BIDDER QUALIFICATION QUESTIONNAIRE

BIDDER QUALIFICATION QUESTIONNAIRE
APPLICANT GENERAL INFORMATION
The information must be provided on this form. A "see attached" response is NOT acceptable. The Questionnaire's contents are confidential and used solely to determine the applicant's qualifications. Please fill out this form "on-screen" and retain an electronic copy for future reference.
PROJECT
LOCATION
APPLICANT CONTACT INFORMATION
COMPANY
ADDRESS
CONTACT PERSON #1 (Exec/PM)
EMAIL

Confirmation Emailexample@example.com
PHONE
Format: (000) 000-0000.
CONTACT PERSON #2 (During Bid Time)
EMAIL
example@example.com
PHONE
Format: (000) 000-0000.
COMPANY'S WORK SPECIALTY
Which subcontractor trade(s) and/or specialty items(s) are you interested in bidding?
COMPANY PROFILE
Years performing work specialty:
Years in business under the present name:
Avg. annual value of work completed in the past 3 years
Value of work in place in previous year:
Years performing work specialty:

If "Yes" enclose a copy of your certifications(s)

Rows	Yes	No	If "yes" provide an explanation
Is your Company rated with Dunn and Bradstreet?
Is your Company a certified MWDBE Enterprise?
Is your Company a "Drug-Free Workplace"?
In the past 3 years, has your Company had any OSHA fines?
In the past 5 years have you had any jobsite fatalities?
In the past 5 years, have you failed for bankruptcy?
In the past 5 years, have you failed to complete a contract?
Any pending claims or judgments against your Company?
Do you have any past or present objections to working with Ajax's personnel, systems, or contract documents?

APPLICANT GENERAL INFORMATION (Continued)
CONTRACTOR LICENSING
Provide license information for Primary Qualifying Agent(s) as issued by the State Licensing Beard applicable to the project:
FIRST NAME
MIDDLE
LAST NAME
LICENSING BOARD
LICENSE TYPE
LICENSE NUMBER
EXPIRATION DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Attach copy of license to this application

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FIRST NAME
MIDDLE
LAST NAME
LICENSING BOARD
LICENSE TYPE
LICENSE NUMBER
EXPIRATION DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Attach copy of license to this Application

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COMPANY'S PERSONNEL AND MANPOWER
List names of key personnel proposed for assignment to this project. Attach a resume or summary of experience for each person
PROJECT EXECUTIVE
PROJECT MANAGER
PROJECT SUPERINTENDENT
Indicate total number of full time employees currently on your company's direct payroll
Managers/Supervisors
Skilled Craftsmen
Unskilled Labor
List other sources of skilled/unskilled labor
What percentage of work do you typically perform with your company's own forces?
Will you subcontract any portions of the work on this project?
If yes, which activity(s)
If yes, approx. % of labor
FINANCIAL INFORMATION
FORM W-9 FOR APPLICANT
Applicant's TIN #
Please submit a signed copy of your Company's form W-9 Taxpayer Identification Number and Certification

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FINANCIAL STATEMENT
Please provide a financial statement for confidential review by SkyBuilders. Include reasonably current data on the Company's general financial condition A summary income statement balance sheet is preferred

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I HEREBY CERTIFY THAT THE PRECEDING INFORMATION IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE:
Signature: (By an Authorized Person or Company Officer)
COMPANY
PRINT NAME AND TITLE
DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
TYPE OF FIRM
BIDDER QUALIFICATION QUESTIONNARIE
EXHIBIT 1 PROJECT EXPERIENCE AND REFERENCES
HISTORY OF COMPLETED PROJECTS
Provide a separate list of major projects completed within the past three (3) years. Indicate dollar value of each subcontract. Include projects of similar type, size, and complexity as this project. Include completed SkyBuilders projects,
1. List two (2) of your Company's most significant projects currently under construction.
2. Select either the Project Manager or General Superintendent of the Contracting Agency as a current reference.
3. Verify the contact information for each reference, making sure that e-mail addresses and telephone numbers are current and correct. Invalid contact information will delay the prequalification process.

Current Project #1

Rows	Description
Contracting agency?
Location:
Project % Complete:
Scheduled completion date:
Scope of your subcontract
Value of your subcontract:
Reference Name:
Reference Title (PM or GS)
Reference Email:
Reference Cell Phone:

Current Project #2

Rows	Description
Contracting agency?
Location:
Project % Complete:
Scheduled completion date:
Scope of your subcontract
Value of your subcontract:
Reference Name:
Reference Title (PM or GS)
Reference Email:
Reference Cell Phone:

SKYBUILDERS PROJECTS

List the name of any current SkyBuilders project(s) and/ or most recently completed SkyBuilders project(s)
SkyBuilders Project #1
SkyBuilders Project #2
BIDDER QUALIFICATIONS QUESTIONARIE
EXHIBIT 2 - BONDING REFERENCE
(Step 1: Subcontractor to complete this top portion and forward to Bonding Agent)
SUBCONTRACTOR
Please provide the following information:
To (Bonding Agent)
Agent's Person
Email
example@example.com
Phone
Format: (000) 000-0000.
Fax
FROM: (Subcontractor)
Inquiry is authorized by: Name:
Name
Title
Email
example@example.com
Phone
Format: (000) 000-0000.
Fax
(Step 2: Bonding Agent to complete this bottom portion and return to Subcontracter
BONDING AGENT
Please provide the following information:
1. Subcontractor's Surety Company
2. Surety's Best Rating
3. Treasury Listing Underwriting Limit
Bonding Limit
Capacity
Now Bonded
Comments
Signature of Agent
Print Name & Title
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
BONDING AGENT: Please return this completed Exhibit 2 form to the Subcontractor at the above address.

The contents of this form are confidential and used solely to determine the applicant's qualifications Your prompt response to this inquiry is greatly appreciated.
EXHIBIT 3: INSURANCE REFERENCE
(Step I: Subcontractor to complete this top portion and forward to Insurance Agent)

SUBCONTRACTOR, Please provide the following information:
TO: (Insurance Agent)
Agent's Contact Person
Email
example@example.com
Phone
Format: (000) 000-0000.
Fax
FROM: (Subcontractor)
Name
Title
Email
example@example.com
Phone
Format: (000) 000-0000.
Fax
(Step 2: Insurance Agent to complete this bottom portion and return to Subcontractor)

INSURANCE AGENT, Please provide the following information:

1. Can the subcontractor meet these minimum project requirements?

COMPREHENSIVE GENERAL LIABILITY

Rows	Min. Limit / Each Occurrence	Min. Limit / General Aggregate
Subcontracts up to $2,000,000
Subcontracts over to $2,000,000

COMPREHENSIVE AUTOMOBILE LIABILITY

Rows	Min. Limit / Each Occurrence	Yes / No
Body Injury
Property Damage

WORKERS COMPENSATION

WORKERS COMPENSATION

Rows	Yes / No
Worker's Compensation $100,000 (Each Accident)
Worker's Compensation $100,000 (Disease-Each Employee)
Worker's Compensation $500,000 (Disease-Policy Limit)

CRANE SERVICES LIABILITY

Crane Services Not Applicable

For Cranes with a Maximum Lifting Capacity Exceeding 35 tons

Rows	Yes / No
Bodily Injury and Property Damage: Minimum Limit: $10,000,000 Each Occurrence
Personal and Advertising Injury: Minimum Limit: $10,000,000
Products-Completed Operations: Minimum Limit: $10,000,000 Aggregate
General Aggregate: Minimum Limit: $10,000,000
Rigger Liability: Minimum Limit: $5,000,000, unless included in required limits indicated above.

For Cranes with a Maximum Lifting Capacity of 35 tons or Less

Rows	Yes / No
Bodily Injury and Property Damage: Minimum Limit: $5,000,000 Each Occurrence
Personal and Advertising Injury: Minimum Limit: $5,000,000
Products-Completed Operations: Minimum Limit: $5,000,000 Aggregate
General Aggregate: Minimum Limit: $5,000,000
Rigger Liability: Minimum Limit: $5,000,000, unless included in required limits indicated above.

Please verify subcontractor's workers' compensation experience modifier for the last three (3) years:
2016
2018
2019
Signature of Agent
Print Name and Title
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
INSURANCE AGENT: Please attach a Certificate of Insurance and return this completed Exhibit 3 form to the Subcontractor at their above address

The contents of this form are confidential and used solely to determine the applicant's qualifications Your prompt response to this inquiry is greatly appreciated.
BIDDER QUALIFICATIONS QUESTIONARIE

Review Bidder Qualifications Questionnaire contents carefully before sending to SkyBuilders USA. Make sure it is complete, and that it contains all required information as listed below. Hold until all information is received No partial submittals please. Mark an "X" in check box next to all enclosed items:
1. Copy of Minority Business Certification(s) (if applicable
2. Copy of License for Qualified Business Organization - (if applicable
3. Copy of License(s) for Primary Qualifying Agent - (if applicable
4. Form W-9, "Request for Taxpayer Identification Number and Certification."
5. Current Financial Statement. A summary income statement/balance sheet is preferred. (See page 6, "Financial Statement"
6. Exhibit No. 1. "Project Experience and References" - with verified contact information.
7. "History of Completed Projects" - Provide a separate list of projects completed within the past three (3) years. Indicate the dollar value of each subcontract. Include SkyBuilders projects.
8. Exhibit No. 2. "Bonding Reference" - completed, signed, and dated by Bonding Agent.
9. Exhibit No. 3. "Insurance Reference" - completed, signed, and dated by Insurance Agent.
10. Insurance Certificates with effective / expiration dates and limits for general liability, workers' compensation, and automobile liability coverage.
NOTE: Include this checklist with your submittal
Should be Empty:

BIDDER QUALIFICATION QUESTIONNAIRE

APPLICANT GENERAL INFORMATION

APPLICANT CONTACT INFORMATION

COMPANY'S WORK SPECIALTY

COMPANY PROFILE

APPLICANT GENERAL INFORMATION (Continued)

CONTRACTOR LICENSING

COMPANY'S PERSONNEL AND MANPOWER

FINANCIAL INFORMATION

BIDDER QUALIFICATION QUESTIONNARIE

EXHIBIT 1 PROJECT EXPERIENCE AND REFERENCES

HISTORY OF COMPLETED PROJECTS

SKYBUILDERS PROJECTS

BIDDER QUALIFICATIONS QUESTIONARIE

EXHIBIT 2 - BONDING REFERENCE

SUBCONTRACTOR

BONDING AGENT

EXHIBIT 3: INSURANCE REFERENCE

WORKERS COMPENSATION

CRANE SERVICES LIABILITY