ࡱ> IKH+ 3bjbj .LDhDh+00$D>>>>>egggggg$J l>>>>ee>@ \$/Q0 (  <( 0X : (Example of) Bidders Questionnaire (This is only a sample form based on the Statement of General Notice, and Statement of Bidders Qualifications/Criteria) This form must be completed and submitted by prospective bidders who wish to be considered for the project. Failure to complete the Bidders Questionnaire could result in disqualification of the prospected bidder. Attachments to this sheet are acceptable (please label properly). 1. Name and Address of Firm:__________________________________________ 2. Under what other name(s) has your business operated?_____________________________________________________ 3. Business form (corporation, partnership, etc.)_______________________ Date of formation:__________________________________________________ Principal location:__________________________________________________ Names and Titles of officers of corporation, or partners and the number of years with the business:__________________________________________________ ________________________________________________________________ ________________________________________________________________ 4. Has your firm or any predecessor firm defaulted on a contract or had work terminated for non-performance within the last five (5) years? If so, on a separate sheet describe the project, owner, date, and circumstances/reasons. 5. Has your firm or any predecessor firm been denied a consent of surety, a bid bond, or a performance bond within the past twelve (12) months? If so, on a separate sheet describe the circumstances/reasons. 6. General Contractor: Provide evidence of successful experience on at least two (2) projects involving separate historic buildings or sites of similar activities and scope of work as the subject project, completed in compliance with the Secretary of the Interiors Standard for the Treatment of Historic Properties (revised 1995) within the past five (5) years preceding the date of the execution of the Bidders Questionnaire. At least one of these projects must have been reviewed by a State Historic Preservation Office, or New Jersey Historic Trust, or the historic review body of a county or municipal authority or a preservation professional that designed the project and can substantiate that the project met the Secretary of Interior Standards. Each project must be at least ($ Dollar Value = 40%-60% of the value of funded project). Project #1 Project Name:__________________________________________________________ Location:______________________________________________________________ Construction Cost:_______________________________________________________ Completion Date:________________________________________________________ Approximate Construction Date of the Historic Building or Site:____________________ Project Superintendent/Manager:____________________________________________ Scope of Work and Nature of Project:________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Owner:________________________________________________________________ Owners Contact Person:__________________________________________________ Phone:__________________________________Fax:___________________________ Architect:______________________________________________________________ Architects Contact Person:________________________________________________ Phone:__________________________________Fax:___________________________ Historical Review Agency:_________________________________________________ Project #2 Project Name:___________________________________________________________ Location:_______________________________________________________________ Construction Cost:_______________________________________________________ Completion Date:________________________________________________________ Approximate Construction Date of the Historic Building or Site:____________________ Project Superintendent/Manager:____________________________________________ Scope of Work and Nature of Project:________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Owner:________________________________________________________________ Owners Contact Person:__________________________________________________ Phone:_________________________________Fax:____________________________ Architect:_______________________________________________________________ Architects Contact Person:________________________________________________ Phone:_________________________________Fax:____________________________ Historical Review Agency:_________________________________________________ 7. Proposed Project Superintendent/Manager: Provide evidence of successful experience on at least two (2) projects involving separate historic buildings or sites of similar activities and scope of work as the subject project, completed in compliance with the Secretary of the Interiors Standards for the Treatment of Historic Properties (revised 1995) within the past five (5) years preceding the date of the execution of the Bidders Questionnaire. At least one of these projects must havebeen reviewed by a State Historic Preservation Office, or New Jersey Historic Trust, or the historic review body of a county or municipal authority or a preservation professional that designed the project and can substantiate that the project met the Secretary of Interior Standards. Each project must be at least ($ Dollar Value = 40%-60% of the value of funded project). Name and Address of Project Superintendent/Manager:___________________ ________________________________________________________________ Project #1 Project Name:______________________________________________________ Location:__________________________________________________________ Construction Cost:__________________________________________________ Completion Date:___________________________________________________ Approximate Construction Date of the Historic Building or Site:_____________ Scope of Work and Nature of Project:__________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Owner:__________________________________________________________ Owners Contact Person:____________________________________________ Phone:______________________________Fax:_________________________ Architect:_________________________________________________________ Architects Contact Person:___________________________________________ Phone:______________________________Fax:_________________________ Historical Review Agency:___________________________________________ Project #2 Project Name:______________________________________________________ Location:_________________________________________________________ Construction Cost:_________________________________________________ Completion Date:__________________________________________________ Approximate Construction Date of the Historic Building or Site:___________ Scope of Work and Nature of Project:_________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Owner:__________________________________________________________ Owners Contact Person:____________________________________________ Phone:______________________________Fax:_________________________ Architect:_________________________________________________________ Architects Contact Person:___________________________________________ Phone:______________________________Fax:_________________________ Historical Review Agency:___________________________________________ 8. Provide a list of the names, titles, and years of experience of all principal members of the prospective bidders staff who will be available and assigned to this particular project. 9. General Contractor: PROVIDE THE FOLLOWING INFORMATION ON ALL CURRENT PROJECTS IN PROGRESS: (If necessary, include additional sheets.) Project Name:______________________________________________________ Location:_________________________________________________________ Owner:______________________________Phone:_______________________ Architect:____________________________Phone:_______________________ Contract Amount:__________________________________________________ Scheduled Completion Date:_________________________________________ Architects Contact Person:___________________________________________ Phone:___________________________________________________________ Project Name:_____________________________________________________ Location:_________________________________________________________ Owner:______________________________Phone:_______________________ Architect:____________________________Phone:_______________________ Contract Amount:__________________________________________________ Scheduled Completion Date:_________________________________________ Architects Contact Person:___________________________________________ Phone:___________________________________________________________ Project Name:_____________________________________________________ Location:_________________________________________________________ Owner:______________________________Phone:_______________________ Architect:____________________________Phone:_______________________ Contract Amount:__________________________________________________ Scheduled Completion Date:_________________________________________ Architects Contact Person:___________________________________________ Phone:___________________________________________________________ CERTIFICATION I (We) the undersigned certify the truth and correctness of all statements and answers contained herein. 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