SCHEDULE B – FORM OF SUBMISSION
REQUEST FOR EXPRESSIONS OF INTEREST AND STATEMENTS OF QUALIFICATIONS
This document is intended to provide information on the capacity, skill, and experience of the Contractor.
Respondent may supplement information requested with additional sheets if required.
Project Title: Construction Management Services – Grandview Heights Aquatic Complex
Type of Pre-Qualification: Construction Manager at Risk
Project No.: 1220-050-2012-039
Submitted To:
Name:
Kam Grewal, CMA, BBA, Corporate Audit Manager, Acting Purchasing &
Accounts Payable Manager at the following location:
Address:
City of Surrey, City Operations Works Yard, Purchasing Section,
1st Floor, 6645 – 148th Street, Surrey, BC V3S 3C7
Fax:
604-599-0956
E-mail for PDF File:
purchasing@surrey.ca
A. SUBMITTED BY FIRM NAME:
1.
Full Legal Name of Firm
2.
Address
3
Phone No.
4
Email:
Fax No.
B. LEGAL STRUCTURE OF COMPANY:
5.
Corporation
6.
If Corporation/Partnership, year incorporated/organized: ___________________________.
7.
Names and addresses of authorized signatories:
C.
8.
__________
Partnership
__________
Individual
____________
FINANCIAL REFERENCES:
Bank Name:
Location:
Contact Person(s):
Phone No.:
Fax No.
Email:
RFEOI/SOQ #1220-050-2012-039
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9.
Bonding Firms Name:
Address:
Contact Person(s):
Phone No.:
Fax No.
Email:
10.
Insurance:
Insurance Company:
CGL Policy Limit:
$
E&O Policy Limit
$
Contact Person(s):
Phone No.:
11.
12.
Fax No.
Annual value of construction work for the past five years:
20__________
$
20__________
$
20__________
$
20__________
$
20__________
$
List categories of work that your company normally performs with its own forces:
_________________________________
__________________________________
_________________________________
__________________________________
_________________________________
__________________________________
13.
Principal Public Sector CMR projects completed in the past five years. Listed in Appendix “A”. (As
attached)
14.
Similar CMR or related projects completed. Listed in Appendix “B”. (As attached)
15.
Major CMR projects underway as of this date. Listed in Appendix “C”. (As attached)
16.
Key administrative/operational personnel proposed for the project, attach resume of qualifications
and experience: (e.g. Principal in Charge, Project Manager, etc.)
17.
Name:
Title / Position:
_________________________________
__________________________________
_________________________________
__________________________________
_________________________________
__________________________________
Site personnel proposed for the project, attach resume of qualifications and experience: (e.g.
project manager, crew superintendent, etc.). Refer to the additional minimum qualification
requirements indicated in Schedule A.
RFEOI/SOQ #1220-050-2012-039
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Name:
Title / Position:
_________________________________
__________________________________
_________________________________
__________________________________
_________________________________
__________________________________
18.
Describe any capabilities that make your firm uniquely qualified to perform the services for this
project.
19.
Describe your firm’s process for assuring the project cost remains within the scope and budget.
20.
Has your firm or any predecessor firm defaulted on a contract or had work terminated for nonperformance within the last five (5) years? If so, on a separate sheet describe the project, owner,
date and circumstances/reasons.
21.
Customer Service:
Briefly describe your firm’s standards and associated process with respect to response time
regarding resolution of service issues. This includes but is not limited to technical support,
warranty claims, non-conformance and order placement issues.
22.
Technical Support Service:
Provide an overview of your technical support services available (i.e. product assessment,
identification of specification changes and troubleshooting problems).
RFEOI/SOQ #1220-050-2012-039
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23.
Additional Information:
What other information is not requested here but which you think the City should consider in
evaluating your company?
Comments
This Submission is submitted this __________ day of _________________________, 2012.
I/We have the authority to bind the Respondent.
___________________________________
______________________________________
(Name of Respondent)
(Name of Respondent)
___________________________________
______________________________________
(Signature of Authorized Signatory)
(Signature of Authorized Signatory)
___________________________________
______________________________________
(Print Name and Position of Authorized
Signatory)
(Print Name and Position of Authorized
Signatory)
RFEOI/SOQ #1220-050-2012-039
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APPENDIX A
PRINCIPAL PUBLIC SECTOR CMR PROJECTS COMPLETED IN THE PAST FIVE YEARS:
Project Title:
______________________________________________________________
Project Location:
______________________________________________________________
Project Scope:
______________________________________________________________
Contract Value ($):
______________________________________________________________
Completion Date:
______________________________________________________________
Role (ie: General Contractor, Sub): ______________________________________________________________
Name of Owner (or Consultant): ______________________________________________________________
Refer To (Contact):
______________________________________________________________
Telephone/Fax Numbers:
Phone: _______________________
E-Mail of Project Reference:
______________________________________________________________
Project Title:
______________________________________________________________
Project Location:
______________________________________________________________
Project Scope:
______________________________________________________________
Contract Value ($):
______________________________________________________________
Completion Date:
______________________________________________________________
Fax: ______________________
Role (ie: General Contractor, Sub): ______________________________________________________________
Name of Owner (or Consultant): ______________________________________________________________
Refer To (Contact):
______________________________________________________________
Telephone/Fax Numbers:
Phone: _______________________
E-Mail of Project Reference:
______________________________________________________________
Project Title:
______________________________________________________________
Project Location:
______________________________________________________________
Project Scope:
______________________________________________________________
Contract Value ($):
______________________________________________________________
Completion Date:
______________________________________________________________
Fax: ______________________
Role (ie: General Contractor, Sub): ______________________________________________________________
Name of Owner (or Consultant): ______________________________________________________________
Refer To (Contact):
______________________________________________________________
Telephone/Fax Numbers:
Phone: _______________________
E-Mail of Project Reference:
______________________________________________________________
RFEOI/SOQ #1220-050-2012-039
Fax: ______________________
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APPENDIX B
SIMILAR CMR OR RELATED PROJECTS COMPLETED:
Project Title:
________________________________________________________________
Project Location:
________________________________________________________________
Project Scope:
________________________________________________________________
Contract Value ($):
________________________________________________________________
Completion Date:
________________________________________________________________
Role (ie: General Contractor, Sub): ________________________________________________________________
Name of Owner (or Consultant): ________________________________________________________________
Refer To (Contact):
________________________________________________________________
Telephone/Fax Numbers:
Phone: _______________________
E-Mail of Project Reference:
________________________________________________________________
Project Title:
________________________________________________________________
Project Location:
________________________________________________________________
Project Scope:
________________________________________________________________
Contract Value ($):
________________________________________________________________
Completion Date:
________________________________________________________________
Fax: ________________________
Role (ie: General Contractor, Sub): ________________________________________________________________
Name of Owner (or Consultant): ________________________________________________________________
Refer To (Contact):
________________________________________________________________
Telephone/Fax Numbers:
Phone: _______________________
E-Mail of Project Reference:
________________________________________________________________
Project Title:
________________________________________________________________
Project Location:
________________________________________________________________
Project Scope:
________________________________________________________________
Contract Value ($):
________________________________________________________________
Completion Date:
________________________________________________________________
Fax: ________________________
Role (ie: General Contractor, Sub): ________________________________________________________________
Name of Owner (or Consultant): ________________________________________________________________
Refer To (Contact):
________________________________________________________________
Telephone/Fax Numbers:
Phone: _______________________
E-Mail of Project Reference:
________________________________________________________________
RFEOI/SOQ #1220-050-2012-039
Fax: ________________________
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APPENDIX C
MAJOR CMR PROJECTS UNDERWAY AS OF THE DATE OF SUBMISSION:
Project Title:
________________________________________________________________
Project Location:
________________________________________________________________
Project Scope:
________________________________________________________________
Contract Value ($):
________________________________________________________________
Completion Date:
________________________________________________________________
Role (ie: General Contractor, Sub): ________________________________________________________________
Name of Owner (or Consultant): ________________________________________________________________
Refer To (Contact):
________________________________________________________________
Telephone/Fax Numbers:
Phone: _______________________
E-Mail of Project Reference:
________________________________________________________________
Project Title:
________________________________________________________________
Project Location:
________________________________________________________________
Project Scope:
________________________________________________________________
Contract Value ($):
________________________________________________________________
Completion Date:
________________________________________________________________
Fax: ________________________
Role (ie: General Contractor, Sub): ________________________________________________________________
Name of Owner (or Consultant): ________________________________________________________________
Refer To (Contact):
________________________________________________________________
Telephone/Fax Numbers:
Phone: _______________________
E-Mail of Project Reference:
________________________________________________________________
Project Title:
________________________________________________________________
Project Location:
________________________________________________________________
Project Scope:
________________________________________________________________
Contract Value ($):
________________________________________________________________
Completion Date:
________________________________________________________________
Fax: ________________________
Role (ie: General Contractor, Sub): ________________________________________________________________
Name of Owner (or Consultant): ________________________________________________________________
Refer To (Contact):
________________________________________________________________
Telephone/Fax Numbers:
Phone: _______________________
E-Mail of Project Reference:
________________________________________________________________
RFEOI/SOQ #1220-050-2012-039
Fax: ________________________
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