NC State Mann Hall Renovation Prequalification Form

NC State Mann Hall Renovation Prequalification Form

State of North Carolina Prequalification Form for First-Tier Subcontractors under CM at Risk
Pursuant to the statute, this form gathers information about the subcontractors seeking to qualify for the work and provides a general format for the prequalification criteria. Completing this questionnaire does not guarantee prequalification. Evaluation of the submittal shall be performed by the prequalification committee in accordance with GS 143-128.1, 143-135.8 and the State of NC Prequalification Policy.
Submitted to:

Contact Name: David Konopka

CM @ R Firm: Holder Construction Company

Address: 6210 Ardrey Kell Rd. Suite 400

City/State Zip Code: Charlotte, NC 28277

Phone Number: (803)-960-7970

E-mail Address: dkonopka@holder.com
Project:

Name of Project: North Carolina State University Mann Hall Renovation

Project Owner: North Carolina State University

Project Architect: Perkins & Will

Total Project Budget: $49,500,000

Anticipated Bid Date: March 2025

Project Start Date (Approx.): April 2025

Project Duration: Twenty-Four (24) Months
Project Description:

The “Mann Hall Renovation” project includes a complete interior abatement and demolition scope of the existing building on NC State's main campus, followed by construction of fully re-programmed classroom, academic and study spaces, fourth floor laboratory space, and an ESports arena.

To support the re-programming of this building, a new mechanical penthouse will be constructed to feed the 4th floor labs and a new elevator shaft will be installed (in addition to replacing the existing cab within a separate shaft). New electrical and mechanical equipment will be required, including replacing the existing transformer, and new fiber will be pulled from the existing manhole to support Esports needs.

NC State is currently under contract (as part of a separate Mann Hall related project) to replace the exterior glass and perform structural repairs, this scope is scheduled for completion August 2024.
If your firm is interested in prequalifying for this project/phase, please check the box for your trade(s). This is a preliminary list of Bid Packages and may change based on response and qualified bidders.*

01 - Concrete02 - Structural Steel03 - Elevators04 - General Trades
SECTION 1. GENERAL COMPANY INFORMATION
Submitted By (Contacts Name)*

First NameLast Name
Company Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Fax Number
Primary Contact Name*

First NameLast Name
Primary Contact Email Address*
Secondary Contact Name

First NameLast Name
Secondary Contact Email Address
Business Type (check one)*

CorporationPartnershipLimited Liability CompanySole ProprietorJoint Venture
Indicate your NC Statewide Uniform Certification (SWUC):*

Black, African American (B)Hispanic (H)Asian American (A)American Indian (I)Female (F)Socially and/or Economically Disadvantaged (D)NoneOther
If Other, please specify and include Certifying Agency/State
Is your firm HUB Certified?*

YesNo
If yes, please provide copy of HUB Certification.

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Is your firm registered with the State of North Carolina to do business?*

YesNo
Is your firm owned or controlled by a parent or any other organization?*

YesNo
Describe Ownership if Yes:
List all other names your firm has operated as for the past five (5) years (if applicable):

Please provide all North Carolina professional licenses required for you to perform your services. (Please put N/A in extra fields to remain empty.) *

	NC License Number	Name of Licensee	License Limit/Level	State/County/City Privilege License (Provide Copy)
1
2
3
4

Please provide copy of licenses for specific work (if required).

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List your primary scope of work performed on a regular basis:*
List your secondary scope of work performed on a regular basis:*
List any other scope of work you perform:
What type of work do you self-perform?*
What is the total number of employees available for Trade Package which you are prequalifying for?*
What is your anticipated percentage of self-performed work (in-house labor) vs. subcontracting to lower tier Subcontractors (outsourcing) for Trade Package which you are prequalifying for?*
Attach a letter, dated within the last 30 days, from your surety company, signed by their Attorney in Fact, verifying their willingness to issue sufficient payment and performance bonds for this project, on behalf of your firm and the dollar limits of that bond commitment, both single and aggregate. Surety company bond rating shall be rated "A" or better under the A.M. Best Rating system or The Federal Treasury List*

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What is your company's payment & performance bond rate (%)?
Please provide response as a %
Have any Funds been expended by a Surety Company on your firm's behalf?*

YesNo
If yes to the above question, please explain:
The minimum requirements of coverage are listed in Article 34 of the State Construction General Conditions. Firms must indicate that they can provide evidence of insurance coverage, should they be the successful bidder by attaching a copy of their insurance certificate. Workers Compensation Insurance as required by law and Employer's LIability Insurance Coverage with minimum limits of $100,000. Comprehensive general liability with minimum limits of $500,000 per occurrence for bodily injury and $100,000 per occurrence/$300,000 aggregate for property damage. Please attach a copy of your insurance certificate:*

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Is your firm willing to participate in an OCIP/CCIP insurance program if requested by the Owner/CM?*

YesNo
Attach latest balance sheet and income statement, if available, based on company type. Audited statements preferred. If not available, attach a copy of the latest annual renewal submission to the relevant licensing board. (Firm must submit financial data and may clearly indicate a request for confidentiality to avoid this item from becoming part of a public record.)*

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SECTION 2. GENERAL REQUIREMENTS

Experience - Size/Capacity/Workload
List the annual dollar value of construction work the company has performed for each year over the last (3) calendar years (if applicable).*
How many projects do you currently have under contract or in progress?*
What is the total dollar value of your projects under contract/in progress?*
What is the total dollar value of the amount remaining to bill on your current/in progress projects?*
What was your largest job completed?*
What is your current backlog (Dollar Amount)?*
List the three largest contracts currently under contract or in progress, including for each, the name of the project, owner, architect and/or GC/CMR and contact information below.*
List the three largest contracts currently under contract or in progress, including for each, the name of the project, owner, architect and/or GC/CMR and contact information below.
List the three largest contracts currently under contract or in progress, including for each, the name of the project, owner, architect and/or GC/CMR and contact information below.
Will this project be managed and directed from an office in NC? An office in NC is defined as "The principal place from which the trade or business of the bidder is directed or managed," per GS 143-59(c).*

YesNo
Has your company been involved in any judgements, claims, arbitration or mediation proceedings, or suits within the last five years, whether resolved or still pending resolution?*

YesNo
If yes to the above question, please state the project name(s), year(s), case number and reason why:
Are there currently any judgements, claims, arbitration or mediation proceedings, or suits pending or outstanding against your company, its officers, owners, or agents?*

YesNo
If yes to the above question, please state the project name(s), year(s), case number and reason why:
Has your company ever failed to complete work awarded to it?*

YesNo
If yes to the above question, please state the project name(s), year(s), and reason why:
Have you ever paid liquidated damages on any project?*

YesNo
If yes to the above question, please state the project name(s), year(s), and reason why:
Has your present company, its officers, owners or agents ever been convicted of charges relating to conflicts of interest, bribery, or bid-rigging?*

YesNo
If yes to the above question, please state the project name(s), year(s), and reason why:
Has your present company, its officers, owners, or agents ever been barred from bidding public work in North Carolina?*

YesNo
If yes to the above question, please state the project name(s), year(s), case number and reason why:
List your company's Experience Modification Rate (EMR) for the past three years:*
Please provide letter from you insurance company stating your firm's current EMR (i.e. current NCCI worksheet or equivalent).*

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List your company's Total Recordable Incident Rate (TRIR) for the past three years:*
Attach OSHA 300 & 300A Logs for the last 3 years:*

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If EMR/TRIR rates reflect corporate performance over a number of locations, please explain, to the extent possible, the performance experience of the location serving this project:
List any OSHA fines and jobsite fatalities in the past 3 years with an explanation:
Does your company currently have a documented plan for engaging subcontractor participation from Historically Underutilized Businesses?*

YesNo
If yes, please attach your company's HUB plan

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SECTION 3. PROJECT SPECIFICS
The assigned project superintendent for this project shall be:*
Please attach above referenced superintendent's resume:*

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How many years of experience does this superintendent have on this specific type of project?*

0-23-45-10>10
The assigned project manager for this project shall be:*
Please attach above referenced project manager's resume:*

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How many years of experience does this project manager have on this specific type of project?*

0-23-45-10>10
List three current or completed projects of similar type which most closely reflects the size and complexity of the type of work being requested for the currently proposed project within the last 10 years:*
List three current or completed projects of similar type which most closely reflects the size and complexity of the type of work being requested for the currently proposed project within the last 10 years:
List three current or completed projects of similar type which most closely reflects the size and complexity of the type of work being requested for the currently proposed project within the last 10 years:
SECTION 4. SIGNATURE
By signing this document, you are acknowledging that all answers are true to the best of your knowledge. Any answers found to be falsified will bar you from being prequalified on this project.
Company Name (as licensed in NC)*
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Dated this day of:*
Submitted by:*

First NameLast Name
Signature*

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Contact Person's Phone Number
(XXX) XXX-XXXX
Contact Person's Email Address
Notary Certification: North Carolina county* County.
I, a Notary Public of the County and State aforesaid, certify that First Name* Last Name* personally appeared before me this day and acknowledged the execution of the foregoing instrument. Witnessed on this date: Date*
Name of Notary Public*

First NameLast Name
Signature of Notary Public*

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Notary Public commission expires*

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Date
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NC State Mann Hall Renovation Prequalification Form

SECTION 1. GENERAL COMPANY INFORMATION

SECTION 2. GENERAL REQUIREMENTS

SECTION 3. PROJECT SPECIFICS

SECTION 4. SIGNATURE