glass Masonry Units 7280 Sprayed-On Fireproofing 4400 Stone & Granite Matl Suppliers 7300 Shingles & Roof Tiles 4500 Refractory – Fire Brick 7400 Manufact. Roofing/Siding Panels 4700 Simulated Masonry 7430 Siding & Soffit Systems 4800 Masonry Assemblies 7500 Membrane & Built-Up Roofing 4890 Masonry Waterproofing/Sealing 7550 Traffic Coatings 4900 Masonry Restoration and Cleaning 7600 Flashing, Sheet Metal Other 7700 Roof Specialties & Accessories 7740 Roof Hatches & Smoke Vents 5000 METALS 7750 Roof Pavers & Roof Walkways 5000 Structural Steel & Aluminum 7810 Fire stopping 5050 Metal Fasteners & Accessories 7900 Joint Sealers & Caulking 5080 Metal Coatings Other 5100 Steel Erection Sub’s 5200 Metal Joists 8000 DOORS AND WINDOWS 5300 Metal Decking 8100 Metal Doors & Frames Suppliers 5400 Cold – Formed Metal Framing 8200 Wood & Plastic Door Suppliers 5500 Misc. Metals Fabrications 8250 Doors/Hardware Installation Subs 5510 Metal Stairs & Ladders 8300 Specialty Doors 5520 Handrails & Railings 8340 Sectional Overhead Doors 5525 Column Covers 8400 Entrances & Store fronts 5530 Gratings & Floor Plates 8450 Automatic Entrance Door 5540 Mezzanines 8500 Metal Windows 5600 Sheet Metal Fabrications 8570 Security Windows & Screens 5700 Ornamental Metals 8600 Skylights 5800 Expansion Joints Assemblies 8700 Door & Window Hardware 5900 Metal Restoration & Cleaning 8800 Glass, Glazing & Mirrors Other 8900 Glazed Curtain Walls Other 6000 WOOD AND PLASTICS 6000 Lumber Material Suppliers 9000 FINISHES 6050 Fasteners/Adhesives & Hardware 9100 Non-Load Bearing Wall Framing 6100 Rough Carpentry Sub’s 9200 Lath & Plaster 6120 Finish Carpentry Sub’s 9250 Gypsum Board 6130 Heavy Timber Construction Sub’s 9300 Tile 6150 Pole Buildings 9400 Terrazzo 6170 Wood Trusses 9450 Stone Facing 6175 Wood Hybrid Roof Framing Systems 9500 Acoustical Ceilings 6180 Glue-Laminated Construction 9520 Metal Ceiling Systems 6200 Architectural Woodwork/Millwork 9570 Wood Flooring 6300 Wood Stairs 9600 Stone Flooring 6400 Manufactured Columns/Moldings 9630 Unit Masonry Flooring 6600 Plastic Fabricators 9640 Fluid Applied Flooring 6650 Solid Surface/Cultured Marble 9650 Resilient Flooring 6600 Wood & Plastic Rest. & Cleaning 9670 Carpet A-5 Attachment A Other 9675 Flooring Material Suppliers 9800 Epoxy & Special Floor Coatings 7000 THERMAL AND MOIST. PROTECTION 9830 Acoustical Treatment/Sound Panels 7100 Waterproofing 9900 Painting Sub’s 7150 Damp proofing 9970 Wall Coverings 7190 Water Repellents Other 10000 SPECIALTIES 13000 SPECIAL CONSTRUCTION 10100 Visual Display Boards 13030 Special Purpose Rooms 10120 Toilet Partition/Urinal Screen 13040 Cold Storage Rooms/Facilities 10150 Cubicle Curtains & Track 13080 Sound/Vibration/Seismic Control 10200 Louvers & Vents 13100 Lighting Protection 10240 Grilles & Screens 13120 Pre-Engineered Structures 10260 Wall and Corner Guards 13125 Pre-Engineered Metal Building Systems 10270 Access Flooring 13127 Pre-Engineered Metal Building Erectors 10290 Pest & Animal Control Devices 13150 Swimming Pools/Hot Tubs/Saunas 10340 Manufactured Exterior Specialties 13170 Heliports 10350 Flagpoles 13200 Liquid & Gas Storage Tanks 10400 Exterior Signage 13700 Security Access and Surveillance 10420 Interior Signage 13800 Building Automation & Control 10500 Lockers 13850 Detection & Alarm 10520 Fire Extinguishers and Cabinets 13900 Fire Suppression 10530 Awnings/Protected Walk Covers Other 10550 Postal Specialties 10600 Wire Mesh Partitions 14000 CONVEYING SYSTEMS 10620 Demountable Partitions 14200 Elevators 10650 Operable Partitions 14300 Escalators & Moving Walks 10670 Storage Shelving 14500 Material Handling System/Conveyors 10750 Telephone Specialties 14580 Pneumatic Tube System 10800 Toilet & Bath Accessories 14600 Overhead Hoists & Cranes 10950 Miscellaneous Specialties 14950 Miscellaneous Conveying Systems Other Other 11000 EQUIPMENT 15000 MECHANICAL 11015 Vacuum Cleaning Systems 15300 Fire Protection Sub’s 11050 Library Equipment 15400 Plumbing Sub’s 11060 Theatre and Stage Equipment 15470 Refrigeration Sub’s 11120 Vending Equipment 15480 Medical Gas Equipment & Piping 11130 Audio-Visual Proj. Screen Equipment 15500 HVAC Sub’s 11140 Vehicle Service Equipment 15700 HVAC Matl/Equipment Suppliers 11150 Parking Control Equipment 15725 Radiant Heating Systems 11160 Loading Dock Equipment 15900 HVAC Instrumentation & Controls 11170 Solid Waste Handling Equipment Other 11190 Detention Equipment 11200 Water Supply & Treatment Equipment 16000 ELECTRICAL 11280 Hydraulic Gates & Valves 16000 Electrical Sub’s 11300 Fluid Waste Treat/Disposal Equipment 16300 Electrical Service/Power Distribution 11460 Unit Kitchens 16400 Substations 11490 Specialty Equipment 16500 High Voltage Transmission Lines 11500 Industrial and Process Equipment 16500 Lighting Suppliers 11600 Laboratory Equipment 16550 Medical/Surgical Lighting 11700 Medical Equipment 16700 Sound & Communication Sub’s 11900 Exhibit Equipment 16800 Security/Surveillance Systems Other 16900 Fire Alarm Systems Other 12000 FURNISHINGS A-6 Attachment A 12300 Manufactured Casework OTHER SCOPES OF WORK NOT LISTED 12400 Window Treatments & Blinds 12950 Miscellaneous Furnishings Other 13. Select the states that the company is licensed to perform work in. Alabama Hawaii Massachusetts New Mexico South Dakota Alaska Idaho Michigan New York Tennessee Arizona Illinois Minnesota North Carolina Texas Arkansas Indiana Mississippi North Dakota Utah California Iowa Missouri Ohio Vermont Colorado Kansas Montana Oklahoma Virginia Connecticut Kentucky Nebraska Oregon Washington Delaware Louisiana Nevada Pennsylvania West Virginia Florida Maine New Hampshire Rhode Island Wisconsin Georgia Maryland New Jersey South Carolina Wyoming Please include with the completed survey, electronic copies of the following items: 1. A certificate of insurance evidencing adequate coverage is in place (see page A-8 for minimum liability requirements). 2. Financial statements for the past three years, including latest balance sheet and income statement. 3. Completed Bank Authorization Release of Information form (page A-9). 4. Completed W-9 form (page A-10). Additional Remarks: COMPLETED BY: Signature: Printed: Title: Date: A-7 Attachment A MINIMUM LIMITS OF LIABILITY FOR ALL CONTRACTORS General Liability/Occurrence Policy: Commercial General Liability General Aggregate $2,000,000 Premises & Operations Occurrence $1,000,000 Products & Completed Operations Aggregate $2,000,000 Personal & Advertising Injury Aggregate $1,000,000 Fire Damage Any One Fire $ 50,000 Medical Payments Single Limit $ 5,000 Automobile Liability: Any One Auto Combined Single Limit Hired Autos Bodily Injury/Property Damage Non-Owned Per Accident $1,000,000 Worker’s Compensation: Worker’s Compensation Policy must cover every state in which the company does business with Bowen Engineering Corporation. Each Accident $ 500,000 Disease Per Policy $ 500,000 Disease Per Employee $ 500,000 Commercial Umbrella: Limit of Liability Each Occurrence $2,000,000 Limit of Liability Annual Aggregate $2,000,000 If the Contractor’s Work involves or includes handling, transporting, disposing or performing operations with hazardous substances, contaminants, waste, toxic materials or any other pollutants, including lead abatement, Contractor shall provide the following Pollution Liability Insurance. Pollution Liability: Occurrence/Aggregate $1,000,000 A-8 Attachment A BANK AUTHORIZATION RELEASE OF INFORMATION FORM Bank Name: Address: City, State, Zip: Telephone: Fax No: Contact: Dear Sir or Madam: The below signature of an authorized company representative serves as authorization for release of financial information for purpose of a credit inquiry from Bowen Engineering Corporation. Signature: Printed Name: Title: Company Name: A-9 Attachment A A-10 Attachment B Contractor Safety Pre-qualification Survey Company’s Legal Name: Street Address: City, State, and Zip: Safety Director: Telephone: Fax: E-Mail Address: Additional Safety Contact: Telephone: Fax: Email Address: Title: In the chart below, please record your company’s safety performance numbers for the past three years and current year-to-date. LOST WORK # OF YEAR MAN HOURS RECORDABLES DAYS EMR DART RIR LTIR FATALITIES 2010 YTD 2009 2008 2007 Please provide the company’s trade related SIC/NAICS Code: B-1 Attachment B Please answer the following questions regarding the Safety Program at your company. YES NO N/A 1. Does the company have a formal Safety Policy? a. Is it part of the Safety Manual? b. Does it include a Drug & Alcohol policy? c. Is it signed by the President or highest authority of the company? 2. Are there clearly defined safety responsibilities for management personnel? a. Are management safety responsibilities in writing? 3. Are there clearly defined safety responsibilities for employees? a. Are employee safety responsibilities in writing? b. Is there a method or methods in place for employees to communicate safety hazards? 4. Does the company designate an on-site safety representative for each jobsite? a. Does the company provide a MSDS for all hazardous material brought on site? 5. Does the company have a designated Safety Director? a. Does the Safety Director report directly to Management? b. Does the company have a written policy stating the role, authority and responsibility of the Safety Director? c. Has the Safety Director completed the OSHA 30-hour? 6. Is a new hire orientation conducted for new employees prior to conducting work? a. Do the topics include, at a minimum: emergency procedures, MSDS training, PPE requirements, Blood borne Pathogens awareness, basic electrical, lead and asbestos and general safety awareness? b. Is a record of new hire orientation attendance documented and maintained? 7. Does the company have a well defined Disciplinary Policy and Procedure? a. Do violations of the safety policies result in disciplinary action? b. Is all disciplinary activity noted in the employee personnel file? c. Is the disciplinary policy part of the new hire orientation? 8. Is a jobsite toolbox safety meeting conducted with all employees on a weekly basis? a. Is attendance at the weekly safety meeting documented and maintained? b. Is the topic of weekly safety meetings recorded and maintained? 9. Do all project managers, job superintendents and foremen receive ongoing training on the company’s safety policy? B-2 Attachment B YES NO N/A 10. Does the company have a formal written HazCom program? a. Is the written HazCom policy posted on all jobsites? b. Is a specific person designated for the training and administration of the HazCom program? c. Are MSDS maintained for each hazardous chemical that is used? d. Is the location of MSDS documented? e. Are all secondary containers clearly labeled? f. Do all employees receive HazCom program training? 11. Are job hazard analyses conducted and documented on a set schedule? a. Are corrective action or preventative action plans reviewed by management? 12. Is there a designated person who conducts job site safety inspections? a. Does this person conduct random searches on a regular basis? b. Are safety inspections completed using a specific inspection form included in the safety program? c. Is corrective action documented in writing? 13. Is a job-specific emergency action plan and procedure documented prior to the start of a job? a. Is the job-specific emergency action plan in writing? b. Are personnel responsibilities discussed at the start of a new job? c. Is necessary emergency equipment present on the jobsite prior to the start of a new job? 14. Does the company have a written Accident Investigation and Reporting Policy? a. Are procedures for personal injury, property damage, chemical spill and other emergency situations clearly defined? b. Are all incidents reported using a company specific form? c. Are incident forms forwarded to management for accident analysis and review? d. Are injured employee and witness statements a routine part of the process? e. Are reporting procedures designed to find the incident cause and document and track prompt corrective measures? f. Are all personnel trained on accident investigation and reporting procedures during new hire orientation? 15. Is an early return-to-work (light duty) program in place? 16. Are job site personnel required to wear and maintain personal protective equipment? a. Is training on the proper use of PPE provided to employees? b. What PPE does the company provide to employees? c. What PPE are employees required to provide on their own? B-3 Attachment B The following sections of the survey are Trade Specific. Please answer only the section or sections that apply to your company. Select N/A for all non-applicable sections. YES NO N/A Asbestos Handling & Removal Policy 1. Are industry standards for housekeeping met? 2. Are industry standards for Hygiene facilities and practices met? 3. Are industry standards for competent person obligations met? 4. Are industry standards for recordkeeping met? 5. Does the company provide necessary protective clothing? 6. Does the company provide respiratory protection including, selection, fit testing and medical evaluation? 7. Are appropriate measures taken to monitor employee exposure levels? 8. Are appropriate measures taken to notify other employers on-site of regulated areas? 9. Are engineering controls and work practices properly explained? 10. Are appropriate measures taken to establish regulated areas? Compressed Cylinder Handling/Storage Policy 1. Are general safe handling and transporting policies adequately referenced? 2. Are appropriate measures taken for compressed cylinder storage? 3. Are appropriate measures taken for the separation of fuel gas cylinders from oxygen in storage? Electrical Safety Policy 1. Does the company safety policy cover general electrical safety rules? 2. Does the company safety policy explain general requirements regarding the use of temporary wiring and GFCIs? 3. Does the company safety policy state the use of proper Personal Protective Equipment (PPE)? Fall Protection Plan 1. Does the company have a written fall protection plan? 2. Does the fall protection plan include requirements for fall protection on walking/working surfaces greater than 6 feet? 3. Are all fall protection equipment and materials adequately inspected on a regular basis? 4. Are all exposed employees trained on fall protection provisions, including a written certification? Hand/Power Tool Safety Policy 1. Are all tools double insulated or properly grounded? 2. Does the safety policy include provisions for identification and removal from service of any defective tool? 3. Are guarding requirements clearly stated? B-4 Attachment B Hearing Conservation Policy YES NO N/A 1. Does the company have an annual training program for all employees exposed to noise at or above an 8 hour time weighted average of 85 dBA? 2. Does the safety policy include provisions for required recordkeeping? 3. Is a baseline audiogram provided within 6 months (12 months for mobile van) of employee exposure? 4. Is audiometric testing performed by a licensed or certified audiologist, otolaryngologist or physician? 5. Are all hearing conservation test results made available to affected employees? 6. Is a system in place for employee notification of sound levels above the action level? 7. Does the company have a person designated to administer the hearing conservation program? If so, please provide the contact name: Housekeeping Policy 1. Does the company have documented general guidelines for keeping a clean jobsite? Ladder Safety Policy 1. Are exposed employees property trained on ladder safety? 2. Does the ladder safety policy document common work rules regarding the proper type, use and limitations of ladders? Manlift, Scissor Lift and Forklift Safety Policies 1. Are appropriate measures taken to inspect equipment (daily if powered industrial truck)? 2. Does the policy include how to document equipment inspections? 3. Are employees trained in equipment operation prior to use? 4. Are employees who operate powered industrial trucks (i.e. Forklift, rough terrain forklift, etc) appropriately certified prior to use? Trenching/Excavation Safety Policy 1. Does the safety policy cover adequate barrier protection for remotely located excavations? 2. Does the safety policy cover proper installation/removal of shoring system supports (if applicable)? 3. Does the safety policy cover requirements for protective systems (ex. Sloping, benching, shielding, shoring)? 4. Does the safety policy cover determination of soil type by visual/manual testing? 5. Does the safety policy cover fall protection on a trenching/excavation site? 6. Does the safety policy cover stability of adjacent structures? 7. Does the safety policy cover protection from hazards associated with water accumulation? 8. Are measures in place for a competent person inspection every day prior to start of work, after a rainstorm or other hazard increasing occurrence? 9. Does the safety policy cover procedures for identification of possible hazardous atmospheres? B-5 Attachment B YES NO N/A 10. Does the safety policy cover procedures for proper access and egress? 11. Does the safety policy cover procedures for safe handling of underground utilities? Scaffolding Safety 1. Are measures in place to ensure oversight of scaffold use by a competent person? 2. Does the safety policy cover falling object protection? 3. Does the safety policy cover safe use of scaffolding? 4. Does the safety policy cover safe access of scaffolding? 5. Does the safety policy provide criteria for supported scaffolds and/or suspension scaffolds? 6. Does the safety policy cover procedures for scaffold platform construction? 7. Does the safety policy cover policies on safe capacity for scaffolds? Crane/Rigging Safety 1. Prior to use, is appropriate training provided to persons responsible for use and maintenance of cranes and rigging? 2. Does the safety policy cover fire protection equipment requirements? 3. Are all slings, chains, rope, etc inspected prior to and during use? 4. Is all other crane/rigging equipment inspected prior to and during use? 5. Does the safety policy cover measures to avoid electrical contact? 6. Do employees use appropriate hand signals while using crane/ rigging equipment? 7. Are appropriate procedures in place for required annual inspections of the hoisting machinery by a competent person recognized by the Department of Labor? Language of Policies 1. Is all signage written in language(s) understood by all employees? 2. Are all policies translated into the language of the workforce? Please include with the completed survey, electronic copies of the following items: 5. OSHA 300 and 300A logs for the current year-to-date and the past 3 calendar years. 6. EMR verification letter for the current year-to-date and the past three years from your company’s insurance provider. If EMR verification is not applicable, please provide a letter stating such from your company’s insurance provider. 7. Company safety policy. Additional Remarks: COMPLETED BY: Signature: Printed: Title: Date: B-6 Attachment C Contractor Quality Pre-qualification Survey Company’s Legal Name: Street Address: City, State, and Zip: Quality Control Manager: Telephone: Fax: E-Mail Address: 1. Does the company have a full time Quality Manager? Yes No Part time? Yes No a. If yes, please list. Name: Title: 2. Does the company have a written Quality program? Yes No 3. Is the company LEEDS Certified? Yes No 4. Does the company have experience with LEEDS projects? Yes No 5. Does the company have a Quality orientation program for new hires? Yes No 6. Does the company hold jobsite quality meetings for field supervisors? Yes No a. If yes, how often? Weekly Bi-weekly Monthly Less often 7. Does the company conduct and document weekly site quality meetings? Yes No 8. Does the company conduct and document weekly site quality inspections? Yes No 9. By title, who will be responsible for supervising quality while on our work site? 10. Have the company’s site quality supervisors received formal quality training? Yes No a. If yes, please list. 11. Does the company have a program of progressive discipline for those who violate quality rules? Yes No 12. What is the company’s Quality Personnel to Craftsperson ratio? C-1 Attachment C 13. What is the company’s Journeyman to Trainee/Apprentice ratio? 14. Does the company have a Certified Training/Apprentice program? Yes No a. If so, what is the name of your Certified Training program? 15. Does the company have an Inspection & Test Plan (ITP) program? Yes No 16. Has the company paid for any quality defects and/or rework during the last three years? Yes No If yes, explain: 17. Does the company have a program that tracks rework? Yes No 18. What is the company’s Cost of Rework Rate? Cost of Rework Rate (CRR) = Total Direct Cost of Rework/Actual Construction Cost 19. Please list all certifications held by the company. Please include with the completed survey an electronic copy of the company’s Quality Control Program. Additional Remarks: COMPLETED BY: Signature: Printed: Title: Date: C-2
"Bowen Supplier Pre-Qualification 06-2010"