sub-contractor pre-qualification questionnaire for ... - STV Group, Inc.

ev .6.12.2013STV Construction, Inc.Sub-contractor Prequalification QuestionnaireNYCHA Project: Interior Stairs Replacement at Whitman Houses ST-2PROJECT DESCRIPTION:Replacement in kind of the metal pan stairs at (10) – six story high buildings located on the grounds of the Whitman Houses, Brooklyn, NY. In general,the work includes but is not limited to:- abatement of asbestos containing materials and lead paint items;- the provision of all temporary scaffolding, rigging and sidewalk bridging including a system of temporarystairs available to residents while the permanent stairs are being replaced;- temporary safety and security protection of areas affected by the work- removal and replacement of existing concrete filled, four sided metal pan stairs;- replacement of the exterior curtain wall;- replacement of interior metal and glass frames, partitions and doors;- restoration of all areas disturbed by construction and new finishes at public areasBusiness Applicant NameTIND/B/A or Trade Name (if any)Applicant must attach a copy of certificate of assumed name filed with county clerk. yes noYears in business under present name:Type of Organization: Corporation State and Date of Incorporation:Limited Liability Company (LLC)State and Date formed:Partnership General Limited Limited Liability (LLP)Sole PartnershipOtherUnder what other names has your company operated?Page 1 of 14

ev. 6.12.2013If applicable, provide the names, locations, ownership and operations of Applicant's parent, affiliates and subsidiaries.Provide date when present management assumed control of the ApplicantApplicant's Business AddressMailing Address (if different)Delivery Address (if different)Office Phone # Mobile Phone # WebsiteContact Person Title EmailProvide copy of Applicant's Certificate of Good Standing from state of registry. yes noProvide a response to all questions. Attach additional sheet(s) of paper to this application as needed to respond fully to all questions.Page 2 of 14

ev .6.12.20131. Experience and Reference Verification: List a minimum of five (5) projects, two (3) of which should be of a minimum value of $10 million each and completed in the last five (5) years.Include any projects with relevant experience in replacing multi-story metal pan stairs and special scaffolding systems. Provide verifiable references.Client Company / Agency / Authority andProject Name/ Architect of Record/ CM orPM/Prime or SubContractorPM's NamePROJECT EXPERIENCE LISTDescription of WorkLocationStart/Finish DatesFirm's Contract Value $Project Type: GPM/ FixedPrice/ Cost PlusClient Reference: ContactName, Title and TelephoneNumber12345Indicate the type of projects your firm is most comfortable and experienced with:List trades the Applicant has sef-performed in the past:List trades the Applicant subcontracts:Provide a response to all questions. Attach additional sheet(s) of paper to this application as needed to respond fully to all questions.Page 3 of 14

ev. 6.12.20132. Capacity(a) Provide a letter on surety letterhead confirming potential bonding capacity for:Single contracting limit: $ Aggregate bonding limit: $Surety Company Name:Surety Contact & phone # Letter attached: Yes NoHow long has Applicant been with surety?What conditions are imposed or restrictions exist on Applicant's bonding capacity?Are there any disputes with owners, contractors, subcontractors, or suppliers on any bonded job?if yes, explainif yes, explainHave you ever had a bond request denied, or had your bond credit terminated?if yes, explainList names and contact information of all other surities who have written bonds for you during past 5 years.(b) Attach a Work in Progress Schedule1Are there any liens for labor or materials filed against the Applicant? no yes explainProvide a complete work-in-progress schedule for all work under contract, showing % complete, notice of any claims in progress, resolved or anticipated.Client Company / Agency / Authority and Prime or SubDescription of WorkFirm's Contract Value $ Client Reference: ContactProject Name/ Architect of Record/ CM or ContractorLocationProject Type: GPM/ Fixed Name, Title and TelephonePM/PM's NameStart/Finish DatesPrice/ Cost PlusNumber2345Indicate Applicant's current backlog (in $)Provide a response to all questions. Attach additional sheet(s) of paper to this application as needed to respond fully to all questions.Page 4 of 14

ev .6.12.20133. Financial Strength and Stability(a) Provide a current year and 3 prior years CPA-audited financial statements, inclusive of Auditor's notes.∙ Current ratio (current assets / current liabilities)∙ Debt to equity ratioProvide name and contact information of Applicant's accounting firm.For how many years has this CPA firm audited Applicant's statements?What is Applicant's largest project awarded?Projects currently in production (in$)?How often does Applicant prepare costs to complete for: labor, material, equipment?(b) Pre-Qualification requires business credit lines with a minimum total of $750,000.00. Provide details below supporting your firm's credit information.∙ Provide a letter from financial institution regarding line of credit∙ Alternative or equivalent measures may be consideredName and Address of Lending InstitutionAmount of Credit Line% Credit Remaining( c ) List three supplier reference for work completed in the last two years:Firm / Products Supplied Contact Person / Title Telephone NumberProvide a response to all questions. Attach additional sheet(s) of paper to this application as needed to respond fully to all questions.Page 5 of 14

ev. 6.12.20134. InsuranceA. General Requirementsa. Are Applicant’s policies written by companies authorized in the State of New York?b. Are Applicant’s policies written by companies with a rating of no less than A.M. Best A:X? If less, what is the rating?B. General Liability (GL)a. Required: $5M occurrence/$5M aggregate. The general aggregate limit MUST apply on a per project basis.b. Does GL policy include 5 Borough exclusion? If yes, can Applicant have exclusion waived by endorsement (provide copy of endorsement).c. Does GL exclude coverage for mold, asbestos, lead? If yes, provide details.d. Does GL exclude coverage for injuries to employees of Contractor and/or employees of Subcontractors? If yes, provide details.e. Does GL contain any height restrictions? If yes, provide details.f. Does GL provide coverage for ongoing AND completed operations in a minimum of 3 years? If no, provide details.g.Can Applicant name STV and NYCHA as additional insureds on primary, non-contributory basis, without requirement that Applicant’s Insurer approve? If no,provide details. Additional Insured status must apply to ongoing AND completed operations.h.i.Does GL coverage include waiver of subrogation in favor of Additional Insureds? If no, Applicant must obtain a waiver by endorsement inorder to be considered.GL must include coverage for: Premises-Operations, Independent Subconsultants, Broad Form Property Damage, Contractual Liability, XCU,and personal and advertising injury.C. Workers Compensationa. Does Applicant have Workers Compensation Insurance as per New York statutory requirements?b. All Workers Compensation policies must include a waiver of subrogation. Provide evidence that Applicant can provide this waiver.c.Includes sole proprietorships and officers of corporation who will be performing the work?D. Employers Liability. Limits not less than:a. Bodily Injury by Accident: $1,000,000 Each Accidentb. Bodily Injury by Disease: $1,000,000 Each Employeec. Bodily Injury by Disease: $1,000,000 Policy LimitPage 6 of 14

ev .6.12.2013E. Automobile Liabilitya. $1M Per Accident/Combined Single Limitb. Must apply to “any auto”c.d. For Applicants involved in the transportation of hazardous material, include copies of the following endorsements: MCS-90 and ISO-9948.F. Contractor Pollution Legal Liability.a. Does contractor have pollution coverage?b.c. If yes, are limits at least $5M/claim or occurrence? If no, what are limits of insurance?d. Does contractor require subcontractors performing abatement work to provide pollution coverage? In what amount?e.G. Builders RiskH. SubcontractorsIf Applicant does not have any Owned autos, provide evidence of coverage for “non-owned” and “hired” autos as stand-aloneauto policy or endorsed onto GL policy.If yes, is coverage claims or occurrence based? If claims-made, coverage must include minimum of 3 years of “tail” coverage.Provide evidence of such coverage.Can Applicant name STV and NYCHA as additional insureds on primary, non-contributory basis for ongoing and completedoperations?a. Does Applicant typically provide a Builders Risk policy for its work?b. Can Applicant provide Builders Risk in 100% amount of contract price?a.b.c.What are Applicant’s typical insurance requirements for its subcontractors?Does Applicant require certificate of insurance from subcontractor before it commences work?How does Applicant enforce insurance requirements on its subcontractors?Provide a response to all questions. Attach additional sheet(s) of paper to this application as needed to respond fully to all questions.Page 7 of 14

ev. 6.12.20135. Licenses:If the work of this subcontractor requires a New York City, State, or Federal license or certification under governing law, provide copies of all required licenses.6. NYC VENDEX and Business Integrity:The Mayor's Office of Contract Services (MOCS) may review data contained in the NYC Vendex system as part of its review of this application.Visit the MOCS website at: http://www.nyc.gov and search for "Vendex."As part of Pre-Qualification, the submittal of a Vendex questionnaire to the Mayor's Office of Contract Services (MOCS) is required.a. Does your firm presently have a Vendex questionnaire submitted to MOCS Yes Noless than three (3) years old? If "no", a new application to Vendex withnotification to CM is required.Date submitted toMOCS:b. Have there been changes to your business since you filed the Vendex Yes Noquestionnaire? If "yes", an amended questionnaire to Vendexwith notification to CM if required.c. If Vendex filing is current, is a Certification of No Change attached to Yes Nothe application?Provide a response to all questions. Attach additional sheet(s) of paper to this application as needed to respond fully to all questions.Page 8 of 14

ev .6.12.20137. Safety:(a) Workers Compensation Experience Information: List the Interstate Workers Compensation Experience Modification Rate (EMR).Year Workers Compensation Insurance Carrier Policy Number EMRIn addition to listing your EMR information in the above chart, also provide this information on your insurance carrier or broker's letterhead.Verification Provided Yes No(b) Applicant's Safety Programa. Does Applicant employ full-time safety representatives? If yes please provide names and qualifications:b. Does Applicant have a formal Safety Program and Manual? If Yes please attach copy.c. Does Applicant require subs to have formal written Safety Program and Manual?d. Does Applicant employ full-time QA/QC representatives? If yes please provide names and qualifications:e. Does Applicant have a formal QA/QC Program and Manual? If Yes please attach copy.f. Does Applicant require subs to have formal written QA/QC Program and Manual?g Does the Applicant firm have an alcohool/drug free workplace policy, inluding pre-employment and random drug screening?h Does Applicant conduct project safety meetings?i Does Applicant conduct site-safety inspections?j Provide copies of OSHA 300 Logs for most recent 3 years.Provide a response to all questions. Attach additional sheet(s) of paper to this application as needed to respond fully to all questions.Page 9 of 14

ev. 6.12.20138. Within the past five (5) years, or the period stated below has the applicant, its owners, officers, principals or related companies:(a) been cited for violations of Labor Law 220 or Davis Bacon Wage violations? Yes No(b) been cited by OSHA or other safety violations including fatalities? Yes No(c) been defaulted on any contract? Yes No(d) engaged in any claims, litigation or alternate dispute resolutionYes Noproceedings in the last 5 years? If yes, explain in detail.(e) are there presently any judgements, suits, claims, arbitration matters,Yes Noor similar actions outstanding against the Applicant, its officers, principalsor related companies? If yes please explain in detail.(e) has Applicant commenced any claims, litigation, or alternate disputeYes Noresolution proceedings against a Client, Owner, or Construction Managerwith regard to construction contracts/projects in the last 5 years? If yesplease explain in detail.(f) are there presently any liens for labor or materials filed against the Applicant?Yes No(g) Has Applicant, any related firm, or any other firm with which Applicant’sYes Noowners or principals were substantially involved in the past 5 years, everfailed to complete any work awarded or been terminated for cause? If yes,provide details.(h) Has a surety ever finished one of your construction projects? If yes, provideYes Nodetails.(i) been suspended, disqualified, or barred from bidding with any Yes Noowner / agencies?(j) been subject to any changes in ownership, control or management ? Yes No(k) ever failed in business, , petitioned in bankrupcy , compromised withYes Nocreditors, defaulted on a contract or cause a loss to a surety?(l) ever been held in violation of of any local, satate or federal licensing orYes Noother regulation violations?If answered 'yes' to any of the above questions, please attach full explanation and details.Provide a response to all questions. Attach additional sheet(s) of paper to this application as needed to respond fully to all questions.Page 10 of 14

ev .6.12.20139. Significant personnel:A. List the principals, owners, and other key personnel of the firmNameTitle Ownership %B. Firm Staffing / SizePlease list the number of:Supervisory staff:Trades persons:Administrative staff:C. Proposed key personnel for the projectNamePositionRelevant ExperienceResume AttachedY/NProject ExecutiveProject ManagerProject SuperintendentAssistant ProjectManager/SuperintendentSite Safety MangerSchedulerOtherProvide a response to all questions. Attach additional sheet(s) of paper to this application as needed to respond fully to all questions.Page 11 of 14

ev. 6.12.201310. Trade Union OR Apprenticeship Program Affiliation:List any trade union OR Apprenticeship Program affiliations your firm may have:11. Affirmative Action Plan and/or Apprentice Programs:Firms must demonstrate participation in a New York State approved apprenticeship program that has at least one graduate and/or having an established and recognizedaffirmative action plan. If yes, supply supporting documentation.Examples of supporting documentation are: a letter from the New York State Department of Labor stating that your firm has participated in an approved apprenticeprogram that has met the criteria listed above; or a copy of a signed union contract.Apprenticeship programs must be appropriate to the work to be performed under the proposed categories of work.YesNoProvide a response to all questions. Attach additional sheet(s) of paper to this application as needed to respond fully to all questions.Page 12 of 14

ev .6.12.201312. Enterprise Programs:IT IS THE OBJECTIVE OF NEW YORK CITY HOUSING AUTHORITY (NYCHA) TO ENSURE THAT ALL BUSINESSES HAVE AN EQUAL OPPORTUNITY TO PARTICIPATE IN ALLASPECTS OF NYCHA'S PROCUREMENT OF ALL GOODS AND SERVICES WITHOUT REGARD TO RACE, COLOR, RELIGION, MILITARY SERVICE, NATIONAL ORIGIN, SEX,AGE, DISABILITY, MARITAL STATUS, OR SEXUAL ORIENTATION OF THE OWNERS, PARTNERS OR STOCKHOLDERS. FURTHER, NYCHA IS COMMITTED TO ACHIEVEMAXIMUM PARTICIPATION OF MINORITY, WOMEN, AND SMALL BUSINESS ENTERPRISES (MWSBEs) IN NYCHA PROCESS OF AWARDING CONTRACTORS FOR GOODSAND SERVICES.PLEASE CHECK HERE IF THE FOLLOWING DOES NOT APPLY TO YOUR BUSINESS1 IS THE BUSINESS AT LEAST FIFTY-ONE (51%) OWNED, CONTROLLED AND OPERATED BY (or in case of publicly owned business at least fifty-one of thestock owned by) CITIZENS OR PERMANENT RESIDENT ALIENS WHO ARE (Please Check All That Apply):ASIAN / PACIFIC - ASIANS AND PACIFIC ISLANDERS AMERICAN PERSONSHAVING ORIGINS IN ANY OF THE FAR EAST COUNTRIES.SOUTH EAST ASIA, THE INDIAN SUBCONTINENT OR THEPACIFIC ISLANDSBLACK -HASIDIC JEWSWOMENBLACK PERSONS HAVING ORIGINS IN ANY OF THEBLACK AFRICAN RACIAL GROUPSHISPANIC - HISPANIC PERSONS OF MEXICO, PUERTORICAN, DOMINICAN, CUBAN, CENTRALAMERICAN OR SOUTH AMERICAN DESCENTOF EITHER INDIAN OR HISPANIC ORIGIN,REGARDLESS OF RACENATIVE AMERICAN - NATIVE AMERICAN OR ALASKANNATIVE PERSONS HAVING ORIGINS INANY OF THE ORIGINAL PEOPLES OFNORTH AMERICAN2 CERTIFIED AS MBE, WBE, SBE OR ROB: IS THE BUSINESS CERTIFIED AS ANY OF THE FOLLOWING TYPES OF BUSINESS BY A NEW YORK STATEGOVERNMENT AGENCY OR AUTHORITY? IF YES, ATTACH COPIES OF ALL SUCH CERTIFICATIONS.MINORITY - OWNED BUSINESS ENTERPRISE (MBE) YES NO SMALL BUSINESS ENTERPRISE (SBE) YES NOWOMEN - OWNED BUSINESS ENTERPRISE (WBE) YES NO RESIDENT OWNED BUSINESS (ROB) YES NOProvide a response to all questions. Attach additional sheet(s) of paper to this application as needed to respond fully to all questions.Page 13 of 14

ev. 6.12.2013A material false statement or omission made in connection with this application is sufficient cause for denial of the application or revocation of a priorapproval thereby precluding the business applicant from performing work for STV Construction, Inc.Application must be signed by the President or CEO of the applicant firm.I, , being duly sworn, state that I am of(Name, print) (Title) - President or CEO (Business Applicant name)and that I have read and understood the questions contained in this application. I certify that to the best of my knowledge the information given in responseto each question and the appendices is full, complete and truthful. I acknowledge that STV Construction, Inc. may, be means it deems appropriate,determine the accuracy and truth of the statements made in the application. I recognize that all the information submitted is for the express purpose of inducingSTV Construction, Inc. to pre-qualify a contractor and does not assure that it will be deemed qualified. I authorize STV Construction, Inc.to contact any entity named in the application for the purposes of verifying the information supplied by the applicant.(Signature)(Date)Sworn to before me this day of 2013Notary PublicCompleted applications, with supporting documentation, are required for your firm to be considered for the pre-qualification list.Applications must be bound and tabbed per the 12 items above and hand delivered by no later than July 10, 2013 to:STV Construction, Inc.Field Office31 Fleet Walk, Apt. 3HBrooklyn, NY 11201Attention: Michael Colban, Project ManagerPh. (347) 586-0722Michael.Colban@stvinc.comProvide a response to all questions. Attach additional sheet(s) of paper to this application as needed to respond fully to all questions.Page 14 of 14