Prequalification Application

Policy, Forms and Scoring Matrix

Guilford Middle School

September 14, 2015

Index

Guilford County Schools Procedures for Prequalification for Construction Projects …………………………Pages 4

Schedule of Project Events………………………………………………………………………………………………………………..Pages 1

Request for Prequalification Advertisement………………………………………………………………………………………Pages 1

Request for Bids Advertisement…………………………………………………………………………………………………………Pages 1

Application for Prequalification………………………………………………………………………………………………………..Pages 18

Appendix A – (Sample Parent Company Guarantee Letter)………………………………………………………………Pages 1

Appendix B – (Bond-Ability Sample Letter from Surety)……………………………………………………………………Pages 1

Appendix C – (Sample Insurance Certificate)……………………………………………………………………………………Pages 1

Prequalification Scoring Matrix………………………………………………………………………………………………………..Pages 2

Construction Manager Prequalification Schedule…………………………………………………………………………….Pages 2

Subcontractor Prequalification Checklist………………………………………………………………………………………....Pages 1

Descriptor Term: PREQUALIFICATION OF BIDDERS FOR CONSTRUCTION PROJECTS

Descriptor Code: FB Presented to the Board: October 23, 2014 Adopted by the Board: December 2, 2014

A. GENERAL

The purpose of this prequalification process is to impartially evaluate a contractor and to

properly determine, by its responsible business practices, work experience and other qualifications,

that it is approved to bid on a Board construction project, including prime contracts awarded by

construction managers pursuant to the Construction Manager at Risk (CM at Risk) process. The

award of contracts should be the result of open competition in bidding, impartiality in the selection

of contractors, integrity in business practices and skillful performance history.

The administration shall be responsible for prequalifying individual contractors to bid on

Board construction projects when the administration believes prequalification is preferred. The

administration is not required to prequalify contractors for any particular project or projects.

However, a contractor shall not be allowed to submit a bid on a construction project subject to

prequalification unless it has been prequalified in accordance with Board policy.

The construction manager, administration and construction counsel shall jointly develop the

assessment tool and criteria for each CM at Risk project, including the prequalification scoring values

and minimum requirement score. The construction manager shall use the process outlined in this

policy for the prequalification of contractors on CM at Risk projects.

Notwithstanding the fact that a contractor was prequalified, the Board, administration and

construction manager reserve the right to reject a contractor’s bid if it is determined that the

contractor has not submitted the lowest responsive bid. The prequalification of the contractor

shall not preclude the Board, administration or construction manager from subsequently concluding

that the contractor is not a responsible bidder pursuant to G.S. 143-129. The prequalification of a

contractor for a project shall only apply to the individual project. All construction and repair

contracts shall be awarded to the lowest responsive and responsible

bidder, taking into consideration quality, performance and the time specified in the proposals for

the performance of the contract.

B. APPLICATION PROCESS

Each prospective bidder on contracts identified for prequalification by the administration and

all CM at Risk projects shall submit an application on the approved prequalification application form

in order to become prequalified. The approved prequalification application form will require

information to be provided on the ownership of the firm, experience of firm’s personnel, any

affiliations with other construction firms, bonding capacity, financial resources, the type of work

performed by the firm and other objective criteria rationally related to the contract to be awarded,

including MWBE participation on prior projects.

The administration shall ensure that applications prepared for the projects comply with this policy

and state law. The application is to be submitted by the deadline established in the notice of

prequalification. The act of submitting the application does not permit the firm to submit a bid.

Incomplete applications may be rejected and/or returned for further detail

or correction at the sole discretion of Guilford County Schools or construction manager.

C. APPLICATION

The application used by Guilford County Schools or the construction manager must be approved by

the director of construction or designee and shall, at a minimum, address the following items:

Organizational Structure – The firm shall provide a list of all owners, officers, partners or individuals

authorized to represent or conduct business for or sign legal documents for the firm. This list must

include the full legal name typed or printed in a clear legible form. Firms experiencing changes in

ownership, organizational structure or material changes in assets must inform the school system

prior to the award of a contract. Failure of the firm to comply with this requirement may result in

the termination of any contract awarded by the school system or construction manager.

Classification – The firm shall indicate the type(s) of work the firm’s workforce and equipment

normally perform, licensure and other pertinent information. The firm shall provide its HUB

(Historically Underutilized Business) status.

Experience – The firm shall furnish information that documents the ability of the firm to undertake a

project involving the type(s) of work for which prequalification is requested.

Financial – Firms will be required to provide a complete current annual financial statement (current

within the previous 12-month period).

Litigation/Claims – Firms must provide information on success at completing projects on time,

including the payment of liquidated damages. The firm will be required to submit information

regarding its litigation history, including litigation with owners, subcontractors and suppliers.

Capacity – Firms shall demonstrate sufficient bonding capacity, insurance and resources for the

project. Firms must provide relevant information on the personnel that will be directly

responsible for the work, including the location of the office that will be primarily responsible for

work. Firms shall also demonstrate an acceptable safety history for construction projects.

Diversity and Inclusion – Firms must show their history of MWBE participation on projects submitted

for review as well as their aggregate average percentage of MWBE participation over the most recent

five-year period.

Legal Authorization – All firms must show that they are legally authorized to conduct business in the

State of North Carolina and have all required licensure for the work to be performed.

D. REVIEW OF APPLICATION – GUILFORD COUNTY SCHOOLS SINGLE PRIME, MULTI PRIME AND

DUAL PRIME

Review of Applications – Guilford County Schools’ Prequalification Committee shall use an

objective assessment process. The prequalification criteria shall not require the firm to have

previously been awarded a construction or repair project by Guilford County Schools. The

prequalification criteria used by the Prequalification Committee shall include project specific

prequalification scoring values and the minimum required score to be prequalified for the project.

Guilford County Schools’ Prequalification Committee shall approve or deny the applications in

accordance with the prequalification criteria and scoring system.

Notice of Decision – The firms shall receive prompt written notification of Guilford County Schools’

Prequalification Committee’s decision, including the reason for denial. Notice shall be provided prior

to the opening of bids for the project and with sufficient time for the firm to appeal the denial of

prequalification.

E. REVIEW OF APPLICATION – CM AT RISK PROJECTS

Prequalification Committee - The construction manager and Guilford County Schools’ staff shall

agree upon the members of the construction manager’s Prequalification Committee. The

construction manager’s Prequalification Committee will review prequalification applications

submitted by the firms and will determine the firm’s prequalification eligibility for the CM at Risk

project.

Review of Applications – The construction manager’s Prequalification Committee and Guilford

County Schools’ staff shall agree upon an objective assessment process. The construction manager

and Guilford County Schools’ staff shall develop prequalification criteria, including project specific

prequalification scoring values and the minimum required score to be prequalified for the project.

The prequalification criteria shall not require the firm to have

previously been awarded a construction or repair project by the construction manager or Guilford

County Schools. The construction manager’s Prequalification Committee shall approve or deny the

applications in accordance with the prequalification criteria and scoring system.

Notice of Decision – The firms shall receive prompt written notification of the construction

manager’s Prequalification Committee’s decision, including the reason for denial. Notice shall be

provided prior to the opening of bids for the project and with sufficient time for the firm

to appeal the denial of prequalification.

F. APPEALS PROCEDURE

The firm may appeal the denial of Prequalification as noted below:

Appeal – The firm may appeal a prequalification denial by submitting a written appeal to the

Superintendent or designee within three (3) business days of the receipt of the prequalification

denial. The written appeal shall clearly articulate the reasons why the firm is contesting the denial

and attach all documents and additional information supporting the firm’s position. If the firm

requests a hearing before the Superintendent or designee, a hearing shall be held within five (5)

business days. The firm shall not be allowed to submit additional information without the written

consent of the Superintendent or designee. Thirty (30) minutes shall be allowed for the hearing.

Additional time may be allowed at the discretion of the Superintendent or designee.

Decision – The Superintendent or designee shall render a decision on the appeal no later than three

(3) business days prior to the opening of bids under N.C. Gen. Stat. § 143-129(b). For projects bid by

Guilford County Schools, the decision of the Superintendent or designee shall be final, and the firm

shall be promptly notified in writing of the decision. For CM at Risk projects, the Superintendent or

designee shall notify the construction manager of its recommended decision. The construction

manager shall review the recommended decision and issue a final decision to Guilford County

Schools and firm. In the event the construction manager rejects a recommendation from the

Superintendent or designee to prequalify the firm, the construction manager shall provide a written

explanation of the denial to both the Superintendent or designee and the firm.

General Rules for Appeals – Firms submitting applications shall be provided an e-mail address

for communication with the construction manager or Guilford County Schools during the

appeal process. The firm shall provide a valid e-mail address for use by Guilford County Schools or

construction manager in communicating with the firm. Legal Ref.: N.C. Gen. Stat. §§ 143-128.1 and 135.8

Note: Procedures to be developed on a per-project basis, per statute referenced above.

Construction Manager Schedule of Events

1. Guilford Middle School Project Outreach Mixer December 16, 2015 – 5:30pm-7:30 pm Guilford Middle School- Cafeteria (320 Lindley Road, Greensboro, NC 27410)

2. Guilford Middle School Pre- Bid Meeting

Tentative - January 14, 2016 – 3:30pm-5:30pm

Guilford Middle School (320 Lindley Rd. Greensboro, NC .27410)

3. Guilford Middle School Contractor’s College

Tentative - January 21, 2016 – 4:00pm-5:30pm

Samet Corporation Main Office (309 Gallimore Dairy Rd., Suite 102, Greensboro, NC 27419)

4. Guilford Middle School Bid Opening

Tentative - February 25, 2016 – 9:30am-5:00pm

Guilford County Schools- Room 100 (501 W. Washington St., Greensboro, NC. 27401)

Request for Prequalification’s

New Guilford Middle School

Samet Corporation / SRS, Inc., a joint venture (SSJV) is now accepting pre-qualifications for the

New Guilford Middle School Project with a Prequalification deadline of 02/02/2016 unless

modified by the CM or Owner at a future date. Please request a prequalification form by

contacting Johnny Sigers at: guilfordmiddlepq@sametcorp.com. All completed Prequalification

Forms must be emailed back to Johnny Sigers at: guilfordmiddlepq@sametcorp.com.

Project Description: The project will be the Demolition of the Old Guilford Middle School and

the New Construction of the New 158,000 sqft Guilford Middle School with New Baseball,

Football and Softball Fields.

In accordance with the N.C. General Statutes 143-129, 143-128.1, 143-135.8, all bidders must be pre-qualified by the Construction Manager in order to submit a sealed bid proposal for this project. All 1st tier subcontractors or suppliers are required to complete the pre-qualification process. This pre-qualification process requires 1st tier subcontractors or suppliers to complete a Subcontractor / Supplier Trade Partner Qualification Form. Interested bidders should contact SSJV team member Johnny Sigers at jsigers@srsincorp.com or 336-944-3012 if you have any questions regarding Prequalification. Minority owned and women owned businesses are encouraged to submit prequalification applications for this construction project. Samet / SRS, a joint venture awards public contracts without regard to race, religion, color, creed, national origin, sex, age or handicapping condition as defined by North Carolina General Statutes, Section 168A-3.

NOTICE TO BIDDERS/ADVERTISEMENT FOR BIDDERS New Guilford Middle School Samet Corporation / SRS, Inc. a joint venture (SSJV) and Guilford County Schools will receive sealed bid proposals from Pre‐qualified Bidders for The New Guilford Middle School Project for Bid Packages 01A-10E until 10:00 AM and Bid Packages 11A-33A until 2:00 PM on February 25, 2016 at 501 W. Washington Street, Room 100, Greensboro, NC 27401 and immediately thereafter the aforementioned designated times, SSJV will publicly open and read aloud each sealed bid proposal for the construction of the New Guilford Middle School Project. Upon arrival, please check-in at the front information desk for room location, sign-in, and to obtain a parking pass for your vehicle. Please allow sufficient time for this, as late bids will not be accepted. Sealed bids shall be addressed to Samet Corporation / SRS, Inc. a joint venture with the name of the submitting company, name of the project and trade package name all noted on the front of the sealed envelope.

In order to submit a sealed bid for the project and accordance with the N.C. General Statutes 143-129, 143-128.1, 143-135.8, all bidders must be pre-qualified by the Construction Manager. All 1st tier subcontractors or suppliers are required to complete the pre-qualification process. This pre-qualification process requires 1st tier subcontractors or suppliers to complete a project specific SSJV Trade Partner Qualification Form. Interested bidders should contact SSJV team member Johnny Sigers at jsigers@srsincorp.com or 336-944-3012. You can also request a Prequalification Application by contacting us at: guilfordmiddlepq@sametcorp.com.

Bid documents will be available for inspection during business hours from January 12, 2016, until bids are opened at the following

locations: Offices of Morris Berg Architects, 1401 W. Morehead St. #125, Charlotte NC 28208; and Samet Corporation /SRS, Inc. a Joint Venture, 309 Gallimore Dairy Rd., Suite 102, Greensboro, NC 27409. Plans may also be viewed at Guilford County Schools website: http://www.gcsnc.com/onlineplanroom. Complete Plans, Specifications, and contract documents will also be open for inspection through SSJV’s Internet/Web Based Plan Room as powered by ISQFT via issuance of an invitation to bid by SSJV to the pre-qualified bidder.

Project Description: The project consist of a new middle school approximately 158,000 square feet. The school will house an

administration wing, classroom wings, science labs, locker rooms, gymnasiums, multipurpose room, full service cafeteria and a media center. The building will be conditioned by a four pipe, boiler chiller mechanical system, electrical service will be 277/480v and 120/208v with an emergency generator (diesel powered). There will be a demolition of the remaining existing school and the construction of baseball, football and softball fields. Pre-Bid Meeting: A Non-Mandatory Pre‐Bid Meeting is scheduled for 3:30 PM-5:30 PM on January 14, 2016 to be held at Guilford Middle School- 320 Lindley Rd. Greensboro, NC 27410 Minority owned and women owned businesses are encouraged to submit Bids for this construction project. SSJV awards public contracts without regard to race, religion, color, creed, national origin, sex, age or handicapping condition as defined by North Carolina General Statutes, Section 168A-3. Additionally, in accordance with General Statute 143-128.2, SSJV is specifically encouraging participation of Minority or Women Owned Business Enterprises / Historically Underutilized Businesses (MWBE / HUB) on this project. Our project goal for participation of certified MWBE / HUB firms is thirty five percent (35%), thus exceeding the Guilford County Board of Education’s goal of 12.46%. Each pre-qualified bidder shall make a good faith effort to recruit and select MWBE / HUB companies to participate in this project. As part of the requirements for submitting a bid, each pre-qualified bidder must submit the proper documentation substantiating their adherence to the requirements depicted within N.C. General Statue 143-128.2 and the bid documents. Bidders who fail to submit the required documents with their bid may result in their bid being rejected by the Construction Manager. The Construction Manager and/or Owner reserves the rights to accept or reject any or all bids and waive any or all informalities or irregularities in the bid process in order to accept bids in the best interest of the Owner or Construction Manager. Notice: The above bids are being solicited under N.C.G.S. § 143-128 and 143-129 respectively.

Samet / SRS a Joint Venture Prequalification Form for First –Tier Subcontractors under CM at Risk

September 14, 2015 Page 1 of 5

Pursuant to the statute, this form gathers information about the subcontractors seeking to qualify for the work and provides a general format for the prequalification criteria. Completing this questionnaire does not guarantee prequalification. Evaluation of the submittal shall be performed by the prequalification committee in accordance with GS 143-128.1, 143-135.8 and the Prequalification Policy (attached). First-Tier Subcontractors are to use the project specific forms prepared for this project by the Prequalification Committee. No other forms shall be permitted for use.

PREQUALIFICATION DUE DATE/TIME: ______ February 2, 2016____________________5:00 pm_____________

(date) (time) Submitted to: Charles Delphias, Johnny Sigers or Jennifer Hart_________________________________________ Contact Name receiving prequalifying packages

Samet Corporation/SRS, Inc. –a joint venture company________________________________________________

CM @ R Firm

309 Gallimore Dairy Road, Suite 102_____________________________________________________________________

Address _____________________________________________________________________________________________________________ Address

Greensboro, N.C. 27419-0050___________________________________________________________________________

City/State Zip Code + 4

(336) 544-2600 ______________________ (336) 544-2597___________________________ Phone number Fax Number

guilfordmiddlepq@sametcorp.com_____________________________________________________________________

E-mail address

Project: Guilford Middle School____________________________________________________________ Name of Project

Guilford County Schools__________________________________________________________________________________

Project Owner

320 Lindley Road, Greensboro, NC 27410_______________________________________________________________

Project Location/Address

Morris-Berg Architects____________________________________________________________________________________

Project Architect

June 2016_____________________________________________ 27 months ______________________________________

Project Start Date (Approx.) Project Duration

February 25, 2016__________________________________________ $28,624,430.00__________________________________

Anticipated Bid Date Total Project Budget

Samet / SRS a Joint Venture Prequalification Form for First –Tier Subcontractors under CM at Risk

September 14, 2015 Page 2 of 5

Project Description: (An in-depth narrative of the details of the project, site, trades, LEED, etc.)

Project consists of phased hazardous material abatement & demolition of the existing Guilford Middle School; construction of a new two story Middle School to include site grading, site utilities new asphalt paving, sidewalks, athletic fields, landscaping, fencing. Additionally, project scope of work includes concrete footings, concrete slabs, masonry, structural steel, TPO roofing, metal roofing, skylights, wood and metal doors, aluminum storefront and aluminum windows, metal stud framing, drywall, acoustical ceilings, acoustical treatments, hard tile flooring, wood flooring, resilient flooring, carpet flooring, painting, visual display boards, signage, lockers, panel partitions, aluminum canopies, food service equipment, athletic equipment, laundry equipment, residential appliances, casework, gymnasium bleachers, window treatments, elevator, sprinkler system, plumbing, HVAC, electrical, security systems and technology systems.

If your firm is interested in prequalifying for this project/phase, please check the box for your trade(s).

This is a preliminary list of Bid Packages and may change based on response and qualified bidders.

Bid Pkg # Scope of Work Preliminary Budget Check Box if

Prequalifying

Subcontractor to Provide

Evidence of Ability to Provide

Performance and Payment

Bond

01A General Trades $169,623.00 ☐ ☐

01B Final Building Cleaning $55,605.00 ☐ ☐

02A Demolition $482,500.00 ☐ ☐

02B Hazardous Material

Abatement $200,000.00 ☐ ☒

03A Concrete Foundations,

Walls & Slabs $1,228,387.00 ☐ ☒

04A Masonry $2,788,020.00 ☐ ☒

05A Structural Steel (furnish

&Erect) $2,017,867.00 ☐ ☐

07A Dampproofing,

Waterproofing & Joint Sealants

$267,400.00 ☐ ☐

07B Membrane Roofing $656,114.00 ☐ ☒

07C Architectural Standing Seam Metal Roofing

$68,000.00 ☐ ☐

07D Skylights $144,500.00 ☐ ☐

08A Doors, Frames,

Hardware, Accessories & Specialties (materials)

$474,248.00 ☐ ☐

Samet / SRS a Joint Venture Prequalification Form for First –Tier Subcontractors under CM at Risk

September 14, 2015 Page 3 of 5

Bid Pkg # Scope of Work Preliminary Budget Check Box if

Prequalifying

Subcontractor to Provide

Evidence of Ability to Provide

Performance and Payment

Bond

08B Doors, Frames,

Hardware, Accessories & Specialties (installation)

$135,000.00 ☐ ☐

08C

Doors, Frames,

Hardware, Accessories & Specialties (installation

& Material)

$608,000.00 ☐ ☐

08D Overhead Coiling Doors $5,000.00 ☐ ☐

08E Aluminum Storefront,

Glass & Glazing $477,306.00 ☐ ☒

09A Drywall, Metal Studs,

Insulation & Carpentry Combined

$648,800.00 ☐ ☒

09B Drywall, Metal Studs,

Insulation $632,400.00 ☐ ☒

09C Carpentry $16,400.00 ☐ ☐

09D Acoustical Ceilings $318,005.00 ☐ ☐

09E Acoustical Treatment $166,680.00 ☐ ☐

09F Hard Tile Flooring $218,284.00 ☐ ☐

09G Resilient Floor & Carpet

Flooring $262,166.00 ☐ ☐

09H Wood Flooring $142,781.00 ☐ ☐

09I Painting $252,900.00 ☐ ☐

09J Polished Concrete $91,000.00 ☐ ☐

10A Visual Display Boards $74,454.00 ☐ ☐

10B Signage $30,000.00 ☐ ☐

10C Lockers $214,000.00 ☐ ☐

10D Operable Panel Partition $45,092.00 ☐ ☐

Samet / SRS a Joint Venture Prequalification Form for First –Tier Subcontractors under CM at Risk

September 14, 2015 Page 4 of 5

Bid Pkg # Scope of Work Preliminary Budget Check Box if

Prequalifying

Subcontractor to Provide

Evidence of Ability to Provide

Performance and Payment

Bond

10E Aluminum Canopy $272,071.00 ☐ ☐

11A Food Service Equipment $350,000.00 ☐ ☐

11B Athletic / Laundry /

Stage Equipment $81,950.00 ☐ ☐

12A Manufactured

Casework, Architectural Woodwork

$755,950.00 ☐ ☒

12B Gymnasium Telescoping

Bleachers $100,000.00 ☐ ☐

12C Window Treatments $15,750.00 ☐ ☐

13A Exterior Bleachers $40,000.00 ☐ ☐

14A Elevator $64,320.00 ☐ ☐

21A Fire Protection $395,000.00 ☐ ☒

22A Plumbing $1,121,800.00 ☐ ☒

23A HVAC $3,169,970.00 ☐ ☒

26A Electrical & Fire Alarm

Combined $2,222,000.00 ☐ ☒

26B Fire Alarm $62,000.00 ☐ ☐

26C Electrical $2,160,000.00 ☐ ☒

27A Technology

Infrastructure / Structured Cabling

$232,260.00 ☐ ☐

27B Technology Integrated

Communications $124,820.00 ☐ ☐

27C Technology Security

System $26,860.00 ☐ ☐

31A Site Preparation $1,673,930.00 ☐ ☒

32A Asphalt Paving Curb &

Gutter $587,194.00 ☐ ☒

Samet / SRS a Joint Venture Prequalification Form for First –Tier Subcontractors under CM at Risk

September 14, 2015 Page 5 of 5

Bid Pkg # Scope of Work Preliminary Budget Check Box if

Prequalifying

Subcontractor to Provide

Evidence of Ability to Provide

Performance and Payment

Bond

32B Track & Track Surfacing $145,000.00 ☐ ☐

32C Site Concrete &

Sidewalk $290,792.00 ☐ ☐

32D Athletic Fields/Turf & Grassing & Irrigation

Combined $446,940.00 ☐ ☐

32E Athletic Fields Irrigation $23,500.00 ☐ ☐

32F Fences & Gates $57,500.00 ☐ ☐

32G Landscaping- Turfs &

Grasses/ Plantings Combined

$175,000.00 ☐ ☐

32H Landscaping- Plantings $100,000.00 ☐ ☐

32I Grass and Sod $75,000.00 ☐ ☐

33A Site Utilities, Water /

Sewer $139,245.00 ☐ ☐

Samet / SRS a Joint Venture Prequalification Form for First –Tier Subcontractors under CM at Risk

September 14, 2015 Page 1 of 13

SECTION 1. MINIMUM REQUIREMENTS [Matrix: There are no points assigned for responses in Section 1 or Section 4 signature page.]

1. a. Primary/Main office location _____________________________________________________________________________________ Company Name ________________________________________________________________________________________________________________________________ Physical Address ________________________________________________________________________________________________________________________________ Mailing Address ________________________________________________________________________________________________________________________________ City/State Zip Code + 4

(______ )_____________________________________ (_____ ) ________________________________________ Phone number Fax number ______________________________________________________________ ________________________________________________________________ Primary Contact Name Secondary Contact Name ______________________________________________________________ _______________________________________________________________ Primary Contact Email Address Secondary Contact Email Address

Office Managing This Project (If Different From Above) _____________________________________________________________________________________ Company Name ________________________________________________________________________________________________________________________________ Physical Address ________________________________________________________________________________________________________________________________ Mailing Address ________________________________________________________________________________________________________________________________ City/State Zip Code + 4

(______ )_____________________________________ (_____ ) ________________________________________ Phone number Fax number ______________________________________________________________ ________________________________________________________________ Primary Contact Name Secondary Contact Name ______________________________________________________________ _______________________________________________________________ Primary Contact Email Address Secondary Contact Email Address

[Matrix: If not completely filled out, proposal is non-responsive and will not be considered for pre-qualification.]

Organization 1. b. Business type (check box) Corporation Partnership Limited Liability Company Sole Proprietor Joint

Venture

Indicate your NC Statewide Uniform Certification: (check box): MBE HBE AABE AIBE WBE SDB DBE See website link for more information: http://www.doa.nc.gov/hub/swuc.htm

_______________________ Other (specify) ______________________ Certifying Agency/State (specify)

Is your firm registered with the State of North Carolina to do business? Yes No

Is your firm owned or controlled by a parent or any other organization? Yes No

Samet / SRS a Joint Venture Prequalification Form for First –Tier Subcontractors under CM at Risk

September 14, 2015 Page 2 of 13

Describe Ownership if Yes:_______________________________________________________________________ Additionally, if you answered Yes that your company is owned or controlled by a parent or any other organization, you agree to sign a Parent Company Guarantee Letter (see Appendix A for sample letter) and submit the same with this Prequalification Application for review and approval. Additionally, an individual who is authorized to bind the Parent Company shall co-sign the contract as a condition precedent to award of a contract. If you do not agree to these terms, your pre-qualification application will not meet the minimum requirements and will be disapproved. List all other names your firm has operated as for the past five (5) years: _________________________________ _____________________________________________________________________________________________ [Matrix: If not completely filled out, proposal is non-responsive and will not be considered for pre-qualification.]

1. c. Licensing Information (Please provide all North Carolina professional licenses required for you to perform your services.)

NC License Type (check box) General Construction Electrical Mechanical Plumbing Burglar Alarm

Fire Protection Other (please specify)

Not Applicable or Required by North Carolina for Trade Package(s) Selected for Pre-qualification _____________________________________________________________________________________________ NC License number/name of licensee License Limit/Level State/County/City Privilege License (provide copy) _______________________________ _________________ _________________________________________ _______________________________ _________________ _________________________________________ _______________________________ _________________ _________________________________________

Has any license ever been denied or revoked? Yes No If yes, please describe, ________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ [Matrix: Enter type of license. If information not provided in application or license does not meet requirement for trade package or State of North Carolina, proposal is non-responsive and will not be considered for pre-qualification.]

1. d. Type of Work Performed on a regular basis

Primary Scope of Work: _________________________________________________________________________

Secondary Scope of Work: _______________________________________________________________________ Other Scope of Work: ___________________________________________________________________________

What type of work do you self perform?____________________________________________________________ Current Number of Employees____________________________________________________________________ Provide list of major equipment /resources used to perform scopes of work __________________________________________________________________________________________________ [Matrix: If not completely filled out, proposal is non-responsive and will not be considered for pre-qualification.]

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Bonding

1. e. (1) Attach letter (see Appendix B for sample letter), dated within the last 30 days, from your surety company, signed by their Attorney in Fact, verifying their willingness to issue sufficient payment and performance bonds for this project, on behalf of your firm and the dollar limits of that bond commitment, both single and aggregate. Surety company bond rating shall be rated “A-” or better and “VII” or higher under the A.M. Best Rating system or The Federal Treasury List.

Have you attached a surety letter? Yes No [Matrix: “Yes or No”. If this information is not provided in application for firms wishing to be approved for a bid package(s) requiring evidence (see bid package list at front of this form) of the ability to provide a Performance and Payment Bond, proposal is non-responsive and will not be considered for pre-qualification. Further, this review and approval for this section will be based on the surety letter stating an amount able to substantiate the surety’s willingness to issue bonds in the sum total of the preliminary budget amounts identified herein for the proposed bid package(s) being sought for pre-qualification approval. This section is not a minimum requirement for firms wishing to become prequalified for bid packages not requiring the ability to provide a Performance and Payment Bond, however all firms are encouraged to provide a surety letter regardless.]

1. e. (2) Have any Funds been expended by a Surety Company on your firm’s behalf? Yes No If yes, explain _____________________________________________________________________________________________ _____________________________________________________________________________________________ [Matrix: If “Yes,” with no explanation given, proposal is non-responsive and will not be considered for pre-qualification.]

Insurance 1. f. The minimum requirements of coverage are defined on the Sample Certificate of Insurance (COI) (See Appendix C for Sample COI). Firms must indicate that they can provide evidence of insurance coverage, should they be considered for approval by attaching a copy of their insurance certificate. Additionally, should your firm not currently carry the exact insurance requirements defined within the Sample Certificate of Insurance, applicant agrees to provide the specified insurance as a precedent to award of a contract. Have you attached a copy of your insurance certificate meeting the aforementioned specified requirements or agree to provide the specified insurance if not currently carried

by your firm? Yes No [Matrix: If “No,” proposal is non-responsive and will not be considered for pre-qualification.]

Financials 1. g. (1) Part 1 – Financial Statements - Attach most recent fiscal year-end balance sheet and income statement, if available, based on company type. Audited statements preferred. If not available, attach a copy of the latest annual renewal submission to the relevant licensing board. In all cases, either a full year audited financial statement or an internal balance sheet with income statement or business tax return must be provided in order to be considered for pre-qualification approval.

Have you attached a balance sheet or other acceptable financial documents referenced above? Yes No [Matrix: If “No,” proposal is non-responsive and will not be considered for pre-qualification.] 1. g. (2) Part 2 – Financial Metrics – As a minimum requirement to become pre-qualified, the metrics illustrated below must be achieved in order to be approved for prequalification with one exception if the firm doesn’t meet or exceed these designated metrics, a Performance and Payment Bond (see requirements under the Bond section above) can be

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substituted by the firm should the company become the successful low bidder for a particular bid package(s). This review and approval for this section will be based on the sum total of the preliminary budget amounts (greatest estimated contract amount if seeking approval for more than one bid package) identified herein for the proposed bid package(s) being sought for pre-qualification approval. This section will be calculated by Samet/SRS. Please note: Samet/SRS will not be including Company Reputation or Good Will as a part of the Matrix evaluation. Have you achieved your metrics or provided evidence of bond-ability based on the anticipated contract value for the bid packages seeking approval?

Yes No [Matrix: If “No,” proposal is non-responsive and will not be considered for pre-qualification.] Metrics: Contract(s) Amounts: $0 to $200,000 Debt to Equity (Total Liabilities/Total Equity) is between 0 and 5.0 Current Ratio (Current Assets/Current Liabilities) is greater than 1.1 Net Current Assets (Current Assets less Current Liabilities) greater than $1 Contract(s) Amounts: $200,000 to $500,000 Debt to Equity (Total Liabilities/Total Equity) is between 0 and 4.0 Current Ratio (Current Assets/Current Liabilities) is greater than 1.2 Net Current Assets (Current Assets less Current Liabilities) greater than $20,000 Contract(s) Amounts: $500,000 and above Debt to Equity (Total Liabilities/Total Equity) is between 0 and 3.0 Current Ratio (Current Assets/Current Liabilities) is greater than 1.3 Net Current Assets (Current Assets less Current Liabilities) greater than $50,000 (Firm must submit financial data and may clearly indicate a request for confidentiality to avoid this item from becoming part of a public record. We understand this information can be extremely confidential and as an option, you may submit your financial statement as an attachment to your pre-qualification package or send under separate cover to our confidential email address financialstatement@sametcorp.com or via facsimile directly to our CFO at Lisa Cunningham (336) 544-6762). Check applicable item below as how financials are being submitted

Attached Sent Via Email Sent Via Facsimile

SECTION 2. GENERAL REQUIREMENTS

Experience - Size/Capacity/Workload 2. a. (1) List the annual dollar value of construction work the company has performed for each year over the last (3)

three calendar years (if applicable).

1 $_______(yr) 2 $_______(yr) 3 $______(yr)

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[Matrix: 0-6 points. For each year completed (positive value), give 2 points each.] 2. a. (2) How many projects do you currently have under contract or in progress and what is their total dollar value?

(# of projects);

$ (Current projects sum of contract amounts);

$ (Projects current amount remaining to bill) [Matrix: 0-5 points. If section completed give 5 points. If not, give 0 points.] 2. a. (3) What was your largest job completed? Sq. Ft. $ (Dollar Amount) Location Year Completed [Matrix: 0-5 points. Step One: Take the “dollar amount of largest job completed” and multiply by 1.5. Step Two: If the result is larger than the sum total of estimated package(s) cost being prequalified for by 100%

then give 5 points;

If the result is larger than the sum total of estimated package(s) cost being prequalified for by 80% and less than 100% then give 4 points; If the result is larger than the sum total of estimated package(s) cost being prequalified for by 60% and less than 80% then give 3 points; If the result is larger than the sum total of estimated package(s) cost being prequalified for by 40% and less than 60% then give 2 points; If the result is larger than the sum total of estimated package(s) cost being prequalified for by 20% and less than 40% then give 2 points; If the result is larger than the sum total of estimated package(s) cost being prequalified for by 10% and less than 20% then give 1 point. If the result is smaller than the sum total of estimated package(s) cost being prequalified for then give 0 points.]

Example No.1: Result of Largest Job Completed = 1,000,000 x 1.5 = $1,500,000 Sum Estimated Total of Bid Package(s): $687,000 $1,500,000 / $687,000 = 2.18 or 118% greater = 5 points

Example No.2: Result of Largest Job Completed = 1,000,000 x 1.5 = $1,500,000 Sum Estimated Total of Bid Package(s): $1,200,000 $1,500,000 / $1,200,000 = 1.25 or 25% greater = 2 points 2. a. (4) Current Backlog $ ________ (Dollar Amount) (Projects Current Amount Remaining to Bill – See 2.a.(2)) [Matrix: 0-5 points] Take "current backlog (2.a.(4)" dollar amount and add "largest job completed (2.a.(3)) multiplied by 1.5".

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(Example 1: Current Backlog = $3,500,000; Largest Job Completed = $1,750,000; $3,500,000 + $1,750,000 = $5,250,000 x 1.5 = $7,875,000)

(Example 2: Current Backlog = $2,000,000; Largest Job Completed = $1,000,000; $2,000,000 + $1,000,000 = $3,000,000 x 1.5 = $4,500,000) Step Two: If the step one value above is less than the 3 year average of the sum of “annual dollar amounts”

listed in (2.a.(1)) divided by 3 and then multiplied by 1.5, then proceed to the table below for applicable points. If the step one value above is greater than the 3 year average of the sum of “annual dollar amounts” listed in (2.a.(1)) divided by 3 and then multiplied by 1.5, then give 0 points

If “current backlog dollar amount plus largest job completed x 1.5” divided by the 3 year average of the sum of “annual dollar amounts” x 1.5 is greater than 0% and less than 20% then give 5 points If “current backlog dollar amount plus largest job completed x 1.5” divided by the 3 year average of the sum of “annual dollar amounts” x 1.5 is between 20% and 40% then give 4 points If “current backlog dollar amount plus largest job completed x 1.5” divided by the 3 year average of the sum of “annual dollar amounts” x 1.5 is between 40% and 60% then give 3 points If “current backlog dollar amount plus largest job completed x 1.5” divided by the 3 year average of the sum of “annual dollar amounts” x 1.5 is between 60% and 80% then give 2 points If “current backlog dollar amount plus largest job completed x 1.5” divided by the 3 year average of the sum of “annual dollar amounts” x 1.5 is between 80% and 100% then give 1 points If “current backlog dollar amount plus largest job completed x 1.5” is greater than the 3 year average of the sum of “annual dollar amounts” x 1.5, then give 0 points (Example 1: 1st Year Annual Dollar Volume = $5,000,000

2nd Year Annual Dollar Volume = $4,500,000 3rd Year Annual Dollar Volume = $6,000,000 Total: $15,500,000 $15,500,000 / 3 = $5,166,666 x 1.5 = $7,750,000 Points Scored: $7,875,000 > $7,750,000 = 0 points

(Example 2: 1st Year Annual Dollar Volume = $4,000,000 2nd Year Annual Dollar Volume = $4,500,000 3rd Year Annual Dollar Volume = $5,000,000 Total: $13,000,000 $13,000,000 / 3 = $4,333,333 x 1.5 = $6,500,000 Points Scored: $4,500,000 < $6,500,000 = Proceed to Table $4,500,000 / $6,500,000 = 69% or 2 points

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2. a. (5) List the three largest contracts currently under contract or in progress, including the name of the project and owner, architect and/or GC/CMR with contact information below.

#1 –Project Name (In addition to project information and at a minimum, list out entity who is providing your reference below)

Description of Work Performed

Contract Delivery Method (CM/GC)?

Owner Name/ Representative

Owner Address/Phone #/Email

Architect Name/Representative

Architect Address/Phone #/Email

GC or CM Name/Representative

GC or CM Address/Phone #/Email

Contract Dollar Value

Percentage Complete

Current Anticipated Completion Date

#2 –Project Name (In addition to project information and at a minimum, list out entity who is providing your reference below)

Description of Work Performed

Contract Delivery Method (CM/GC)?

Owner Name/ Representative

Owner Address/Phone #/Email

Architect Name/Representative

Architect Address/Phone #/Email

GC or CM Name/Representative

GC or CM Address/Phone #/Email

Contract Dollar Value

Percentage Complete

Current Anticipated Completion Date

#3 –Project Name (In addition to project information and at a minimum, list out entity who is providing your reference below)

Description of Work Performed

Contract Delivery Method (CM/GC)?

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September 14, 2015 Page 8 of 13

Owner Name/ Representative

Owner Address/Phone #/Email

Architect Name/Representative

Architect Address/Phone #/Email

GC or CM Name/Representative

GC or CM Address/Phone #/Email

Contract Dollar Value

Percentage Complete

Current Anticipated Completion Date

[Matrix: 0-5 points for each project listed, total of 15 points. For each project above, give 5 points for a positive reference from either the owner, architect or GC/CMR. Positive reference can be in the form of a written reference accompanied with this application from the designated entity (owner, architect or GC/CMR) or through verification by CM following submission of application. CM will attempt to reach out to each reference above in written form and failure of the entity to respond back to the CM’s written inquiry (either written or oral) within five (5) business days will result in forfeiture of points applicable to the given entity. If reference is obtained verbally, CM will document conversation for the record.]

2. b. (1) Has your company ever failed to complete work awarded (under contract) to it? Yes No If yes, please provide project name(s), year(s), and reason why: _____________________________________________________________________________________ ______________________________________________ [Matrix: 0-5 points. If company has never failed to complete work it has been awarded then give 5 points; if the company has failed to complete one (1) project it has been awarded then give 2 points; if the company has failed to complete two (2) or more projects it has been awarded then give 0 points.]

2. b. (2) Have you ever paid liquidated damages on any project? Yes No If yes, state the project name(s), year(s), and reason why. ___________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________ [Matrix: 0-3 points. If company has never paid liquidated damages on any of its projects then give 3 points; if the company has paid liquidated damages on only one project then give 2 points; if the company has paid liquidated damages on only two (2) projects then give 1 point; if the company has paid liquidated damages on three or more projects then give 0 points.] 2. b. (3) Has your present company, its officers, owners, or agents ever been convicted of charges relating to conflicts of

interest, bribery, or bid-rigging? Yes No If yes, state the project name(s), year(s), and reason why. ___________ __________________________________________________________________________________________________ [Matrix: 0 -3 points. If “Yes,” give 0 points. If “No,” give 3 points.]

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2. b. (4) Has your present company, its officers, owners, or agents ever been barred from bidding public work in North

Carolina? Yes No If yes, state the project name(s), year(s), case number and reason why. __________________ __________________________________________________________________________________________________ [Matrix: 0 - 3 points. If “Yes,” give 0 points. If “No,” give 3 points.]

Safety Record 2. c. List your company’s Experience Modification Rate (EMR) for past three years. (Attach OSHA 300 Log for the last

3 years.) Have you attached OSHA 300 log? Yes No Present Rate Last Rate Year before rate If these rates reflect corporate performance over a number of locations, please explain, to the extent possible, the performance experience of the location serving this project: __ _____ ________________________________________________________ _____

List any OSHA fines and Jobsite fatalities in the past 3 years with an explanation: _____ ______________________________________ [Matrix: 0-5 points. If company has EMR rating less than or equal to 1 then give 5 points; if the company has EMR rating greater than 1 and less than 1.10 then give 3 points; if the company has EMR rating greater than 1.10 then give 0 points.

Historically Underutilized Business (HUB) Plan

2. d. Does the company currently have a documented plan for engaging subcontractor participation from Historically

Underutilized Businesses? Yes No If yes, please attach your company’s HUB plan. [Matrix: 0-3 points. If company has a current documented plan give 3 points. If not, give 0 points.] 2. e. What has been your company’s typical percentage level of Historically Underutilized Business participation for similar projects in North Carolina for the past 5 years? ____________%

List the HUB participation you provided in three “similar” projects cited in Section 3. e. as defined below, including name, percentage achieved and CM/GC/Owner representative’s name and telephone number.

Project Name HUB % CM/GC/Owner’s Rep Contact Phone #

[Matrix: 0-3 points, 3 points total. If information provided for each project, give 1 point per project. If information is not provided per project, give 0 points per project. To get points, not all HUB % listed needs to be over 10%]

Litigation/Claims

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2. f. (1) Has your company been involved in any judgments, claims, arbitration or mediation proceedings, or suits within

the last five years, whether resolved or still pending resolution? Yes No If yes, state the project name(s), year(s), case number and reason why: ____ ______________________________________________ _____________ [Matrix: 0-4 points. If “Yes,” with no explanation given then give 0 points; if “Yes” with an explanation given or “No” then give 5 points] 2. f. (2) Are there currently any judgments, claims, arbitration or mediation proceedings or suits pending or outstanding

against your company, its officers, owners, or agents? Yes No If yes, state the project name(s), year(s), case number and reason why: _____________ ______________________________________________ [Matrix: 0-4 points. If “Yes,” with no explanation given then give 0 points; if “Yes” with an explanation given or “No” then give 5 points]

SECTION 3. PROJECT SPECIFICS 3.a. The assigned project superintendent for this project shall be: _______________________________________.

Include a resume. Have you included a resume? Yes No [Matrix: 0-2 points. If resume included, give 2 points. If not, give 0 points.] 3.b. The experience this superintendent has on this specific type of project is: ___ 0-2 ___ 3-4 ___ 5-10 ___ >10 years. [Matrix: 0-5 points. If 0-2 years give 1 pt, 3-4 years give 2 pts, 5-10 years give 4 pts, >10 years give 5 pts.] 3.c. The assigned project manager for this project shall be _____________________________________________.

Include a resume. Have you included a resume? Yes No [Matrix: 0-2 points. If resume included, give 2 points. If not, give 0 points.] 3.d. The experience this project manager has on this specific type of project is: ___ 0-2 ___ 3-4 ___ 5-10 ___ >10 years. [Matrix: 0-5 points. If 0-2 years give 1 pt, 3-4 years give 2 pts, 5-10 years give 4 pts, >10 years give 5 pts.] Similar Projects 3.e. List three (3) current or completed projects of similar type which most closely reflects the size and complexity of the type of work being requested for the currently proposed project within the last 5 years.

#1 –Similar - Project Name (In addition to project information and at a minimum, list out entity who is providing your reference below)

Description of Work Performed

Contract Delivery Method (CM/GC)?

Owner Name/ Representative

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Owner Address/Phone #/Email

Architect Name/Representative

Architect Address/Phone #/Email

GC or CM Name/Representative

GC or CM Address/Phone #/Email

Contract Dollar Value

Percentage Complete

Current Anticipated Completion Date

MWBE Percentage Achieved

#2 –Similar - Project Name (In addition to project information and at a minimum, list out entity who is providing your reference below)

Description of Work Performed

Contract Delivery Method (CM/GC)?

Owner Name/ Representative

Owner Address/Phone #/Email

Architect Name/Representative

Architect Address/Phone #/Email

GC or CM Name/Representative

GC or CM Address/Phone #/Email

Contract Dollar Value

Percentage Complete

Current Anticipated Completion Date

MWBE Percentage Achieved

#3 –Similar - Project Name (In addition to project information and at a minimum, list out entity who is providing your reference below)

Description of Work Performed

Contract Delivery Method (CM/GC)?

Owner Name/ Representative

Owner Address/Phone #/Email

Architect Name/Representative

Architect Address/Phone #/Email

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GC or CM Name/Representative

GC or CM Address/Phone #/Email

Contract Dollar Value

Percentage Complete

Current Anticipated Completion Date

MWBE Percentage Achieved

[Matrix: 0-5 points for each project listed, total of 15 points. For each project above, give 5 points for a positive reference from either the owner, architect or GC/CMR. Positive reference can be in the form of a written reference accompanied with this application from designated entity (owner, architect or GC/CMR) or through verification by CM following submission of application. CM will attempt to reach out to each reference above in written form and failure of the entity to respond back to the CM’s written inquiry (either written or oral) within five (5) business days will result in forfeiture of points applicable to the given entity. If reference is obtained verbally, CM will document conversation for the record.]

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SECTION 4. SIGNATURE (MINIMUM REQUIREMENT) By signing this document, you are acknowledging that all answers are true to the best of your knowledge. Any answers found to be falsified will bar you from being prequalified on this project. ___________________________________________________________________________________________ Company Name (as licensed in NC)

___________________________________________________________________________________________ Physical Address

___________________________________________________________________________________________ Mailing Address

a. Dated this day of:

Submitted by: Signature By Authorized Officer Print Title of Authorized Officer

Phone:____________________________________________ Contact person’s phone number

E-mail:_____________________________________________ Contact person’s E-mail address

b. Notary Certification: North Carolina County I, a Notary Public of the County and State aforesaid, certify that , personally appeared before me this day and acknowledged the execution of the foregoing instrument. Witness my hand and official seal, this the day of , 20 . (Official Notary Seal or Stamp) Signature of Notary Public My commission expires , 20

[Matrix: If signature section is NOT fully executed with notary, proposal is non-responsive and will not be considered for pre-qualification.]

Appendix (attachments)

A. Sample Parent Guarantee Letter B. Sample Surety Letter C. Sample Certificate of Insurance (COI)

APPENDIX A.

July 25, 2013

___________________

Samet / SRS a Joint Venture

309 Gallimore Dairy Rd

Greensboro, NC 27409

Re: Trade Qualification

Company Name

Parent Company Performance Guarantee

Dear Samet /SRS:

At the request of _______________________ (hereinafter “Subcontractor”) and in consideration of the

execution of a written Agreement between Subcontractor and Samet /SRS a Joint Venture,

_______________________ (hereinafter “Guarantor”) for value received and intending to be legally

bound hereby, agrees that in the event Subcontractor shall default or otherwise fail to perform the

Agreement and all modifications thereto in accordance with the terms and conditions thereof,

Guarantor, upon written notice from Samet /SRS, will remedy such default or failure to perform and

shall complete the Work in accordance with the terms of the Agreement and all modifications thereto,

including, without limitation, all guaranty, warranty and/or maintenance obligations of the

Subcontractor thereunder.

This undertaking shall be for the sole benefit of Samet Corporation, its successors and assigns.

__________________________

Signature – Guarantor Entity (___________________)

__________________________

Print Name

__________________________

Title

APPENDIX B.

[AGENCY LETTERHEAD]

[DATE]

Samet Corp/SRS, Inc. a Joint Venture

309 Gallimore Dairy Rd., Suite 102

Greensboro, NC 27409

Re: [SUBCONTRACTOR/SUPPLIER]

To Whom It May Concern:

It has been the privilege of [AGENCY] and [SURETY COMPANY] to provide surety

bonds on behalf of [SUBCONTRACTOR/SUPPLIER] for over [NUMBER] years,

during which time [SUBCONTRACTOR] has performed and we have issued

performance and payment bonds for contracts valued in the range of [DOLLAR

AMOUNT]. In our opinion, [SUBCONTRACTOR/SUPPLIER] remains properly

financed, well equipped, and capably managed.

At the present time, [SURETY COMPANY] provides a [DOLLAR AMOUNT] single

project / [DOLLAR AMOUNT] aggregate surety program to

[SUBCONTRACTOR/VENDOR]. As always, [SURETY COMPANY] reserves the

right to perform normal underwriting at the time of any bond request, including, without

limitation, prior review and approval of relevant contract documents, bond forms, and

project financing. We assume no liability to Samet Corporation / SRS, Inc. a Joint

Venture or its affiliates if for any reason we do not execute such bonds.

[SURETY COMPANY] is listed on the U.S. Treasury Department’s Listing of

Approved Sureties (Department Circular 570), and is rated [GRADE] ([FINANCIAL

SIZE CATEGORY]) by A.M. Best Company.

Very truly yours,

[SURETY COMPANY]

By:______________________________________________

[Name of Producer], Attorney-in-Fact

The ACORD name and logo are registered marks of ACORD

CERTIFICATE HOLDER

© 1988-2014 ACORD CORPORATION. All rights reserved.ACORD 25 (2014/01)

AUTHORIZED REPRESENTATIVE

CANCELLATION

DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE

LOCJECTPRO-POLICY

GEN'L AGGREGATE LIMIT APPLIES PER:

OCCURCLAIMS-MADE

COMMERCIAL GENERAL LIABILITY

PREMISES (Ea occurrence) $DAMAGE TO RENTEDEACH OCCURRENCE $

MED EXP (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $

PRODUCTS - COMP/OP AGG $

$RETENTIONDED

CLAIMS-MADE

OCCUR

$

AGGREGATE $

EACH OCCURRENCE $UMBRELLA LIAB

EXCESS LIAB

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

INSRLTR TYPE OF INSURANCE POLICY NUMBER

POLICY EFF(MM/DD/YYYY)

POLICY EXP(MM/DD/YYYY) LIMITS

PERSTATUTE

OTH-ER

E.L. EACH ACCIDENT

E.L. DISEASE - EA EMPLOYEE

E.L. DISEASE - POLICY LIMIT

$

$

$

ANY PROPRIETOR/PARTNER/EXECUTIVE

If yes, describe underDESCRIPTION OF OPERATIONS below

(Mandatory in NH)OFFICER/MEMBER EXCLUDED?

WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY Y / N

AUTOMOBILE LIABILITY

ANY AUTOALL OWNED SCHEDULED

HIRED AUTOSNON-OWNED

AUTOS AUTOS

AUTOS

COMBINED SINGLE LIMIT

BODILY INJURY (Per person)

BODILY INJURY (Per accident)PROPERTY DAMAGE $

$

$

$

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIODINDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

INSDADDL

WVDSUBR

N / A

$

$

(Ea accident)

(Per accident)

OTHER:

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THISCERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIESBELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZEDREPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject tothe terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to thecertificate holder in lieu of such endorsement(s).

COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:

INSURED

PHONE(A/C, No, Ext):

PRODUCER

ADDRESS:E-MAIL

FAX(A/C, No):

CONTACTNAME:

NAIC #

INSURER A :

INSURER B :

INSURER C :

INSURER D :

INSURER E :

INSURER F :

INSURER(S) AFFORDING COVERAGE

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED INACCORDANCE WITH THE POLICY PROVISIONS.

Date:Project

Name:

Project #: 1 2 3 4 5 6 7 8

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Form # Description Completed yes / no / n/a yes / no / n/a yes / no / n/a yes / no / n/a yes / no / n/a yes / no / n/a yes / no / n/a yes / no / n/a

1.a. Primary/Main Office Location yes / no1.b. Business Type yes / no1.c. Licensing Information yes / no1.d. Type of Work Performed yes / no

1.e.(1) Bonding - Surety letter attached, if required by Bid Package yes / no

1.e.(2) Bonding - Funds expended by Surety Co. on firm's behalf yes / no

1.f. Insurance certificate attached yes / no

1.g. (1) Financial Statements attached yes / no

1.g. (2) Financial Metrics achieved yes / no

4. Signature (See end of Form)4.a. Signed and Dated yes / no4.b. Notary Certification yes / no

(Must meet minimum requirements to proceed to Section 2/3)

2. GENERAL REQUIREMENTS Max Pts Pts Pts Pts Pts Pts Pts Pts Pts

2.a.(1) Experience - Annual dollar value last 3 years 6

2.a.(2) Experience - Number of current projects under contract 5

2.a.(3) Experience - Largest job completed 52.a.(4) Experience - Current Backlog Amount 52.a.(5) Experience - Selected Contract 1 52.a.(5) Experience - Selected Contract 2 52.a.(5) Experience - Selected Contract 3 52.b.(1) Failed to complete construction contract 52.b.(2) Paid Liquidated Damages on a project 32.b.(3) Convicted of conflicts of interest/bribery/bid-rigging 32.b.(4) Barred from public work in NC 3

2.c. EMR rate less than/equal 1 or greater than 1 less than 1.10 52.d. Documented HUB Plan 32.e. Documented HUB Participation on 3 representative projects 3

2.f. (1) Lawsuits, Arbitrations or Mediations - Last five (5) years? 5

2.f. (2) Judgements, Claims, Arbitrations, Lawsuits - Pending/Outstanding? 5Subtotal 71 0 0 0 0 0 0 0 0

Samet / SRS a Joint Venture Prequalification Ratings Matrix for First-Tier Subcontractors under CM @ Risk

1. MINIMUM REQUIREMENTS

Date:Project

Name:

Project #: 1 2 3 4 5 6 7 8

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r N

ame

Co

ntr

acto

r N

ame

Co

ntr

acto

r N

ame

Co

ntr

acto

r N

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Co

ntr

acto

r N

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Co

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r N

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Form # Description Completed yes / no / n/a yes / no / n/a yes / no / n/a yes / no / n/a yes / no / n/a yes / no / n/a yes / no / n/a yes / no / n/a

Samet / SRS a Joint Venture Prequalification Ratings Matrix for First-Tier Subcontractors under CM @ Risk

1. MINIMUM REQUIREMENTS

3. PROJECT SPECIFIC REQUIREMENTS Max Pts Pts Pts Pts Pts Pts Pts Pts Pts3.a. Project Superintendent included resume 23.b. Superintendent Experience 53.c. Project Manager included resume 23.d. Project Manager Experience 53.e.(1) Similar Project Information 1 53.e.(2) Similar Project Information 2 53.e.(3) Similar Project Information 3 5

Subtotal 29 0 0 0 0 0 0 0 0

TOTAL POINTS 100 0 0 0 0 0 0 0 0All scores 70 and above will be prequalified.

Construction Manager Prequalification Schedule

1. Prequalification Schedule: November 2nd , 2015- February 2, 2016

2. Prequalification Advertisement Date:

November 2nd , 2015

3. Project Outreach Mixer Date:

December 15, 2015

4. Last Date To Submit Prequalification: February 2, 2016

5. Last Date For Prequalification Denial Notification:

February 9, 2016

6. Last Date To File Appeal:

February 12, 2016

7. Last Date For Appeal Hearings:

February 17, 2016

8. Last Date For Guilford County Schools To Render An

Opinion On The Appeal: February 22, 2016

9. Last Date For Construction Manager To Appeal Decision:

February 23, 2016

Subcontractor Prequalification Check List/ Items

To Be Turned In With Prequalification Package

1. Completed Samet/SRS Application Prequalification

Form

2. Letter From Surety Company, see appendix B, if

Trade Package(s) you are prequalifying for

requires a Bond.

3. Current Insurance Certificate

4. W-9 if you have never been Prequalified with

Samet/SRS

5. Current Financial Statement

6. Appendix “A” (If applicable)