1. Experience and Reference Verification: List a minimum of five (5) projects, two (2) of which should be of a minimum value of $3 million each and completed in the last five (5) years. Provide verifiable
Firm's Trade Specialty:
Provide a letter on surety letterhead confirming potential bonding capacity for:
3. Financial Strength and Stability:
a) Provide a current (within the last 12 months) CPA-audited or -reviewed financial statement to demonstrate the following criteria:
b) Pre-qualification requires business credit lines with a minimum total of $200,000.00. Provide details below suppporting your firm's credit information
4. Firm Staffing / Size
Please list the number of:
4. NYC VENDEX and Business Integrity:
The Mayor's Office of Contract Services (MOCS) may review data contained in the NYC Vendex system as part of its review of this application.
Viist the MOCS website at: http://www.nyc.gov and search for "Vendex."
As part of Pre-Qualification, the submittal of a Vendex questionnaire to the Mayor's Office of Contract Services (MOCS) is required.
INFORMATION REGARDING OWNERSHIP, MANAGEMENT AND AFFILIATION:
5. Identify each person who is, or has been within the past five years, an owner of 5% or more of the firm's shares, a director, an officer, a partner or the proprietor.
For purposes of questions 6 through 10 of this Questionnaire, the following terms shall have the following meanings:
“Affiliate” shall mean any person or entity which is directly or indirectly controlled by the person or entity to which the question relates, or any person or entity which directly or indirectly controls such person
or entity. For purposes of this definition, control means the power to direct the management of the firm, person or other entity, whether through ownership of shares, the right to designate the Board of Directors, contract or otherwise.
“Predecessor Company or Entity” shall mean any entity in which any person or entity enumerated in Items 5. above had an ownership or other interest.
“Principal” shall mean any person who is or has been, within the past five years, either an owner of five percent (5%) or more of the firm’s shares, one of the firm’s five largest shareholders or a director,
officer, partner or proprietor of the firm.
Answer questions 6, 7, and 8 for each individual who participates in policy making, financial decisions, or the firm’s operations in relation to the NYCHA project:
6. List any other firm(s) in which the individual owns or has owned 5.0% or more within the past five years.
7. Identify any affiliates of the individual(s) or firms identified in question 7 above that are not listed in the answer to question 7.
8. For any individual, firm or affiliate identified in questions 7 and 8 above, (a) list and describe all judgments, liens or claims over $25,000 filed against the individual, firm or affiliate and remaining
undischarged or unsatisfied for more than 90 days; and (b) list and describe all liquidated damages assessed. Also list any litigation currently pending against the individual, firm or affiliate if the
judgment sought relates to the type of work to be performed for NYCHA, or could have a material adverse financial impact on the individual, firm or affiliate.
9. Within the past five years has any individual, firm or affiliate identified in questions 5 through 8 above been the subject of any of the following (respond to each question and describe in detail the circumstances of each affirmative answer; attach additional pages if necessary):
r) any citations, Notices, violation orders, pending administrative hearings or proceedings or determinations for violations of:
10. Within the past five years has the firm, any affiliate, any predecessor company or entity, any principal, or any manager or individual who participates in policy making, financial decisions, or the firm’s operations in relation to NYCHA (respond to each question and describe in detail the circumstances of each affirmative answer; attach additional pages if necessary):
11. Apprentice Programs:
Firm must demonstrate participation in a New York State approved apprenticeship program that has at least one graduate. If yes, supply supporting documentation. Examples of
supporting documentation are: a letter from the New York State Department of Labor stating that your firm has participated in an approved apprentice program that has met the
criteria listed above; or, a letter from a union of which your firm is a signator or a copy of a signed union contract. Apprenticeship programs must be appropriate to the work to
be performed under the proposed categories of work.
(a) Workers Compensation Experience Information: List the Interstate Workers Compensation Experience Modification Rate (EMR).
Alternative or equivalent measures may be considered.
In addition to listing your EMR information in the above chart, also provide this information on your insurance carrier or broker's letterhead.
If the work of this subcontractor requires a New York City, State, or Federal license or certification under governing law, provide copies of all required licenses.
14. Trade Union Affiliation:
List any trade union affiliations your firm may have:
15. Enterprise Programs:
IT IS THE OBJECTIVE OF NEW YORK CITY HOUSING ATHORITY (NYCHA) TO ENSURE THAT ALL BUSINESSES HAVE AN EQUAL OPPORTUNITY TO
PARTICIPATE IN ALL ASPECTS OF NYCHA'S PROCUREMENT OF ALL GOODS AND SERVICES WITHOUT REGARD TO RACE, COLOR,
RELIGION, MILITARY SERVICE, NATIONAL ORIGIN, SEX, AGE, DISABILITY, MARITAL STATUS, OR SEXUAL ORIENTATION OF THE
OWNERS, PARTNERS OR STOCKHOLDERS. FURTHER, NYCHA IS COMMITTED TO ACHIEVE MAXIMUM PARTICIPATION OF MINORITY,
WOMEN, AND SMALL BUSINESS ENTERPRISES (MWSBEs) IN NYCHA PROCESS OF AWARDING CONTRACTORS FOR GOODS AND
1 IS THE BUSINESS AT LEAST FIFTY-ONE (51%) OWNED, CONTROLLED AND OPERATED BY (or in case of pubicly owned business at least fifty-one of the stock is owned by) CITIZENS OR PERMANENT RESIDENT ALIENS WHO ARE (Please Check All That Apply):
2 CERTIFIED AS MBE, WBE, SBE OR ROB : IS THE BUSINESS CERTIFIED AS ANY OF THE FOLLOWING TYPES OF BUSINESS BY A NEW YORK STATE GOVERNMENT
AGENCY OR AUTHORITY ? IF YES, ATTACH COPIES OF ALL SUCH CERTIFICATIONS.
A material false statement or omission made in connection with this application is sufficient cause for denial of the application or revocation of a prior approval thereby precluding the business applicant from performing work for TDX Construction Corporation.
, being duly sworn, state that I am of and that I have read and understood the questions contained in this application. I certify that to the best of my knowledge the information given in response
to each question and the appendices is full, complete and truthful. I acknowledge that TDX Construction Corporation may, by means it deems appropriate, determine the accuracy and truth of the statements made in the application. I recognize that all the information submitted is for the express purpose of inducing TDX Construction Corporation to pre- qualify a contractor and does not assure that it will be deemed qualified. I authorize TDX Construction Corporation to contact any entity named in the application for the purposes of verifying the information supplied by the applicant.