2008 Subcontractor Questionnaire
Subcontractor Questionnaire & Pre-Qualification Statement
SaskPower Great Plains Power Station
Moose Jaw, SK
• Company Name:
• Company Address:
• Company Website:
• Contacts. Complete the table below, adding rows as needed.
|Name |Role/ Title |Phone |Email |Office/Region Served |
|First Last |Officer |(###) ###-#### |abcdefg@ |Regina, Central Canada |
| |General Inq. | | | |
| |RFP/Estimating | | | |
| |Regionals | | | |
| |Other | | | |
• General Company Information:
Business Type:
( Sole Proprietorship Owner
( General Partnership No. of Partners _________
( Limited Partnership No. of Partners _________
( Corporation or Public Limited Company
( Joint Venture
( Indigenous Owned
( 51% Indigenous Joint Venture
( Other (describe) __________________________________________________
Number of Years in Business:
Total Number of Employees Normally in the Office: ___________ Normally in the Field: __________
% Permanent vs. Seasonal: _____________ % Manual vs. Non-Manual: ______________
Union, CLAC, or Merit Shop:
If Union, what unions are your Company signatory with? ______
Affiliations, Trade or Otherwise (parent and subsidiaries)
Small/Minority/Woman Owned/Disadvantaged Business Enterprise Status, if any
Indigenous/First Nation Status or Partnerships, if any (describe approach for involvement on Project)
If yes, what % of labor would be Indigenous? ________________________________
If no, what would be the company’s plan to include Indigenous Labor? __________________________________________________________________________
Licensing Status per State/Province (include Type of License, Issuing State/Province, License Number and Expiry Date)
• Services Provided. In the cell adjacent to the scope, enter:
P = self-perform >50%; S = subcontract; blank = does not perform scope
| |General Site Work, Trenching, Grading, Roadways (Gravel & | |Sheet Metal & Ductwork Installation, including Power |
| |Paved), Culverts, Storm Sewers | |House Siding and roofing |
| |Underground Utility & Process Piping | |Above Grade Electrical Installation (up to 5kV) |
| |Underground Electrical Duct Banks & Grounding | |High Voltage Electrical Installation (greater than 5kV) |
| |Deep Foundations (Please Specify Self-Performed Pile Types | |Piping & Equipment Insulation Installation |
| |in Notes below) | | |
| |Concrete Foundations | |Heat Trace Installation |
| |Concrete Flatwork | |Protective Coatings |
| |Pre-Engineered Metal Building Structural Steel | |Fireproofing |
| |Heavy Structural Steel Erection (Power House Building) | |Building Finishes (Specify what types below) |
| |Equipment Setting (Millwright) | |Scaffolding ___________________ |
| |Above Grade Pipefitting & Pipe Welding | |Other (Specify) ___________________ |
Other General Notes:
• Company Safety Information:
Does your company have a written safety program? Yes ( No ( If yes, please attach a copy of program
Does your company have personnel dedicated to safety? Yes ( No ( If yes, how many?
Name & title of Safety & Health contact:
If no, who is responsible for safety audits on projects?
What is the frequency of on-site inspections? On-site safety meetings?
Does your company safety program include the following procedures/training? (Please answer yes or no to all safety topics listed, leave no topic unanswered)
( Pre-Task Analysis ( Personal Protection ( Fall Protection
( Field Safety Inspection ( Housekeeping ( First Aid
( Emergency Response ( Fire Protection & Prevention ( Blood Borne Pathogens
( Accident Investigation ( Defensive Driving ( Respiratory Protection
( Work Hazard Reporting ( Heavy Equipment Operation ( Electrical Safety
( Injury Reporting ( Aerial Equipment ( Excavation/Trenching
( Lockout/Tag-out ( Controlled Substance Abuse ( Alcohol Abuse
( Pre-employment Drug Testing ( Random Drug Testing ( Post-Accident Analysis
• Has an external safety audit of your organization been performed? If so please provide OSHA, OHS, COR, or other organization’s pertinent information evidencing findings.
• Does your company maintain a Substance Abuse Policy? Please provide.
• Does your company subscribe to ISNetworld for contractor prequalification including safety statistic reporting? If no, is contractor willing to subscribe to ISNetworld as a prerequisite to qualification?
Other Safety Notes:
• Safety Statistics (Complete as applicable, US and/or Canada)
Rates shall be calculated per 200,000 Man-Hours. Example: [No. of Cases] x 200,000 / [Total Man-hours]
Canada:
|Item Description |2020 |2019 |2018 |2017 |2016 |
|Avg. Number of Employees | | | | | |
|Total Hours Worked | | | | | |
|Lost Time Injury (LTI) Cases | | | | | |
|Number of Days Away | | | | | |
|Lost Time Injury Rate (LTIR) | | | | | |
|Restricted Work Cases (RWC) | | | | | |
|Number of Restricted Days | | | | | |
|Medical Treatment Only (MTO) Cases | | | | | |
|Number of Fatalities | | | | | |
|WCB Exp/Premium Rate | | | | | |
|WCB Industry Code | | | | | |
|WCB Industry Avg. Rate | | | | | |
|OHS Citations | | | | | |
USA:
|Item Description |2020 |2019 |2018 |2017 |2016 |
|Avg. Number of Employees | | | | | |
|Total Hours Worked | | | | | |
|OSHA Recordable Cases | | | | | |
|Days Away Cases | | | | | |
|Number of Days Away | | | | | |
|Restricted or Transferred Days | | | | | |
|Total Recordable Incident Rate | | | | | |
|(TRIR) | | | | | |
|Days Away, Restricted, Transferred | | | | | |
|Rate (DART) | | | | | |
|Number of Fatalities | | | | | |
|Experience Modification Rate (EMR) | | | | | |
|OSHA Citations | | | | | |
Subcontractor shall include a copy of their safety logs for the previous three years to the above referenced statistics are based on.
• Company Financial Information:
Current Bonding Capacity Per Project $ Aggregate Bonding Capacity $
Revenue:
| |Canada Only | US or Other: ___________ |
|Year |Revenue |
|Accounts Receivable (including retainage) |$ |
|Related Party Receivables |$ |
|Current Portion of Notes Receivable |$ |
|Investments |$ |
|Inventory |$ |
|Cost and Estimated Earnings in Excess of Billings |$ |
|Prepaid Expenses |$ |
|Other Assets |$ |
Current Liabilities:
|Line of Credit |$ |
|Current Portion of Long Term Debt |$ |
|Accounts Payable (including retainage) |$ |
|Accrued Liabilities |$ |
|Billings in Excess of Costs and Estimated Earnings |$ |
|Income Taxes Payable |$ |
|Current Portion of Deferred Income Taxes |$ |
|Other Current Liabilities |$ |
Total Liabilities: _______________
Total Equity: _______________
Total Revenue: _______________
Net Income: _______________
Cashflow from Operating Activities: _______________
Current Estimated Project Backlog: 2020 $_________ 2021 $_________ 2022 $________
Normal Project Capability: Quantity __________ Type __________ Size $ ___________
Other Financial Notes:
Bank Reference:
Name of Bank:
Address: City: State/Province: Postal Code:
Bank Contact: Telephone No: ( )
Subcontractor shall include a copy of their most recent “Audited” Financial Statement. All Financial Information is solely for the use of prequalification and shall remain confidential.
• Quality Assurance/Quality Control Information:
Does your company operate under a formal, documented Quality Management System? ( Yes ( No If yes, please attach a copy of program
Does your company develop project specific Quality Plans and/or Inspection and Test Plans? ( Yes ( No
Is your company registered with the APPLICABLE PROVINCE SAFETY AUTHORITY? ( Yes ( No
Does your company have techniques to verify that the service has been delivered in accordance with the contract requirements? ( Yes ( No
Is your company familiar with and capable of developing and maintaining an Inspection & Testing Plan onsite? ( Yes ( No
Does your company employ any continuous improvement processes to monitor and improve the quality of services provided? ( Yes ( No
Does your company employ any processes to monitor jobsite activities to ensure conformance to project, procedures, and specifications? ( Yes ( No
If yes how often?
Other Quality Notes:
• Other Project Information:
• Has your company previously performed work for Burns & McDonnell or SaskPower? If yes, provide a brief summary of the project, scope and year work was performed.
• Has contractor ever been barred/suspended from a Burns & McDonnell or SaskPower project? If yes provide a summary of why and what steps were taken to prevent a future similar situation and the status now.
• Current Projects (size of project, description, location, contract value range)
a. If Contractor performs work outside of Canada, provide the countries and percentage of total work for each country listed
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b. List any work scope items that contractor typically includes in its scope of work, but has the work performed by a subcontractor. Provide names of the subcontractors typically used.
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• Partners you would recommend for work your company does not self-perform
• Provide a list of past projects similar in scope to this Project (type and size).
• Relevant Client/Project references (provide name and contact information).
1.
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• What is company’s staffing plan/strategy to support projects in remote areas of Saskatchewan given any current and/or forecasted labor shortages?
• What experience does your firm have in working in remote areas of Saskatchewan?
• What, if any, experience does your firm have in working near Moose Jaw, SK?
The information provided herein is true and sufficiently complete so as not to be misleading
__________________________________ ____________________ ___________
Signature of Preparer Title/Position Date
Additional Comments, Information, and/or Notes:
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