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).

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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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