Respondent S Request for Expressions of Interest and Statements of Qualifications

SCHEDULE B – FORM OF SUBMISSION

RESPONDENT’S REQUEST FOR EXPRESSIONS OF INTEREST AND STATEMENTS OF QUALIFICATIONS

This document is intended to provide information on the capacity, skill, and experience of the Contractor. Respondent maysupplement information requested with additional sheets if required.

Project Title:Relocation of Furniture, Fixtures, Equipment, Files Etc. From Current City Hall to New City Hall

Reference No.: 1220-050-2013-007

A. SUBMITTED BY FIRM NAME:

1.
Full Legal Name of Firm
2.
Business Address
3. / Phone No. / Fax No.
4. / Email:
5. / Contact Person:

B. LEGAL STRUCTURE OF COMPANY:

6. / Corporation / ______/ Partnership / ______/ Individual / ______
7. / If Corporation/Partnership, year incorporated/organized: ______.
C. / FINANCIAL REFERENCES:
8. / Bank Name:
Location:
Contact Person(s):
Phone No.: / Fax No.
Email:
9. / Average value of relocation work completed within the past five years:
2012 / $
2011 / $
2010 / $
2009 / $
2008 / $

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D.RESPONDENT’S CAPACITY, SKILL, EXPERIENCE, REPUTATION AND RESOURCES:

10.Principal furniture relocation projects completed in the past three years. Listed in Appendix “A”.(As attached)

11.Similar or furniture related relocation projects completed.Listed in Appendix “B”. (As attached)

12.Major furniture relocation projects underway this date.Listed in Appendix “C”.(As attached)

13.Respondents should provide information on the background and experience of all key personnel proposed to undertake the Services (use the spaces provided and/or attach additional pages, if necessary) (resumes preferred):

Name:

Experience:

Dates:

Project Name:

Responsibility:

Name:

Experience:

Dates:

Project Name:

Responsibility:

Name:

Experience:

Dates:

Project Name:

Responsibility:

14.Respondents should provide the following information on the background and experience of all sub-contractors proposed to undertake a portion of the Services (use the spaces provided and/or attach additional pages, if necessary):

DESCRIPTION OF SERVICES / SUB-CONTRACTORS NAME / YEARS OF WORKING WITH CONTRACTOR / TELEPHONE NUMBER AND EMAIL

15.Additional Information:

(a) Confirmation of physical resources available, including total number owned and ability to provide for the duration of the project of the following items:
(i) dollies
(ii) library carts
(iii) plastic totes
(iv) trucks
Comments
(b) A description of Respondents ability to offer flexibility in scheduling and last minute requirements.
Comments
(c) Describe your experience and protocols for working with confidential information.
Comments

(d) Provide damage claim/lost item histories, within the past five years:

2012 / $
2011 / $
2010 / $
2009 / $
2008 / $
(e) Describe your ability to provide 20+ experienced movers per move wave throughout the project in the stipulated time frame with consistent crews who are familiar with the project.
Comments

(f)A general description of the standards to be met by the Respondent in providing the goods and services (if any).

Comments

(g)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, describe the project, owner, date and circumstances/reasons.

Comments

(h)What other information is not requested here but which you think the City should consider in evaluating your company?

Comments

I/We confirm that this Submission is accurate and true to best of my/our knowledge.

This Submission is submitted this ______day of ______, 20_ _.

I/We have the authority to bind the Respondent.

______

(Name of Respondent)(Name of Respondent)

______

(Signature of Authorized Signatory)(Signature of Authorized Signatory)

______

(Print Name and Position of Authorized(Print Name and Position of Authorized Signatory) Signatory)

APPENDIX A (Reference Form)

PRINCIPAL FURNITURE RELOCATION PROJECTS COMPLETED IN THE PAST THREE YEARS

Project Title:______

Project Description:______

______

Location of Project:______

______

Contract Value ($):______

Start and Completion Dates:______

______

Name of Contract Owner:______

Refer To:______

Telephone/Fax Numbers:Phone: ______Fax: ______

E-Mail of Project Reference:______

Project Title:______

Project Description:______

______

Location of Project:______

______

Contract Value ($):______

Start and Completion Dates:______

______

Name of Contract Owner:______

Refer To:______

Telephone/Fax Numbers:Phone: ______Fax: ______

E-Mail of Project Reference:______

Project Title:______

Project Description:______

______

Location of Project:______

______

Contract Value ($):______

Start and Completion Dates:______

______

Name of Contract Owner:______

Refer To:______

Telephone/Fax Numbers:Phone: ______Fax: ______

E-Mail of Project Reference:______

APPENDIX A (cont’d)

PRINCIPAL FURNITURE RELOCATION PROJECTS COMPLETED IN THE PAST THREE YEARS

attach additional pages, if necessary as follows (as applicable):

Project Title:______

Project Description:______

______

Location of Project:______

______

Contract Value ($):______

Start and Completion Dates:______

______

Name of Contract Owner:______

Refer To:______

Telephone/Fax Numbers:Phone: ______Fax: ______

E-Mail of Project Reference:______

Project Title:______

Project Description:______

______

Location of Project:______

______

Contract Value ($):______

Start and Completion Dates:______

______

Name of Contract Owner:______

Refer To:______

Telephone/Fax Numbers:Phone: ______Fax: ______

E-Mail of Project Reference:______

Project Title:______

Project Description:______

______

Location of Project:______

______

Contract Value ($):______

Start and Completion Dates:______

______

Name of Contract Owner:______

Refer To:______

Telephone/Fax Numbers:Phone: ______Fax: ______

E-Mail of Project Reference:______

APPENDIX B (Reference Form)

SIMILAR OR RELATED FURNITURE RELOCATION PROJECTS COMPLETED

Project Title:______

Project Description:______

______

Location of Project:______

______

Contract Value ($):______

Start and Completion Dates:______

______

Name of Contract Owner:______

Refer To:______

Telephone/Fax Numbers:Phone: ______Fax: ______

E-Mail of Project Reference:______

Project Title:______

Project Description:______

______

Location of Project:______

______

Contract Value ($):______

Start and Completion Dates:______

______

Name of Contract Owner:______

Refer To:______

Telephone/Fax Numbers:Phone: ______Fax: ______

E-Mail of Project Reference:______

Project Title:______

Project Description:______

______

Location of Project:______

______

Contract Value ($):______

Start and Completion Dates:______

______

Name of Contract Owner:______

Refer To:______

Telephone/Fax Numbers:Phone: ______Fax: ______

E-Mail of Project Reference:______

APPENDIX B (Reference Form)(cont’d)

SIMILAR OR RELATED FURNITURE RELOCATION PROJECTS COMPLETED

attach additional pages, if necessary as follows (as applicable):

Project Title:______

Project Description:______

______

Location of Project:______

______

Contract Value ($):______

Start and Completion Dates:______

______

Name of Contract Owner:______

Refer To:______

Telephone/Fax Numbers:Phone: ______Fax: ______

E-Mail of Project Reference:______

Project Title:______

Project Description:______

______

Location of Project:______

______

Contract Value ($):______

Start and Completion Dates:______

______

Name of Contract Owner:______

Refer To:______

Telephone/Fax Numbers:Phone: ______Fax: ______

E-Mail of Project Reference:______

Project Title:______

Project Description:______

______

Location of Project:______

______

Contract Value ($):______

Start and Completion Dates:______

______

Name of Contract Owner:______

Refer To:______

Telephone/Fax Numbers:Phone: ______Fax: ______

E-Mail of Project Reference:______

APPENDIX C (Reference Form)

MAJOR FURNITURE RELOCATION PROJECTS UNDERWAY AS OF THE DATE OF SUBMISSION

Project Title:______

Project Description:______

______

Location of Project:______

______

Contract Value ($):______

Start and Completion Dates:______

______

Name of Contract Owner:______

Refer To:______

Telephone/Fax Numbers:Phone: ______Fax: ______

E-Mail of Project Reference:______

Project Title:______

Project Description:______

______

Location of Project:______

______

Contract Value ($):______

Start and Completion Dates:______

______

Name of Contract Owner:______

Refer To:______

Telephone/Fax Numbers:Phone: ______Fax: ______

E-Mail of Project Reference:______

Project Title:______

Project Description:______

______

Location of Project:______

______

Contract Value ($):______

Start and Completion Dates:______

______

Name of Contract Owner:______

Refer To:______

Telephone/Fax Numbers:Phone: ______Fax: ______

E-Mail of Project Reference:______

APPENDIX C (Reference Form) (cont’d)

MAJOR FURNITURE RELOCATION PROJECTS UNDERWAY AS OF THE DATE OF SUBMISSION

Project Title:______

Project Description:______

______

Location of Project:______

______

Contract Value ($):______

Start and Completion Dates:______

______

Name of Contract Owner:______

Refer To:______

Telephone/Fax Numbers:Phone: ______Fax: ______

E-Mail of Project Reference:______

Project Title:______

Project Description:______

______

Location of Project:______

______

Contract Value ($):______

Start and Completion Dates:______

______

Name of Contract Owner:______

Refer To:______

Telephone/Fax Numbers:Phone: ______Fax: ______

E-Mail of Project Reference:______

Project Title:______

Project Description:______

______

Location of Project:______

______

Contract Value ($):______

Start and Completion Dates:______

______

Name of Contract Owner:______

Refer To:______

Telephone/Fax Numbers:Phone: ______Fax: ______

E-Mail of Project Reference:______

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