FORM CCDB2 EXPRESSION OF INTEREST BUILDING CONTRACTOR SERVICES Building Contractors submitting an Expression of Interest (EOI) must complete this form in full. No additional information or supporting documentation is required, and therefore no attachments or promotional materials are to be referenced or submitted. Failure to provide any of the required information will exclude the submitting Contractor from inclusion of the GU Suppliers Register. Construction Contracts (place an X against each contract type and value for which you wish to be registered) Traditional Lump Sum Fixed Price Contracts Design & Construction Management Contracts $100,000 to $250,000 $250,000 to $1,000,000 $1,000,000 to $2,000,000 $2,000,000 to $5,000,000 Over $5,000,000 Less than $5,000,000 $5,000,000 - $10,000,000 $10,000,000 - $25,000,000 $25,000,000 - $50,000,000 Over $50,000,000 Contractor Details Trading Name: ....................................................................................................................ABN: ......................................................... Registered Name (if varies from Trading Name): ................................................................................................................................. Street Address: ..................................................................................................................................................................................... Mailing Address: ................................................................................................................................................................................... Phone No: (07) ......................................Fax No: (07)........................................Website: .................................................................... Resources (insert number): Managers ..........Operational..........Estimators..........Construction Operatives..........Trainees......... Principal Contact Name: ............................................Position: .................................Email: ............................................................. QBSA Licence Licence No.: ........................................... Licence Class/es: ................................................................................................................... Qld Government Prequalification (PQC) Do you have a PQC registration; Yes No Registration No.: ............................. Level Attained: 1 2 3 4 Quality Management System (QMS) Have you implemented a Quality Management System; Yes No . If Yes, indicate the current status of your QMS below; Self Assessed 2nd Party Certified 3rd Party Certified Awaiting Certification Awaiting 3rd Party Audit Environmental Management System (EMS) Do you have a certified EMS Yes No ; If No, have you applied for and awaiting 3rd party certification Yes No Memberships of Industry Associations/Institutes Queensland Master Builders Yes No ; Australian Institute of Building Yes No ; Other ........................................... Professional Indemnity Insurance (for Contractors wishing to undertake D&C Contracts, $5m min. cover required) Insurer: ....................................................Policy No: .............................................Value of Cover: $..........m Excess: $..................... Public Liability Insurance ($10m min. cover required) Insurer: ...................................................Policy No: ..............................................Value of Cover: $..........m Excess: $................... CCDB2 Page 1 of 2 FORM CCDB2 Workers Compensation Insurance WorkCover Policy No: .......................................................................................................................................................................... Relevant Experience Indicate the number of projects undertaken by your company in South East Queensland within the past five (5) years in the following categories; Project Type < $0.5m $0.5–1m $1 - 2m $2–5m $5–10m $10-20m $20-50m >$50m University Administration University Academic University Science/Research Other Research Institutions TAFE Secondary Education Health (excl. Aged Care) Other Government Projects Food & Beverage Student Accommodation Sporting Facilities Referees Provide details of a minimum of three (3) Project Client referees for whom you have undertaken projects included in the table above in the past three (3) years who may be contacted at the discretion of the University. At least one reference from an Educational sector client is desirable. Client Details Project 1 Project 2 Project 3 Project 4 Referee Name Client Organisation Position in Organisation Contact Phone No. Project Type Project Value Preferred Project Locations (place an X against the campuses on which you would prefer to undertake projects) Nathan Mt Gravatt South Bank Logan Gold Coast All campuses Declaration I, ..............................................................(name) on behalf of.................................................................................(insert trading name of Contractor) certify that I have read and understood the GU Guide to Building Contractors Submitting an EOI, that the above particulars are true and correct and that I am authorised to provide this information to Griffith University in support of this EOI to provide building contractor services to GU. I acknowledge that the submission and acceptance of this EOI for inclusion on the GU Register of Approved Suppliers does not constitute an entitlement to be invited to submit tenders or proposals or be awarded a Contract for the provision of contractor services on GU projects. Signature: .............................................................................Position: ................................................................Date: ....../......./....... CCDB2 Page 2 of 2