2013 flood damage repairs general contractor …lefthandwater.org/.../2012/11/contractor-soq.pdf ·...

STATEMENT OF QUALIFICATIONS

2013 FLOOD DAMAGE REPAIRS

GENERAL CONTRACTOR STATEMENT OF QUALIFICATIONS (SOQ)

LHWD 2013 FLOOD DAMAGE SOQ Page-2

Table of Contents

STATEMENT OF QUALIFICATIONS .........................................................................1

Section I-General Information .....................................................................3 1. Introduction ............................................................................................................3 2. Qualification Procedure ........................................................................................3 3. Project Description ................................................................................................3 4. Procurement Process .............................................................................................4 5. Schedule ..................................................................................................................4 Qualifications Questionnaire ............................................................................................5

Section II-Scope and Instructions ................................................................5 Section III-Statement of Qualifications Form ..............................................9

Personnel/Firm .................................................................................................................19 Equipment ........................................................................................................................20 Construction Projects Under Contract ..........................................................................21 List of Qualifying Projects ..............................................................................................22

Project 1 .................................................................................................................22 Project 2 ............................................................................................ (as necessary) Project 3 ............................................................................................ (as necessary)

Letter from Surety ...........................................................................................................24 Safety Pre-Qualification Form ........................................................................................25


Section I-General Information 1. Introduction

Left Hand Water District (LHWD) is soliciting for qualifications from contractors (Firm) to construct various raw and treated water pipeline and structure repairs or replacements to return the LHWD system to normal operations. The various projects may be bid and constructed in contracts combining several projects or in contracts for individual projects released at different scheduled intervals. Major components of the work will generally consist of the following:

• Replacement of raw or treated water pipelines and appurtenances with diameters ranging from 2-inch up to 20-inch with footages ranging from 100 lineal feet to over 1,000 lineal feet

• Installation methods may include both open-cut and horizontal direction drilling (HDD)

• Placement of fill material to add cover to existing pipelines • Construction of small concrete structures • Construction Site Restoration

Release of initial Construction packages are anticipated in October 2013 and all projects will be completed by the end of year 2013. This Statement of Qualifications (SOQ) will pre-qualify Firms for all potential construction packages. LHWD intends to pre-qualify 3-6 Firms to bid on the 2013 Flood Damage Projects. Pre-qualification is not a guarantee that Firm will be awarded any of the potential construction contracts. 2. Qualification Procedure

General Firms that wish to submit bids on any of the potential construction packages are required to complete and submit this Statement of Qualifications, including instructions and forms. Because of the urgency and critical nature of this work, the LHWD does not wish to consider joint ventures for these projects.

Only those firms that wish to submit prime bids on the project need to submit their SOQ. Subcontractors(with the exception of HDD subcontractors) and suppliers will be evaluated during the bid evaluation process. 3. Project Description

The potential Projects consist of approximately ten (10) individual components at various locations within the LHWD service area. The Projects are located within both Boulder County and Weld County and will require coordination and permitting with the Colorado


Department of Transportation, the Boulder County Transportation Department, and the Weld County Transportation Department. Following is a list of the potential project sites, existing pipe diameters, and estimated lineal footages requiring repair/replacement:

1. WCR 20.5 west of WCR 7, 2-inch pipeline, 100 ft. 2. SH 119 near WCR 7, 16-inch pipeline, 600 ft. 3. WCR 1, south of Niwot Road, 10-inch pipeline, 100 ft. 4. WCR 1 at St. Vrain River, 6-inch pipeline, 600 ft. 5. 109th St. south of Lookout Rd. near Boulder Creek, 6-inch pipeline, 200 ft. 6. 95th St. north of Isabelle Rd. near Boulder Creek, 12-inch and 8-inch pipelines, 1,000 ft. 7. 41st St. north of Oxford Rd., 4-inch pipeline, 200 ft. 8. Oxford Rd. east of 41st St., 4-inch pipeline, 100 ft. 9. Foothills Highway (Hwy. 36) south of Nelson Rd. at Left Hand Creek, 8-inch pipeline,

1,000 ft. 10. LHWD Spurgeon WTP, secondary outlet from existing 20-inch Left Hand Valley

Reservoir raw water pipeline 4. Procurement Process

For smaller projects (projects with an estimated construction value of $60,000 or less), the LHWD reserves the right to sole source such projects to one of the pre-qualified contractors. For larger projects (estimated construction value greater than $60,000), LHWD will identify 3-4 of the pre-qualified contractors for each bid package. After receipt of bids and bid evaluation, LHWD will award a contract to the lowest responsive bidder deemed by the LHWD to be in the best interests of the LHWD. Notice of Award is anticipated in 3-5 days after bid opening. Notice to Proceed is anticipated in 1-3 days after Notice of Award. 5. Schedule

The construction of these projects is expected to take place between October 2013 and December 31, 2013. The proposed SOQ schedule is shown below.

• Release of SOQ: October 1, 2013 • SOQ Due Date: October 3, 2013 • Qualification decision provided to Bidders: October 7, 2013


Qualifications Questionnaire

Section II-Scope and Instructions 1. Any general contractor (firm) that wishes to submit a bid on the potential 2013 Flood

Damage Projects is required to complete and submit this Qualifications Questionnaire, including all instructions and forms. Bids received by LHWD for the 2013 Flood Damage Projects from firms that have not completed the Prequalification Process will not be considered.

2. Separate performance and payment bonds, each in the amount of 100 percent of the contract amount will be required at contract execution. Firms wishing to qualify shall identify their anticipated surety company.

3. The completed SOQ documents shall be submitted to the Left Hand Water District to the attention of A. Darwin Williams, P.E., District Engineer, at 6800 Nimbus Road, Longmont, CO 80503. SOQ documents may also be emailed to [email protected]. SOQ’s are due no later than 3:00 p.m., local time on October 3, 2013. Any SOQ received after this deadline will not be considered. SOQs will be reviewed and the firms notified individually of their qualified status by LHWD no later than October 7, 2013. A list of qualified firms for the 2013 Flood Damage Projects will be provided to each qualified firm.

4. The Qualifications Questionnaire shall be completed in full by typing in black ink. All sections (including instructions and forms) included in this document shall be submitted. Where space provided for responses is inadequate, supplement with additional referenced attachments as necessary.

5. Information submitted for the selection process shall become the sole property of LHWD. To the extent permitted by law, financial information will be considered confidential by LHWD and the Engineer, and will not be subject to review by outside individuals or Firms.

mailto:[email protected]�


6. In determining a firm's qualifications, the following factors will be considered. Similar work completed by the firm and whether the firm: a) maintains a permanent place of business; b) has adequate equipment to perform the work properly and expeditiously within the

time available; c) has the financial resources to meet obligations incident to the work; d) has appropriate technical experience; e) has a good track record of successful fast-track or emergency project completion,

with minimal interference to the public or public complaints, as demonstrated through references;

f) has an adequate safety program and good safety record on completed and ongoing projects, and has successfully completed the Contractor Safety Prequalification Form (Attachment F) and passed the evaluation.

7. In order for a Firm to be considered qualified for this project, the Firm must meet all of the following criteria (it is important that firms are specific in Attachment D which projects satisfy the criteria listed below, since only those firms which meet these criteria, and other criteria listed in the SOQ will be deemed qualified). Provide references for completed projects. Qualifying projects must have been principally pipeline projects. Large infrastructure projects with ancillary pipeline work will not be considered as qualified projects. Qualifying pipeline projects must have been performed by firms own forces. a) Demonstrate relevant Firm experience, within the last three (3) years, of a minimum

of three (3) water main construction projects consisting of 1,500 linear feet (each project) of 8-inch (8”) diameter or larger pipeline. Qualifiying pipeline projects shall have been constructed of either AWWA C900 or C905 PVC or ductile iron pipe.

b) Demonstrate the satisfactory completion as a general contractor of at least three (3) individual pipeline project having a construction cost of $250,000 or greater within the last three (3) years.

c) Demonstrate experience within the last three (3) years of construction of a pipeline, one thousand (1,000) feet or longer in Colorado Department of Transportation or Boulder County right-of-way involving utility conflict resolution and traffic control. Projects must have had a successful relationship with the permitting agency as verified by inspector references.

d) Demonstrate relevant experience with at least two (2) pipeline projects each of a minimum 250 lineal feet within the last five (5) years that were completed on a fast-track or emergency basis under a general services or on-call services contract.

e) Demonstrate the ability to complete critical water main projects on schedule.

f) Demonstrate that the Firm’s Construction Project Manager has at least fifteen (15) years of experience in heavy civil and pipeline construction. Demonstrate relevant


experience with construction of at least 15,000 feet of eight (8”) diameter or larger water pipeline within the last five (5) years.

g) Demonstrate that the Firm’s Construction Superintendent has at least ten (10) years of experience in heavy civil and pipeline construction. Demonstrate relevant experience with construction of at least 5,000 feet of eight (8”) diameter or larger water pipeline within the last three (3) years.

h) Demonstrate with adequate documentation that the Firm possesses sufficient equipment and labor to furnish a complete pipeline installation crew and the proper equipment for placement of imported fill material for the duration of this project and that said equipment and crew will be dedicated continuously, from start to finish.

Non-compliance with the above requirements will be reason for disqualification.

8. Firms will be approved for qualification on the basis of an evaluation of factors judged to

be in the best interest of LHWD. These factors will include those listed above, as well as the firm's previous performance on work for LHWD, plus other factors as determined by LHWD, including but not limited to, overall experience of the Firm, the experience of the personnel proposed for assignment to the project, references from owners of similar projects, financial condition of the firm, bonding and insurance capacity of the principal firm, dispute/litigation history, and other factors as determined by LHWD.

9. No Statement of Qualifications will be accepted from, nor will a contract be awarded to, any firm who is in arrears to LHWD upon any debt or contract, or who is in default, as surety or otherwise, upon any obligation to LHWD or is deemed to be irresponsible, unsafe, or unreliable by LHWD.

10. In the event a firm challenges the decision made by LHWD, or any recommendation made by the Engineer, and LHWD’s decision or the Engineer's recommendation is upheld upon review by an appropriate review agency or court, the firm shall be liable for all costs and expenses incurred by LHWD and the Engineer, including attorney's fees, related to this appeal process and the costs and expenses of associated delays in project completion. The firm's submittal of a Statement of Qualifications questionnaire shall indicate its approval of the foregoing provision. The place of venue for any challenge of the selection process and decisions shall be Boulder, Colorado.

11. Material misstatements on the qualification form may be grounds for rejection of the firm's bid on this project. Any such misstatement, if discovered after award of the contract to such firm, may be grounds for immediate termination of the contract. Additionally, the firm will be liable to LHWD for any additional costs or damages to LHWD resulting from such misstatements, including costs and attorney's fees for collecting such costs and damages.

12. LHWD reserves the right to reject any or all Statement of Qualifications, to waive irregularities therein in determining the firm’s qualifications, and to qualify only those firms that it deems are in the best interest of LHWD. Firms shall agree that such rejection or decision shall be without liability on the part of LHWD or the Engineer for


any damage or claim brought by any firm because of such rejections or decisions, nor shall the firm seek any recourse of any kind against the LHWD or the Engineer because of such rejections or decisions. The signing of this document shall constitute an agreement of the firm to these conditions.

13. Specific questions regarding the Project or the qualification process shall be addressed to:

A. Darwin Williams, P.E., District Engineer Left Hand Water District 6800 Nimbus Road Longmont, CO 80503 E-Mail – [email protected] Phone – 303-530-4200 Fax - 303-530-5252

All questions must be submitted in writing no later than 3:00 p.m., local time, on October 2, 2013. E-mail is the preferred method. The person listed above is the primary designated liaison between Left Hand Water District and firm. Any unauthorized contact between any firm, its agent, employees, or others on the firm’s behalf and LHWD staff other than personnel as listed above may result in rejection of the Statement of Qualifications.


Section III-Statement of Qualifications Form Request is hereby made to submit a bid on the 2013 Flood Damage Projects for Left Hand Water District.

Company Name:

By:

Title: Telephone:

Date: Fax:

1. General

a) Firm Doing Business as:

Business Address:

Telephone Number:

Indicate as Applicable: A Corporation

Partnership

An Individual

Principal Office:

b) If a corporation, answer this:

Date of Incorporation:

State of Incorporation:

Chief Executive Officer’s name:

President’s name:

Vice President’s name(s):


Secretary’s name:

Treasurer’s name:

If a partnership, answer this:

Date of organization:

State whether partnership is General or Limited:

General Limited

Name and address of each partner:

c) If an individual, answer this:

Name and business address:

d) Identify all individuals and their position not previously named which exert a significant amount of business control over this Firm:

e) Is this Firm legally qualified to do business in Colorado according to Colorado Revised Statutes, Sections 7-9-101 to 7-9-119

Yes

?

No

f) How many persons are currently employed by this Firm?

g) Complete Contractor Safety Pre-qualification Form and attach in Attachment F.


2. Experience

a) Key Personnel Experience-Provide qualifications and references of the firm’s personnel including experience, education, position occupied and duties on each assignment, number of years with the Firm and role on qualifying projects. Label Attachment A. Minimum information to be contained on the biographical summary for each individual, if applicable, shall include primary language, technical experience, managerial experience, education, position occupied on each assignment, description of duties on each assignment, and number of years with the Firm. The following positions on the firm's project team shall be identified at this time and shall be binding throughout the duration of the project unless otherwise approved by LHWD.

i) Project Manager

ii) Project Superintendent

iii) Safety Manager

iv) Other (indicate position)

b) Firm Experience

How many years has this Firm been in business as a construction company under the present business name?

List any other names this Firm has, does, or anticipates operating under, including the names of related companies presently doing business.

c) How many years experience in the proposed type and size of construction work (pipeline) has this Firm had?

i) As a general contractor:

ii) As a joint venture partner:

iii) As a subcontractor:

d) Provide a brief description of the structure of the firm's Firm with a block schematic diagram. Include titles and names of key personnel. Include w/Attachment A.

e) Has this Firm, or any officer or partner of this Firm, ever failed to complete a construction contract operating as this Firm or any other Firm?

Yes No

If yes, identify who and when, and give details:


f) Are there any judgments, claims, arbitration proceedings, or lawsuits pending, outstanding, or threatened to which this Firm, or an officer or partner in this Firm, has been a party?

Yes No

If yes, describe:

g) Has this Firm, or an officer or partner of this Firm, filed any lawsuits, or requested arbitration proceedings with regard to any work performed in the last five years?

Yes No

If yes, describe:

h) Identify major items of equipment which this Firm owns or leases (designate which) which will be available for use on the proposed project. Include as Attachment B.

i) General Work Summary

What general types of work does this Firm normally perform with their own work force?

j) What construction projects does this Firm currently have under contract and what are the originally scheduled and anticipated completion dates? Give the name and location of each project, name of Owner or Engineer with telephone numbers, description of project, and contract amount, include as Attachment C.


k) List projects of a similar nature that this Firm has completed or made substantial progress towards completing during the last 5 years which satisfies the criteria listed in Section II.9. Use the format attached entitled "Projects." The information for each project shall contain at a minimum, name of project, location, name of Owner, name of Engineer, telephone numbers of Owner and Engineer, description, individuals to contact, contract completion time, actual completion time, bid price, actual total cost, amount of change orders, amount and number of claims that resulted in litigation, amount of settlement, and name of surety providing performance bond. Use as many lines as needed to fully describe each project in order to substantiate that the project meets qualification criteria as outlined in Section II.9. The listing of names shall indicate to LHWD that this Firm has no objection to contacting the named individuals. Include as Attachment D. Firms shall also attach a matrix of projects matching qualifying projects against the SOQ criteria, in order to clearly indicate which projects meet stated criteria.

3. Financial Background

a) What is the largest contract (name, owner, and dollar amount) that this Firm has completed?

b) What is this Firm’s current working capital?

$

c) Has this Firm, or any officer or partner, been involved in a bankruptcy or reorganization proceeding?

Yes No

If yes, describe:

d) Please provide a letter from your current surety that identifies your firms current total bonding capacity as well as your surety’s commitment to provide necessary bonding for this project should your firm be the successful bidder, include as Attachment E.

e) What is the name, address, and telephone number of this Firm's predominant Bonding Company?


f) Has this Firm been refused surety, bond, or liability insurance in the last 10 years?

Yes No

If yes, describe:

g) In what other businesses does this Firm actively participate?

h) List all companies, firms, or Firms that own any part of this Firm:


4. Affidavits

One of the following three affidavits shall be executed as indicated below. Affidavits which are not applicable to this Firm shall be left blank.


Affidavit for Corporation (1)

State of

County of

being duly sworn deposes and says:

that he/she is of

the corporation submitting the foregoing statement of experience and financial condition; that he/she has read the same; and that the same is true and correct.

Signature

Signed and sworn to before me this day of , 20

.

Notary Public

Address

My commission expires:

(Note: Use full corporate name and attach corporate seal.)


Affidavit for Partnership (2)

State of

County of


that he/she is of

the partnership submitting the foregoing statement of experience and financial condition; that he/she has read the same; and that the same is true and correct.

Signature


.

Notary Public

Address



Affidavit for Individual (3)

State of

County of


that he/she is the person submitting the foregoing statement of experience and financial condition; that he/she has read the same; and that the same is true and correct.

Signature


.

Notary Public

Address



ATTACHMENT A Personnel/Firm

Provide Firm’s qualifications and references of the firm’s personnel. Indicate on a separate page which projects used as qualifying projects personnel worked on and what their role was. Insert Brief Description of the Structure of the Firm with a Block Schematic Diagram.


ATTACHMENT B Equipment

Insert Firm’s Major Items of Equipment.


ATTACHMENT C Construction Projects Under Contract

Insert a List of the Firm’s Construction Projects Currently under Contract.


ATTACHMENT D List of Qualifying Projects (Firm’s shall also attach a matrix which shows qualifying projects against the criteria those projects meet)

Project Information (Firm shall complete this form for each project used to qualify for this project)

Project Name and Location:

Bid Amount:

Final Contract Amount: $ Year Completed:

Contract Completion Time: Days

Amount and Number of Change Orders:

Actual Completion Time: Days

Percentage of Work completed by Firms own forces: %

Description of Work:

Names and Titles of Key Firm Personnel:

Name, Telephone Number, and email address of Owner/Engineer/Inspector Reference:


Project (Continued)

Number and amount of claims resulting in arbitration or litigation: No. of Claims

Amount of Settlement: $

Further Information of Claims:

ATTACHMENT E Letter from Surety

Insert Firm’s Letter from Surety


ATTACHMENT F Safety Pre-Qualification Form

Insert Firm’s Safety Pre-Qualification Form

SQF-1

Attachment F Contractor Safety Qualification Form (SQF)

SECTION 1 - GENERAL INFORMATION Company Name

Telephone # Fax

Are You A Division of a Corporation? Y or N

If Yes, provide name of parent corporation

Street Address Mailing Address

Are you self-insured for Worker’s Compensation Insurance? Yes No SPQF Completed by: (Name) Date

Title Telephone Fax

SECTION 2 - SAFETY & HEALTH INFORMATION Highest ranking safety/health professional in the Company: Title Telephone Fax

Safety Representative assigned to this project:

Title Telephone Fax Do you have or provide: a. Full time Safety/Health Director? Yes No b. Full time Safety/Health Supervisor? Yes No c. Full time Job Safety/Health Coordinator? Yes No

SECTION 3 - SAFETY & HEALTH PROGRAMS AND PROCEDURES Do you have a written Safety and Health Program? Yes No

A current Safety and Health Program is required to be submitted prior to award of this contract. Does the program address the following key elements: a. Management commitment and expectations? Yes No b. Employee participation? Yes No c. Accountabilities & responsibilities for managers, supervisors, and employees? Yes No d. Resources for meeting safety & health requirements? Yes No e. Periodic safety and health performance appraisals for all employees? Yes No f. Hazard recognition and control? Yes No

SQF-2

SECTION 3 - SAFETY & HEALTH PROGRAMS AND PROCEDURES CONT’D…. Does the program satisfy your responsibility under the law for:

a. Ensuring your employees follow safety rules of the facility? Yes No b. Advising Owner of any unique hazards presented by your work and of any hazards found by your employees? Yes No Does the program include work practices and procedures such as: a. Equipment Lockout and Tagout (LOTO) Yes No b. Confined Space Entry Yes No N/A c. Injury and Illness Recording Yes No d. Fall Protection Yes No N/A e. Personal Protective Equipment Yes No f. Portable Electrical/Power Tools Yes No g. Vehicle Safety Yes No N/A h. Compressed Gas Cylinders Yes No N/A i. Electrical Equipment Grounding Assurance Yes No N/A j. Powered Industrial Vehicles (Cranes, Forklifts, JLGs, etc.) Yes No k. Housekeeping Yes No l. Accident/Incident Reporting Yes No m. Unsafe Condition Reporting Yes No n. Emergency Preparedness, including evacuation plan Yes No o. Waste Disposal Yes No p. Back Injury Prevention Yes No Do you have a substance abuse program? Yes No If yes, does it include the following:

• Pre-placement Testing? Yes No • Random Testing? Yes No • Testing for Cause? Yes No • DOT Testing? Yes No N/A

Medical: a. Do you have personnel trained to perform first aid and CPR? Yes No

b. Describe how you will provide first aid and other medical services for your employees while on-site. Specify who will provide this service: First Aid Care Given on site, service provider in place prior to beginning work ____________________________ _____________________________________________________________________________

c. Do you supply first aid kits on the job site? Yes No Do you hold site safety and health meetings for:

• Field Supervisors Yes No • Employees Yes No • New Hires Yes No • Subcontractors Yes No

a. Are the safety and health meetings documented? Yes No Personal Protective Equipment (PPE): a. Is applicable PPE provided for employees? Yes No b. Do you have a program to ensure that PPE is inspected and maintained? Yes No Do you have a corrective process for addressing individual safety and health performance and deficiencies? Yes No Equipment and Materials: a. Do you have a system for establishing applicable health, safety, and environmental specifications for acquisition of materials and equipment? Yes No N/A

b. Do you conduct inspections on operating equipment (e.g. cranes, forklifts, JLGs) in compliance with regulatory requirements? Yes No c. Do you maintain operating equipment in compliance with regulatory requirements? Yes No

d. Do you maintain the applicable inspections and maintenance certification records for operating equipment? Yes No N/A

SQF-3

SECTION 3 – SAFETY & HEALTH PROGRAMS AND PROCEDURES CONT’D……. Do you use subcontractors? (If No, proceed to Inspections & Audits) Yes No a. Do you use safety & health performance criteria in selection of contractors? Yes No

b. Do you evaluate the ability of subcontractors to comply with applicable health and safety requirements as part of the selection process? Yes No c. Do your subcontractors have a written Safety and Health Program? Yes No Inspections and Audits a. Do you conduct safety and health inspections? Yes No b. Do you conduct safety and health program audits? Yes No c. Are corrections of deficiencies documented? Yes No Do you have a Safety and Health Orientation Program for new hires and newly hired or hired or promoted supervisors? Yes No SECTION 4 – INCIDENT INVESTIGATION & ANALYSIS Are all incidents investigated to determine their cause, and are corrective measures taken? Yes No Do you have a written incident investigation procedure? Yes No Do you provide accident investigation training for appropriate people in your organization? Yes No Do you develop a periodic statistical summary that illustrates your safety performance? Yes No Do you complete and maintain OSHA Form 301A? Yes No Do you complete and maintain OSHA Form 300? Yes No N/A SECTION 5 - JOB ANALYSIS & OBSERVATION Are all critical jobs identified and analyzed? Yes No Are all procedures for critical jobs written and reviewed with the employee before work begins? Yes No

Are job observations, such as job safety analysis (JSAs) conducted? Yes No

SECTION 6 - SAFETY & HEALTH PERFORMANCE Provide your current Experience Modification Rate (EMR) for Worker’s Compensation Insurance Have you received any regulatory citations in the last three years? Yes No If yes, please attach copies. Injury & Illness Data

Provide the following data (excluding subcontractors) using your OSHA 200/300 Log or equivalent Record-keeping for the past three years:

Year Ending December 31, 2012 Total number of recordable injuries: _____________ Rate: ________ Total number of injuries resulting in restricted workdays: _____________ Rate: ________ Total number of injuries resulting in days away from work: _____________ Rate: ________ Total number of injuries resulting in NO restricted or lost workdays _____________ Rate: ________ Year Ending December 31, 2011 Total number of recordable injuries: _____________ Rate: ________ Total number of injuries resulting in restricted workdays: _____________ Rate: ________ Total number of injuries resulting in days away from work: _____________ Rate: ________ Total number of injuries resulting in NO restricted or lost workdays _____________ Rate: ________ Year Ending December 31, 2010 Total number of recordable injuries: _____________ Rate: ________ Total number of injuries resulting in restricted workdays: _____________ Rate: ________ Total number of injuries resulting in days away from work: _____________ Rate: ________ Total number of injuries resulting in NO restricted or lost workdays _____________ Rate: ________

This document must be signed Title:

Signature: Date:

SQF-4

SQF EVALUATION (LEFT HAND WATER DISTRICT USE ONLY) Contractor Is: Acceptable for the Approved Contractor List Or Conditionally Acceptable for Approved Contractor List with the following conditions – _________________________________________________________________________ _________________________________________________________________________ or Rejected (list reasons): _________________________________________________________________________ _________________________________________________________________________ Reviewer

Date

2013 flood damage repairs general contractor …lefthandwater.org/.../2012/11/contractor-soq.pdf ·...

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