City of St. Louis Commercially Useful Function (CUF) Review – Part I I General Information 1. Date of Interview: 2. Project Name: 3. Contracting Agency: 4. M/W/DBE Name: 5. Firm Address, City, State, Zip: 6. Name of President/CEO: 7. Telephone: Fax: Cell: 8. MBE E-Mail: WBE DBE 9. Are you certified by the: City of St. Louis State of Missouri Metro (formerly Bi-State) MoDOT Small Business Admin IDOT SLMBC ______YES ______YES ______YES ______YES ______YES ______YES ______YES ______NO ______NO ______NO ______NO ______NO ______NO ______NO 10. What is the principal’s percent of ownership in the company? 11. Who are the officers of the company and their individual ownership in the company: 12. What is your business organization? Partnership Corporation Limited Liability Company 13. What is the age of your company? 14. What is the bonding capacity of your company? 15. What is the financial strength of your company any liens and/or tax problems? Page 1 of 9 7/31/2015 City of St. Louis Commercially Useful Function (CUF) Review – Part I I General Information (cont.) 16. Please list major customers or projects of the business for the last two year (list most recent first). If new business, list previous business references. Customer Telephone Contact Person Type of Project Contract Amount Year ** *** SUB NU SUB NU SUB NU SUB NU SUB NU SUB NU SUB NU SUB NU SUB NU ** Indicate whether you were a (P) Prime Contractor; (JV) Joint Venture; (SUB) Subcontractor *** Indicate Union (U) or Non-Union (NU). II Taxes 1. Current with City Taxing & Licensing Requirements? Yes No (explain) III Insurance 1. Name of Insurance Company 2. Agents Name and Telephone Number 3. Amount of Coverage 4. Type of Coverage 5. Current Certificates for Workmen/s Compensation, General Liability Page 2 of 9 7/31/2015 City of St. Louis Commercially Useful Function (CUF) Review – Part I IV. Bonding 1. Name of Bonding Company 2. Agents Name and Telephone Number 3. Single Limit (per project) Aggregate Limit $ $ 4. Amount currently available $ V. Banking 1. Name and Address of Bank 2. Name and Telephone Number of Account Manager 3. With bank since 4. Current Line of Credit $ 5. Amount in use $ 6. Secured by: Corporate Signature Personal Signature Inventory Other (describe) 7. Terms Rate Accounts Receivable Repayment Page 3 of 9 7/31/2015 City of St. Louis Commercially Useful Function (CUF) Review – Part I VI. Project Information 1. Name of general contractor or prime sub-contractor 2. What is the scope of your contract? Do you have a copy of the contract specifications? 3. Do you understand the contract’s exclusions and liquidated damages clauses? 4. Have you prepared and submitted a schedule of values and unit cost? 5. What is the total dollar amount of your proposed contract? 6. Has your attorney reviewed your proposed contract? 7. Did you bid this work? (Please provide copy of proposal) 8. Does your proposed contract include administrative costs and overhead? 9. Are you required to bond this project? 10. Are you willing and able to bond this project? 11. Do you have a Letter of Intent to perform work or provide services? Yes No 12. What is the expected duration of your contract? Start date End Date 13. Provide a copy of quotes and fax transmittals you received from manufacturers and/or suppliers, if applicable. (This information is required.) Page 4 of 9 7/31/2015 City of St. Louis Commercially Useful Function (CUF) Review – Part I VI. Project Information (cont.) 14. Are you planning to subcontract any of the work? Yes No If so, to which M/W/DBE and/or non M/W/DBE firm(s)? What are the dollars? Proposed Subcontractor M/W/DBE (yes or No) Subcontract Amount 15. Do you have the adequate insurance to perform the work associated with this project? Yes No 16. Will you have a dual check arrangement with General Contractor and/or material supplier(s)? Yes No 17. Are special licenses, certifications, or permits required to perform your scope of work? Yes No Does your firm have the special licenses, certifications, or permits? (If yes, please list) Yes No 18. Are you self performing or in a Joint Venture with another subcontractor? If you are in a Joint Venture with another subcontractor you must attach a copy of the Joint Venture agreement, which should include percentage of Joint Venture, officers of Joint Venture, responsibility matrix and organizational chart. Page 5 of 9 7/31/2015 City of St. Louis Commercially Useful Function (CUF) Review – Part I VII. Project Workforce 1. Have you operated as union non-union both 2. How many tradesmen, by craft, for this project? 3. Who is your project manager for this contract? How long has this person been employed with your firm? 4. What is the estimated weekly total amount of your payroll for this project? 5. What is the total dollar amount you will need to meet your monthly payroll expenses? 6. What is the total dollar amount you will need to fulfill the obligations of your contract? 7. Is the prime contractor or subcontractor assisting you (financially) with your payroll? Page 6 of 9 7/31/2015 City of St. Louis Commercially Useful Function (CUF) Review – Part I VIII. Project Equipment/Supplies 1. List equipment owned by your company and provide insurance, license number and VIN information as appropriate. 2. What equipment will you need to complete your work? 3. List equipment leased by your company that you are planning to use on this project, and answer the following questions regarding your lease arrangement. a. Is this a long term or short term lease? b. Is the lease paid for by company check? (Provide cancelled check and copy of lease agreement.) c. Will equipment be leased from the general contractor or another on-site subcontractor or one of their subsidiaries? d. Is the equipment being leased specialized or scarce? Page 7 of 9 7/31/2015 City of St. Louis Commercially Useful Function (CUF) Review – Part I VIII. Project Equipment/Supplies (cont.) 4. Where will supplies be purchased? DBE WBE MBE Non M/W/DBE 5. Will they be delivered to the job site by the supplier? If not, how will they be delivered and stored? 6. Is the supplier an M/W/DBE listed by you as a subcontractor/supplier? 7. Will the supplier have a drop off point for supplies to be stored on site? IX. Other Contractors Needs 1. Are there any support services needed by your firm to assist you on this project? 2. Are you aware of the programs offered by the BDD office? 3. Have you talked with your (union representatives) in regards to providing operators, carpenters, laborers, etc. on the project? 4. Are you aware of the workforce goals in regards to women and minorities on this project? 5. Are there other barriers to success and or completion of project? 6. Are estimated confirmed? Page 8 of 9 7/31/2015 City of St. Louis Commercially Useful Function (CUF) Review – Part I For Internal Use Only X. Contractor/Subcontractor Analysis XI. BDD Office Page 9 of 9 7/31/2015