| Contractor: |
|
| Street Address: |
|
| Mailing Address: |
|
| City, State, Zip: |
|
| Country: |
|
| Contact Person: |
|
| Email Address: |
|
| Telephone Number: |
|
| Fax Number: |
|
| Construction Contractor's Board License Number: |
|
| OR Secretary of State Business Registration Number: |
|
| Asbestos Abatement License Number: |
|
For statistical purposes, please indicate if your company is an Oregon Disadvantaged Business Enterprise, Minority Business Enterprise, Women Business Enterprise, or Emerging Small Business |
| Check all that apply: |
|
** Category of Proposed Services listed below but not limited to: |
| Check all that apply: |
Asbestos, Lead, Mold or Silica Abatement
General Requirements
Site Work
Concrete
Masonry
Metals
Wood & Plastics
Thermal & Moisture Protection
Doors & Windows
Finishes
Specialties
Equipment
Furnishings
Special Construction
Conveying Systems
Mechanical
Electrical
Incidental Services
** Please see the description of proposed services beginning on page 5 of this form.
|
Contractor Experience:
|
| Respondents must meet one of following experience criteria: |
Has your company been in the construction related service business for at least 5 years?
Yes
No
Do the principals/owners of the company have 5 consecutive years experience providing construction related services?
Yes
No
|
| Please provide experience information: |
|
Ability to Respond:
|
| Check the Oregon geographical areas in which you are willing to work: |
All OUS sites within Oregon
Ashland
Corvallis
Eugene
Klamath Falls
La Grande
Monmouth
Portland
Other miscellaneous sites
Are you willing to provide quotations and to respond to work requests within a reasonable amount of time, generally one to two weeks?
Yes
No
|
Legal Compliance:
|
|
Have you read the Request for Proposal for Construction Related Services?
Yes
No
Do you understand the conditions and requirements as outlined in the Request for Proposal?
Yes
No
If selected, are you willing to execute the Retainer Contract exactly as written? (No changes to the contract will be accepted.)
Yes
No
|
| Do you have knowledge of and will you comply with the following: |
Bureau of Labor and Industry prevailing wage rates
Yes
No
N/A
Federal and State regulatory requirements
Yes
No
N/A
State and Local Building Codes
Yes
No
N/A
National Fire Protection Association Rules and Regulations
Yes
No
N/A
|
|
Has your company ever obtained a performance and payment bond for a project?
Yes
No
N/A
Is your company eligible to obtain a performance and payment bond?
Yes
No
N/A
What dollar range of contract work is your firm willing to undertake:
$
What is the maximum amount of your company's individual project performance bond capacity?
$
|
Insurance Coverage:
|
| If issued a Retainer Contract Supplement, will you be able to provide proof of the required insurance coverages listed below: |
Workers Compensation
Yes
No
N/A
Commercial General Liability
Yes
No
N/A
Commercial Automobile Liability
Yes
No
N/A
Professional Liability (required only on Design-Build projects)
Yes
No
N/A
Pollution Liability (required for Asbestos, Mold, Lead, Silica Abatement projects)
Yes
No
N/A
|
Safety:
|
|
If requested, will you provide a copy of your company’s OR-OSHA 200 log for the prior three (3) years?
Yes
No
N/A
Has your company had any OSHA citations in the last three (3) years?
Yes
No
N/A
If yes, provide detail of the citation (s) continue on an attached sheet if necessary:
|
Contracting with other State of Oregon Public Agencies:
|
|
If selected, are you willing to perform work for other State of Oregon Public Contracting Agencies within the Retainer Contract program?
Yes
No
|
List Four (4) Projects and References for Projects Completed in the Last Two Years:
|
| Reference #1 |
|
| Reference #2 |
|
| Reference #3 |
|
| Reference #4 |
|
PROPOSER SIGNATURE PAGE TAX LAWS AND NON-DISCRIMINATION CERTIFICATION
Proposals may be submitted in one of the following methods after completing the Construction Related Services Required Information Form (Exhibit A):
1) Go to http://www.ous.edu/dept/capcon and complete the online form. Before you submit the form, use the print function at the bottom of the page to print a copy of the Required Information Form for your files. An authorized representative MUST sign a copy of the Signature Page and return via scan/email to ccs-rfp@ous.edu, fax- 541-346-5790, or mail – Attention: Patricia Stewart, P.O. Box 3175, Eugene, OR 97403-0175.
2) Complete and sign the Required Information Form (Exhibit A) and mail a hardcopy to: Attention: Patricia Stewart, P.O. Box 3175, Eugene, OR 97403-0175.
A complete Required Information Form and signed Signature Page must be received by June 4, 2008, 4:00 p.m., PDT, for the Proposal to be complete. INCOMPLETE PROPOSALS WILL BE REJECTED.
By the signature below of its authorized representative, Contractor acknowledges having read and understood the Request for Proposal (RFP) for Construction Related Services. Contractor certifies that all the information provided on this form is true to the best of its knowledge, and that if awarded the Contract, agrees to be bound by its terms and conditions and by the representations made in this Proposal. This Construction Related Services Required Information Form will become part of the Retainer Contract and any misrepresentations found in the information provided on this form will result in termination of the Retainer Contract. Contractor certifies that it has not discriminated against minority, women or emerging small business enterprises in obtaining any required subcontracts.
Certificate of Compliance with Tax Laws
For purposes of this certification, "Oregon Tax Laws" means a state tax imposed by ORS 401.792 to 401.816 and ORS chapters 118, 314, 316, 317, 318, 320, 321 and 323; the elderly rental assistance program under ORS 310.630 to 310.706; and local taxes administered by the Department of Revenue under ORS 305.620.