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GENERAL CONTRACTOR
PROJECT CONSTRUCTION EXPERIENCE INFORMATION FORM
I. Pre-Qualification Process
A. Applicants may not be deemed qualified by the Village of Lombard (VoL) if:
1. Applicants fail to submit a responsive Application, including failing to provide all required documentation. Applicants shall confirm response to all noted criteria.
2. Applicants fail to reasonably meet the Project Construction Experience Criteria.
3. Applicants fail to reasonably meet the Corporate Criteria. Any determination that an Applicant meets or fails to meet the Criteria rests solely with the VoL.
4. The General Contractor Applicant, or any of its affiliated companies, is a party to more than one Application.
5. The General Contractor Applicant, or any of its affiliated companies, has a Claim against the VoL.
6. Reasonable grounds exist that Applicant(s) are involved in collusion among other applicants; or
7. Applicants fail to execute the Disclosure Affidavit.
B. Final determination of Applicant's qualification status rests solely with the VoL.
II. Pre-Qualification Criteria
A. Project Construction Experience Criteria - General Contractor
1. The Contractor must have satisfactorily completed a minimum of three (3) sewer line relining/replacement projects within the continental Untied States since January 1, 2012. Each of the projects must have:
a. Minimum of 60-inch diameter up to and including180-inch diameter sewer mains
b. Minimum of 1,500 linear feet of pipe
c. Included more than one bidder
d. Included bypass pumping (if required/necessary) to maintain service
2. The Superintendent proposed for the project must have been the Superintendent on at least three (3) replacement projects meeting the criteria in 1a. and must have a minimum of five (5) years (career) supervisory field experience.
3. At least 70 percent of the labor related items on the project must have been completed by the Applicant's own work force. This requirement does not include traffic control, erosion control, utility locate or other similar support services.
4. Projects currently under construction will not qualify.
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Project Construction Experience

Applicant Name:*
Reference 1
Project Title:*
Project Description (including diameters, material, length and bypass pumping capacity):*
Contractor's Office in Responsible Charge:*
Contractor's Superintendent:*
Major Subcontractors:*
Major Material Suppliers:*
Project Owner/Municipality:*
Owner Name:*
Contact Person:*
Phone Number/Email:*
Design Firm
Company Name:*
Contact Person:*
Phone Number/Email:*
Construction Contract Administration/Inspection Firm
Company Name:*
Contact Person:*
Phone Number/Email:*
Joint Venture:*
1. Yes
2. No
Name of Joint Venture Partner(s) (if applicable):
Description of JV Work; Basis of Qualification (if applicable):
Percentage of Work Performed by Applicant:*
Construction Contract
Bid Date:*
Bid Price/Initial Contract Price:*
Final Contract Price:*
Contract Time:*
Initial Performance Time:*
Actual Time to Complete Construction:*
Completion Date:*
Value/Description of Major Change Orders over $10,000:*
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Step Three

Reference 2
Project Title*
Project Description (including diameters, material, length and bypass pumping capacity):*
Contractor's Office in Responsible Charge:*
Contractor's Superintendent:*
Major Subcontractors:*
Major material Suppliers:*
Project Owner/Municipality:*
Owner Name:*
Contact Person:*
Phone Number/Email:*
Design Firm
Company Name:*
Contact Person:*
Phone Number/Email:*
Construction Contract Administration/Inspection Firm
Company Name:*
Contact Person:*
Phone Number/Email:*
Joint Venture:*
1. Yes
2. No
Name of Joint Venture Partner(s) (if applicable):
Description of JV Work; Basis of Qualification (if applicable):
Percentage of Work Performed by Applicant:*
Construction Contract
Bid Date:*
Bid Price/Initial Contract Price:*
Final Contract Price:*
Contract Time:*
Initial Performance Time:*
Actual Time to Complete Construction:*
Completion Date:*
Value/Description of Major Change Orders Over $10,000:*
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Step Four

Reference 3
Project Title:*
Project Description (including diameters, material, length and bypass pumping capacity):*
Contractor's Office in Responsible Charge:*
Contractor's Superintendent:*
Major Subcontractors:*
Major Material Suppliers:*
Project Owner/Muncipality:*
Owner Name:*
Contact Person:*
Phone Number/Email:*
Design Firm
Company Name:*
Contact Person:*
Phone Number/Email:*
Construction Contract Administration/Inspection Firm
Company Name:*
Contact Person:*
Phone Number/Email:*
Joint Venture:*
1. Yes
2. No
Name of Joint Venture Partner(s):
Description of JV Work; Basis of Qualification:
Percentage of Work Performed by Applicant:*
Construction Contract
Bid Date:*
Bid Price/Initial Contract Price:*
Final Contract Price:*
Contract Time:*
Initial Performance Time:*
Actual Time to Complete Construction:*
Completion Date:*
Value/Description of Major Change Orders Over $10,000:*
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Corporate Criteria

Material Manufacturer/Material Data/Liner Thickness

State the name and manufacturer of the proposed liner material and complete the table below (as applicable).
Product Name:*
Type of Product:*
Number of Years in Production:*
Number of Installations Since 2013:*
Product Application/Installation Method*
Training/Certification Process*
Letter of Certification
Include a letter of certification from the lining manufacturer that demonstrates compliance with the chemical and physical properties listed within the specifications.
File Upload*
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Project Construction Experience Information Form

Approved Product
Pre-approved Manufacturer's include:
1.   Geotree (a division of Clockspring NRI)
2.   Quadex, LLC
3.   APM Permaform
Note the submitted product from the approved manufacturers must meet the testing standards listed with specifications.
Check the manufacturer and list the name of the specific product*
1. Geotree (a division of Clockspring NRI)
2. Quadex, LLC
3. APM Permaform
Certifications
Attach PDF files in response to the items below:
•   A letter from the manufacturer certifying that the product meets or exceeds all technical and packaging requirements and that materials have been approved for the installation conditions shown on the Drawings and as specified within the Contract Documents.
•   Original third-party verification that materials meet physical properties specified for design at 24 hour and 28 day per ASTM C-78 & C39
•   Manufacturer’s Materials Warranty certificate
File Upload*
Approved Substitution
- The submittal of information under this section in no way implies that the product, manufacturer, or installer will be deemed to be qualified. The VILLAGE, in its sole discretion, will determine whether a product, manufacturer, or installer does or does not qualify as an approved substitution.
  1. Provide the following information for an approved substitution of product for evaluation by the VILLAGE
Product Name*
Manufacturer name*
Years of experience manufacturing the product*
Country of manufacture of all product components*
Total footage installed in the U.S.A.*
The year the product was first available in the U.S.A.*
Typical lining thickness for pipe sizes between 96 and 108 inches in diameter*
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Step Eight

B. Attach PDF files in response to the items below.
•   A listing of applicable ASTM standards, or other nationally recognized standards related to the properties of the product
•   Testing results including but are not limited to leakage, physical properties, chemical resistance, strain corrosion, external loading, flow characteristics, infiltration/inflow reductions, structural capacity, and external hydrostatic loading capacity
•   An outline of quality control procedures regarding the manufacture of the product.
•   On-site inspection requirements and testing procedures
•   A letter signed and dated by the product manufacturer assuring compliance with all applicable technical specifications in the Contract Document.
File Upload*
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Step Nine

A notarized Disclosure Affidavit is required with this submittal. Download the affidavit, and once it's signed and notarized, click on Upload to attach it to this submittal.
Download Disclosure Affidavit
Upload Signed & Notarized Disclosure Affidavit*

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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Request for Pre-Qualification (RFPQ)

Steps

Step One

Project Construction Experience

Step Three

Step Four

Corporate Criteria

Material Manufacturer/Material Data/Liner Thickness

Project Construction Experience Information Form

Step Eight

Step Nine

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