request for proposals for construction rfp number: 50-550-00-00671 construction … dam and...

REQUEST FOR PROPOSALS FOR

CONSTRUCTION

RFP Number: 50-550-00-00671

Construction of the Cabresto Dam and Reservoir Liner Project

Questa, New Mexico

April 21, 2016

STATE OF NEW MEXICO OFFICE OF THE STATE ENGINEER

DAM SAFETY BUREAU

State of NM, OSE RFP 50-550-00- 00671 OSE Project No.D-240

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TABLE OF CONTENTS

I. PROJECT INFORMATION ....................................................................................................................... 1 A. PURPOSE OF THIS REQUEST FOR PROPOSALS ...................................................................... 1 B. BACKGROUND ............................................................................................................................... 1 C. PROJECT DESCRIPTION ............................................................................................................... 1 D. PROCUREMENT SCHEDULE: ....................................................................................................... 2 E. DEFINITION OF TERMINOLOGY ................................................................................................... 2

II. CONDITIONS GOVERNING THE PROCUREMENT .............................................................................. 4 A. SEQUENCE OF EVENTS ............................................................................................................... 4 B. EVALUATION PROCESS ................................................................................................................ 5 C. GENERAL REQUIREMENTS / INFORMATION.............................................................................. 7

III. RESPONSE FORMAT AND ORGANIZATION .................................................................................... 10 A. NUMBER OF RESPONSES/COPIES ........................................................................................... 10 B. VOLUME I: TECHNICAL PROPOSAL FORMAT ......................................................................... 10 C. VOLUME 2: COST PROPOSAL FORMAT .................................................................................... 11

IV. EVALUATION ...................................................................................................................................... 12 A. EVALUATION CRITERIA ................................................................................................................ 12 B. EVALUATION FACTORS ............................................................................................................... 13

APPENDICES: FORMS A. GENERAL CONTRACTOR’S & SUBCONTRACTOR’S STATEMENTS OF QUALIFICATIONS W/ ATTACHMENTS B. SUBCONTRACTOR LISTING FORM C. CAMPAIGN CONTRIBUTION DISCLOSURE FORM D. ASSIGNMENT OF ANTITRUST CLAIMS FORM


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I. PROJECT INFORMATION

A. PURPOSE OF THIS REQUEST FOR PROPOSALS

The New Mexico Office of the State Engineer (OSE) is requesting competitive sealed proposals for

construction services based on the scope of work described below. All potential Offerors are to read,

understand, and accept the requirements of this Request for Proposals (RFP).

B. BACKGROUND The intent of the State of New Mexico is to have dam owners operate and maintain all reservoirs and dams in accordance with the Rules and Regulations Governing Dam Design, Construction, and Dam Safety (Rules and Regulations). The objective of the Cabresto Dam and Reservoir Liner Project (Project) is to mitigate seepage on the right side of the embankment and through the right abutment. Work for the project includes furnishing all labor, material, transportation, tools, supplies, equipment, and appurtenances necessary to complete the removal, stockpile, and replacement of existing riprap on the dam and reservoir slope, excavation and regrading of a portion of the reservoir slope, installation of geosynthetic liner, and backfill over liner to restore the reservoir slope. In addition the successful contractor shall be required to secure all necessary permits and clearances for the project. The project is located approximately 7 miles northeast of the Village of Questa, New Mexico. The proposed construction services shall be performed in accordance with the OSE Rules and Regulations Governing Dam Design, Construction and Dam Safety dated December 31, 2010. The regulations are posted on the OSE website and may be accessed at http://www.ose.state.nm.us/DS/dsRegs.php. The OSE is requesting proposals for the construction of the Cabresto Dam and Reservoir Liner Project. Cabresto Dam is located on Lake Fork Creek, a tributary to Cabresto Creek, and resides on United States Forest Service (USFS) lands administered by the Questa Ranger District, under Special Use Permit, to the joint owners of the dam; Cabresto Lake Irrigation Company and Llano Community Ditch Association. Cabresto Dam is located approximately 7 miles northeast of the Village of Questa, New Mexico. Access to Cabresto Dam from the Village of Questa is by State Highway 563, Forest Road 134, and Forest Road 134A. The Cabresto Dam and Reservoir Liner Project was designed by RJH Consultants, Inc. of Englewood, Colorado under the direction of the OSE. C. PROJECT DESCRIPTION

The Project will mitigate seepage through the right abutment at Cabresto Dam. Once seepage has

been mitigated, the dam will return to full function and allow for the removal of storage restrictions

currently placed on the dam by the OSE because of dam safety concerns.

The Project consists of the following major work items:

Riprap Salvage: removal, stockpile, and replacement of existing riprap on the dam and reservoir

slope

Excavation: excavation and regrading of a portion of the reservoir slope, and subgrade

preparation

Geosynthetic Liner Installation: installation of geosynthetic liner over prepared subgrade

Fill: backfill over the geosynthetic liner to restore the reservoir slope

A mandatory pre-proposal conference and site visit will be held on April 29, 2016. A tour of the

project site will be conducted following the pre-proposal meeting. The pre-proposal meeting


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will be conducted at the Village of Questa Council Chamber, 2500 Old State Road 3, Questa, NM

87556 at 10:00 am local time. All prime contractors intending to submit on this project must

attend this meeting. The OSE recommends that a four wheel drive type vehicle be used to

attend this meeting because of the potential for harsh weather conditions and location of the

project.

D. PROCUREMENT SCHEDULE:

Submission of Proposals: May 13, 2016 (3:00 PM local time)

Contractor Selection: June 3, 2016

Signed Contract: June 23, 2016

Notice to Proceed: June 24, 2016

Substantial Completion: September 23, 2016

Contract documents are available for inspection at the following locations:

Construction Reporter

1609 Second Street NW

Albuquerque, NM 87102

(505) 243-9793

(505) 242-4758 FAX

Builder’s News and Plan Room

3435 Princeton Drive NE


(505) 884-1752

(505) 883-1627 FAX

Dodge Reporters/McGraw Hill

1615 University Blvd NE


(505) 243-2817

(505) 842-0231 FAX

Project Estimate: The ENGINEER estimate of probable construction costs $ 425,000.00

*(note: excludes New Mexico gross receipts taxes.)

This procurement shall be under the Competitive Sealed Proposals for Construction and Facility

Maintenance, Services and Repairs rule per New Mexico Administrative Code (NMAC) 1.4.8, and will

result in a single award. The RFP documents consist of all the documents listed in the Table of

Contents and all said documents are incorporated in this RFP by reference.

Prospective Offerors are required to visit the site and are expected to understand the local conditions

under which the Work will be performed.

E. DEFINITION OF TERMINOLOGY

This paragraph contains definitions and meanings that are used throughout this RFP, including

appropriate abbreviations.

“Addenda” Written or graphic instruments issued prior to the Proposal submittal date, which clarify,

correct, or change the Proposal requirements or proposed Contract Documents.

“Construction Contractor” means a member of the project construction team who is a New Mexico licensed general contractor and is responsible for the coordination and supervision of the construction services for the contract.

"Contract" An agreement between a State agency and a firm selected to perform the Work called for in

this RFP.

“Contract Documents” means any one or combination of the following contract documents: Contract,

conditions of the Contract, construction drawings and specifications, and/or lease agreement.


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“Contractor” means any business having a contract with a State agency or a local public party.

"Contracting Agency" means the Office of the State Engineer who is responsible for management

and construction of this project.

"Contracting Agency Contact" The person designated as the point of contact by the contracting

agency to act on its behalf concerning the scope of work and programming requirements of the

Contract Documents for the project.

"Determination" Written documentation of a decision made by the Evaluation Committee including

findings of fact required to support a decision. A determination becomes part of the procurement file to

which it pertains.

"Engineer" means a member of the project design team who is a New Mexico licensed engineer

and is responsible for the engineering services. The Engineer for this project is RJH Consultants, Inc.

“Firm” means the company or other business entity referenced under 1.4.8 NMAC for the purpose of

identifying, individually or collectively: a general contractor, a prime contractor, or a subcontractor, of

any tier, whether basic trade subcontractor, subcontractor or other.

The terms “can”, “may”, “should”, “preferably”, or “prefers” identifies a desirable or discretionary

item of the RFP. Failure to comply with such an item will not result in the rejection of the Offerors

proposal.

The terms "must," "shall," "will," "is required," or "are required" identify a mandatory requirement

of this RFP. Failure to comply with such a mandatory factor shall result in the rejection of the Offerors

proposal. Rejection of the proposal will be subject to review by the Evaluation Committee and a final

decision on rejection will be made by the OSE Dam Safety Bureau Chief.

"Offeror" is any person, corporation, or partnership who chooses to submit a proposal in response to

this RFP, with the intent of providing services for this project.

“OSE" Office of the State Engineer. The OSE is the entity requesting proposals.

“Owner” is the Cabresto Lake Irrigation Company and Llano Community Ditch Association.

“Project Team” is comprised of the OSE, OSE Project Manager, representatives of Cabresto Lake

Irrigation Company and Llano Community Ditch, and the Project Design Team.

“Pre-listed Subcontractors” means the subcontractors, of any tier, that the Offeror is required to list,

pursuant to 1.4.8.13 NMAC of 1.4.8 NMAC, at the time it submits a proposal in response to this RFP.

"Prime Contractor" means the New Mexico licensed Contractor selected for this project by the OSE.

“Project Team” All members of the ENGINEER firm, including consultants who will be responsible for

the design of and who will be participating in the construction and completion of the project.

"Proposal" is the Offeror’s response to this RFP.


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"Request for Proposals" or "RFP" This document, any attachments incorporated by reference, and

any amendments issued for use in soliciting proposals, for this project.

“RFP documents” means any one or combination of the following request for proposal documents:

technical proposal; price proposal; financial proposal; contractor qualifications statement; and

subcontractor qualification statement, contracts, or agreements.

"Responsive Offer" or "Responsive Proposal" An offer or proposal, which conforms in all material

respects to the requirements set forth in the RFP as determined by the Evaluation Committee. Material

respects of an RFP include, but are not limited to quality, quantity, or delivery requirements.

"Selection” A formal written notice by the chair of the Evaluation Committee that a firm has been

selected to enter into a contract for services.

"Selection Committee or Evaluation Committee" A body constituted in accordance with Section

1.4.8.16 NMAC 2005 to evaluate proposals and make selection recommendation and or selection. The

Evaluation Committee consists of at least three members. The committee should collectively possess

expertise in the technical requirement of the project, construction design, and contracting. The

Evaluation Committee is chaired by the OSE Dam Safety Bureau Chief, OSE staff and representatives

from the Engineer.

"Statement of Qualifications Forms” means the forms included as part of this RFP, which all Offerors

shall complete, including the qualifications for the team member or partners and subcontractors

proposed for the project.

“Technical Irregularities” are matters of form rather than substance evident from the proposal

document, or insignificant mistakes that can be waived or corrected without prejudice to other Offerors;

that is, when there is no effect on price, quality, or quantity. If discussions are not held, the Evaluation

Committee may waive such irregularities or allow an Offeror to correct them if either is in the best

interest of the State. Examples include the failure of an Offeror to:

a. Submit the number of signed proposals required by the RFP.

b. Sign the proposal, but only if the unsigned proposal is accompanied by other material

indicating the Offeror’s intent to be bound; or

c. Acknowledge receipt of an amendment to the RFP, but only if: a) it is clear from the

proposal that the Offeror received the amendment and intended to be bound by its terms;

or b) the amendment involved had no effect on price, quality, or quantity.

II. CONDITIONS GOVERNING THE PROCUREMENT

This section of the RFP outlines and describes the major events of the selection process and specifies

general requirements.

A. SEQUENCE OF EVENTS

Action Responsibility Date

Issue RFP State Purchasing Division 4/21/2016


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Deadline to Submit Acknowledgment of Receipt (Appendix B)

Potential Offerors 5/2/2016

Mandatory Pre-Proposal Conference Contracting Agency and Potential Offerors

4/29/2016

Deadline to Submit Additional Written Questions

Potential Offerors 5/5/2016

Response (Addenda) to Written Questions

Contracting Agency 5/10/2016

Deadline for Submission of Proposals to Contracting Agency

Potential Offerors 5/13/2016 3:00 PM

Proposal Evaluation Contracting Agency/Evaluation Committee

5/16/2016 to 6/3/2016

Interviews (If Necessary) Contracting Agency/Evaluation Committee

TBD

Contract Finalization and Award Contracting Agency 6/23/2016

Notice to Proceed/Kick-off Meeting Project Manager 6/24/2016

NOTICE: OSE reserves the sole right, without incurring any liability, to change any aspect of the proposed procurement described above; including the right to not proceed with the procurement and/or the right to proceed in a different manner or on a different timeline than as described above. B. RFP INFORMATION

1. RFP and Construction Documents available.

a. Issue RFP – This RFP is issued by the OSE Dam Safety Bureau in accordance with the

provisions of Sections 13-1-111 through 13-1-117 NMSA 1978. This and other RFPs will

be posted on the OSE website:

http://www.ose.state.nm.us/AgencyInfo/contractManagement.php

and on the RJH Consultants website: https://file.ac/eYVBXrjvxKs/

b. Contract Documents – A compact disc containing the full RFP and Contract Documents is

available for a fee of ten dollars ($10) at the following location:

Attn: Marcos Mendiola

NM Office of the State Engineer/Interstate Stream Commission

Bataan Memorial Building, Room 101

Santa Fe, NM 87504

Phone: 505-476-0261

2. Questions/Clarifications – Between issuing the RFP and Submission of Proposals, potential

Offerors may contact in writing the OSE (OSE) Primary Contact with questions about the scope

of the Project or the RFP schedule. Copies of the Standard Agreement between Contracting

Agency and Contractor are included in the Project Manual. Offerors are encouraged to


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familiarize themselves with this Standard Agreement between the Contracting Agency and

Contractor. All questions and inquiries concerning the project or selection process shall be in

writing to:

Marcos Mendiola, OSE Primary Contact Bataan Memorial Building, Room 101 407 Galisteo Santa Fe, NM 87504 Phone: 505-476-0261 Fax: 505-827-6188 Email: [email protected]

3. Mandatory Pre-proposal Conference – Provides interested Offerors an opportunity to request

clarification about the procurement process and discuss the intent of the Project with the OSE

and Engineer. A representative from each interested prime contractor is required to attend.

During the meeting, a presentation will be made to describe the overall scope of work and

intended schedule.

Subcontractors and suppliers are invited to attend this meeting but it is not mandatory for them.

THE PRIME CONTRACTOR’S ABSENCE FROM THE PRE-PROPOSAL CONFERENCE

PRECLUDES PARTICIPATION AS AN OFFEROR ON THIS PROJECT.

4. Response Addenda – If an addendum is deemed necessary it will be issued no later than May

10, 2016. Any addenda issued prior to the submittal deadline shall become part of the RFP

and any information required shall be included in your proposal. The OSE will distribute the

addenda in writing to all recipients of the RFP.

5. Product Substitute and/or “Equal” Items – The Offeror shall submit the cost proposal with the

products referenced in the Contractual Documents and in accordance with Article 10 of

Specification Section 00200: INSTRUCTIONS TO OFFERORS.

6. Submission of Proposal – Offerors shall submit a two-part, two-volume written proposals in

accordance with Article 14 of Specification Section 00200: INSTRUCTIONS TO OFFERORS.

Each prospective Offeror shall submit a two-part, two-volume proposal.

a. Deliver the proposals to the following place:

Attn: Brittany Christiansen

RFP Number 10-550-00-00529

State Purchasing Division

Joseph Montoya Building 1100 St. Francis Drive Santa Fe, NM 87505

b. Receipt of Proposals: State Purchasing Division will time-stamp proposals and hold in a secure location. A public log will be kept of the names and submittal times of all proposals. Proposals received after the deadline will be deemed non-responsive, and will be returned unopened to the Offeror.

c. Proposal Submittal Deadline: May 13, 2016 (3:00 PM local time)

mailto:[email protected]


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7. Cost Proposal Security – Provide in accordance with the RFP and Construction Documents.

8. Proposal Process – The proposal process will include the following steps:

a. Evaluation of Proposals –The OSE shall first confirm each proposal meets the

requirements set forth in the RFP. The evaluation committee will review and score each

proposal. The technical proposal evaluation will be scored first and independently of the

price proposal evaluation. Points will be allocated by each Committee member, per

Section IV of this RFP. The Committee member rankings will be totaled and added to the

cost score to compute the overall ranking of the firms. The Evaluation Committee may

hold interviews with all Offerors or only certain Offerors, or at its discretion may not hold

interviews, based on conditions of Event 8.b and Event 8.c. If fewer than three proposals

are received, the Evaluation Committee may recommend award or may reissue the RFP.

b. Pre-Interview Teleconference (If Necessary) – If selected for an interview, the OSE will

notify firms with a date and time for a Pre-interview Teleconference meeting. The Pre-

Interview Teleconference will be conducted by the OSE Staff to answer any questions

regarding the interview process.

c. Interviews (If Necessary) – Notice to interviewees will include the interview date, time, and

location. The purpose of the interview(s) is for the Evaluation Committee to obtain

additional information necessary to evaluate the proposal(s). However, all Offerors may

not be requested to participate in the interviews. A firm can be considered for selection

without an interview at the discretion of the Evaluation Committee. Ninety (90) minutes will

be allotted for the interview to include a forty five (45) minute question and answer session

by the Evaluation Committee.

C. GENERAL REQUIREMENTS / INFORMATION

This section contains information about the RFP process and conditions, which this RFP is issued and

how the intended project will be completed.

1. Right to Protest – Any Offeror who is aggrieved in connection with a solicitation or the award of

a Contract may protest to the OSE Primary Contact in accordance with Article 27 of

Specification Section 00200: INSTRUCTIONS TO OFFERORS.

2. Incurring Cost – All costs incurred by the Offeror in preparation, transmittal, or presentation of

any proposal or material submitted in response to this RFP shall be borne solely by the Offeror.

3. Subcontractors – Since the award decision includes evaluation of qualifications, replacement of

subcontractors after award of and prior to the Contract execution may cause the Offeror to be

disqualified. Submit proposed subcontractor replacements to OSE for consideration prior to

Contract execution.

4. Pre-listed Subcontractors – Prior to the award of the Contract, the OSE will notify the Offeror, in

writing, if either the OSE or the Engineer, after due investigation, has reasonable and

substantial objection to any person or organization on such list, and refuses in writing to accept

such person or organization, the Offeror may, at their option, (1) withdraw their Proposal, or (2)

submit an acceptable substitute Subcontractor with no increase in the Proposal price. In the


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event of withdrawal under this paragraph, Cost Proposal Security will not be forfeited,

notwithstanding anything to the contrary in Paragraph 6 below.

5. Amended Proposals – An Offeror may submit an amended proposal prior to the deadline for

receipt of proposals. Such amended proposals must be complete replacements for a

previously submitted proposal and must be clearly identified as such in the transmittal letter.

OSE personnel will not collate or assemble proposal materials for the Offeror.

6. Offeror's Rights to Withdraw Proposal – Offerors will be allowed to withdraw their proposals at

any time. The Offeror must submit a written withdrawal request signed by the Offerors duly

authorized representative and addressed to the OSE Primary Contact.

7. Disclosure of Proposal Contents – Proposal contents will be kept confidential until conclusion of

successful Contract negotiations. At that time, all proposals will be subject to public inspection

as provided by law, except for the material that has clearly been noted and deemed as

proprietary or confidential by the Offeror. Confidential data is normally restricted to confidential

financial information concerning the Offeror’s organization and data that qualifies as a trade

secret under the Uniform Trade Secrets Act, Sections NMSA 1978 § 57-3A-7. Any pages of a

proposal on which the Offeror has stamped or imprinted “proprietary” or “confidential” must be

readily separable from the proposal in order to facilitate public inspection for the non-

confidential portion of the qualifications-based proposal.

8. Termination of RFP – This RFP may be canceled at any time and any and all proposals may

be rejected in whole or in part when the OSE Primary Contact or the OSE Dam Safety Bureau

Chief determines such action to be in the best interest of the State of New Mexico. The RFP

process may be terminated at any time if sufficient appropriations or authorizations do not exist.

Such termination will be effected by sending written notice to the Offeror. The OSE decision as

to whether sufficient appropriations and authorizations are available will be accepted by the

Offeror as final.

9. Contract – A copy of the Construction Agreement between Contracting Agency and Contractor

(Specification Section 00520) is provided in the Contractual Documents. Any questions about

the contract terms and conditions must be brought to the attention of the OSE Primary Contact

prior to submission of a project proposal.

10. Contract Negotiations – The Contracting Agency and the selected Offeror will begin Contract

negotiations as soon as possible after Notice-of-Intent to Award. If contract negotiations are

not finalized within 120 days after Notice-of-Intent to Award, Contracting Agency may conclude

negotiations with the selected Offeror and begin negotiations with the next ranked Offeror.

11. Right to Waive Technical Irregularities – The Evaluation Committee reserves the right to waive

technical irregularities.

12. Notice – The Procurement Code, Sections 13-1-28 through 13-1-199 NMSA 1978, imposes

civil and misdemeanor criminal penalties for its violation. In addition, the New Mexico criminal

statutes impose felony penalties for bribes, gratuities, and kickbacks.

13. Clarifications from Offerors – The Evaluation Committee, after review of the proposals and/or

interviews, may request clarifications on information submitted by any and all Offerors in a

written format, with a specified deadline for response.


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14. Licensing Requirements – The Contractor shall comply with and require all of its

Subcontractors to comply with the license laws as required by the State of New Mexico.

15. New Mexico Employees Health Coverage

a. If Contractor has, or grows to, six (6) or more employees who work, or who are expected to

work, an average of at least 20 hours per week over a six (6) month period during the term

of the Contract, Contractor certifies, by signing this agreement, to have in place, and agree

to maintain for the term of the Contract, health insurance for those employees and offer

that health insurance to those employees no later than May 18, 2011, if the expected

annual value in the aggregate of any and all Contracts between Contractor and the State

exceed $250,000 dollars.

b. Contractor agrees to maintain a record of the number of employees who have (a) accepted

health insurance, (b) declined health insurance due to other health insurance coverage

already in place, or (c) declined health insurance for other reasons. These records are

subject to review and audit by a representative of the State.

c. Contractor agrees to advise all employees of the availability of State publicly financed

health care coverage programs by providing each employee with, as a minimum, the

following web site link to additional information: http://insurenewmexico.state.nm.us/.

16. Employee Pay Equity Reporting – Contractor agrees, if it has ten (10) or more employees OR

eight (8) or more employees in the same job classification, at any time during the term of this

Contract, to complete and submit the PE10-249 form within thirty (30) days of Contract award.

For Contracts that extend beyond one (1) calendar year, or are extended beyond one (1)

calendar year, Contractor also agrees to complete and submit the required form (PE10-249 or

PE250, depending on their size at the time) within thirty (30) days of the annual Contract

anniversary date or, if more than 180 days has elapsed since submittal of the last report, at the

completion of the Contract, whichever comes first. Should Contractor not meet the size

requirement for reporting at Contract award but subsequently grows such that they meet or

exceed the size requirement for reporting, Contractor agrees to provide the required report

within ninety (90 days) of meeting or exceeding the size requirement. That submittal date shall

serve as the basis for submittals required thereafter. Contractor also agrees to levy this

requirement on any Subcontractor(s) performing more than 10% of the dollar value for this

Contract if said subcontractor(s) meets, or grows to meet, the stated employee size thresholds

during the term of the Contract. Contractor further agrees that, should one or more

Subcontractor not meet the size requirement for reporting at Contract award but subsequently

grows such that they meet or exceed the size requirement for reporting, Contractor will submit

the required report, for each such Subcontractor, within ninety (90 days) of that subcontractor

meeting or exceeding the size requirement. Subsequent report submittals, on behalf of each

such Subcontractor, shall be due on the annual anniversary of the initial report submittal.

Contractor shall submit the required form(s) to the State Purchasing Division of the General

Services Department, and other departments as may be determined, on behalf of the

applicable Subcontractor(s) in accordance with the schedule contained in this paragraph.

Contractor acknowledges that this subcontractor reporting requirement applies even though

Offeror itself may not meet the size requirement for reporting and be required to report itself.

http://insurenewmexico.state.nm.us/


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17. Insurance – Contractor shall comply with all insurance requirements as indicated in the RFP and

Contract Documents, III. Supplementary Conditions, Article 5.

III. RESPONSE FORMAT AND ORGANIZATION

A. NUMBER OF RESPONSES/COPIES

The proposal shall be submitted in two parts; Volume 1: Technical Proposal and Volume 2: Cost Proposal. Only one proposal may be submitted by each Offeror for this Project. Offerors shall provide eight (8) identical copies of their Technical Proposal, mark one as “Original”; and two (2) identical copies of their Cost Proposal, mark one as “Original” at the location specified in Section II

B. VOLUME I: TECHNICAL PROPOSAL FORMAT

Format will be 8-1/2" x 11" with foldout sheets allowed up to 11" x 17" in size. All foldout sheets, up to a

maximum of 11" x 17" sheets will be counted as two pages and shall be labeled as such. Text will be

no smaller than 10 point font. If there is any question as to format requirements, contact the OSE for

clarification, prior to submittal of the proposal.

1. Proposal Organization – All pages shall be numbered. All foldout pages shall be counted as

two (2) pages and shall be numbered as such. Proposals shall be organized and tabbed as

follows:

a. Submittal Letter

b. Table of Contents

c. Glossary

d. Part I. General Contractor’s Qualifications Statement with tabbed attachments

e. Part 2. Subcontractor’s Qualifications Statement with tabbed attachments

2. Submittal Letter (three page maximum) – Each proposal must be accompanied by a submittal

letter. Submittal letters that omit any of the following minimum information may be

deemed non-responsive. The submittal letter shall contain an acknowledgement and

certification section with the following provisions:

a. Signed by a Director, Officer, or Manager of the submitting firm who has sufficient

knowledge to fully address all matters and respond to all inquiries included in RFP

documents and has the authority to contractually bind the firm.

b. Provide telephone numbers, fax, and e-mail address of the Director, Officer, or Manager to

be contacted for clarification questions regarding this RFP.

c. Submitting firm shall represent that the information provided in the RFP documents is

truthful, accurate, and complete and that the firm and individual responsible for the

submission shall be fully responsible for and bound by all information, data, certifications,

disclosures, and attachments included in the RFP documents.


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d. Explicitly indicate the information and data provided in connection with the RFP

documents, as well as any other relevant information obtained from any other sources

regarding the firm, may be reviewed to determine whether it qualifies as a responsible

contractor pursuant to 1.4.1.75 NMAC and whether its offer represents the best value to

the issuing agency.

e. Explicitly indicate understanding that the firm’s failure to meet responsibility standards or

provide requested information may render it ineligible to perform work on the prospective

procurement Contract.

f. Explicitly acknowledge the firm’s obligation to carefully review and complete, and (when

applicable) update the RFP documents.

g. Acknowledge that omission of any material fact concerning requested or submitted

information, or the submission of any material false or misleading statement, or

misrepresentation of a material fact concerning any requested or submitted information,

may lead to the disqualification of the proposal.

h. Explicitly agree that if awarded the Contract, the RFP documents and all terms and

conditions specified therein, and all information, data, certifications and disclosures

included in the RFP documents, shall be incorporated into the Contract.

i. Explicitly indicate understanding that if it is determined that it has intentionally or recklessly

failed to disclose requested information, or has intentionally or recklessly made a false

statement, misrepresentation, or omission regarding a material fact relating to the RFP

documents, the firm may be declared in default of Contract and any such conduct shall be

grounds to terminate the Contract and/or withhold full or partial payment and/or impose any

sanctions or penalties, as deemed appropriate, and available under New Mexico law.

j. Identify the name and title of the person(s) authorized to contractually obligate the Offeror

for the purpose of this RFP and Contract;

k. Acknowledge receipt of any and all addenda to this RFP.

3. Statement of Qualifications Form – Each Offeror shall complete the Statement of Qualifications

form and include this form in their proposal. Each Offeror shall also include in their proposal

the appropriate earthwork, stream diversion/reservoir control, and geosynthetic liner

Subcontractor Qualification forms. All Offeror qualifications will be reviewed and rated by the

selection committee.

C. VOLUME 2: COST PROPOSAL FORMAT

1. Before Submitting a Proposal – Each Contractor shall carefully examine the RFP, shall visit the

site of the Work, shall fully inform themselves as to all existing conditions and limitations, and

shall include in the proposal the cost of all items required by the RFP. If the Contractor

observes that portions of the Contract Documents are at variance with applicable laws, building

codes, rules, regulations, or contain obvious erroneous or uncoordinated information, the

Contractor shall promptly notify the specified OSE Representative and the necessary changes

shall be accomplished by addenda.


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2. Cost Proposal Form – Each Offeror shall complete the Cost Proposal Form and include this

form in Volume 2: Cost Proposal. The cost proposal, bearing original signatures, must be

typed or hand-written in ink on the Cost Proposal Form and submitted in a sealed envelope at

the time and location specified in Part II of this RFP. Late proposals will be disqualified and

returned to the Offeror unopened. Two (2) original price proposals are required with the

proposal submission. If awarded this Contract, one copy of the Volume 2: Cost Proposal and

all backup must be submitted by the selected Offeror for escrow purposes.

a. The Contractor shall complete all line items on the Cost Proposal Form.

b. Proposals will be available for public inspection after the award and conclusion of successful

contract negotiations.

3. Subcontractor Listing Form – Each Offeror shall complete the Subcontractor Listing Form and

include this form in their proposal. The Offeror shall provide a list of all subcontractors that will

perform work on the Project above $20,000.00. The Offeror may not change any of the firms

listed without the Contracting Agency’s written consent.

a. The Contracting Agency’s will consider any request for a change in the listed firms in

conformance with the New Mexico “Subcontractors Fair Practices Act” (New Mexico

Statutes Annotated, Chapter 13, Sections 13-4-31 through 13-4-43).

4. Assignments of Antitrust Claims Form – Each Offeror, their Subcontractors, and suppliers shall

complete the Assignment of Antitrust Claims Form and include this form in Volume 2: Cost

Proposal.

5. Include Cost Proposal Security documents as required in the RFP and Contract Documents.

6. Each Offeror shall complete the following Documents and include in Volume 2: Cost Proposal:

a. Non-Collision Affidavit

b. Certificate of Non-Segregated Facility

c. Certificate of Equal Employment Opportunity

d. Campaign Contribution Disclosure Form

IV. EVALUATION

A. EVALUATION CRITERIA A maximum total of 1000 points are possible in scoring each proposal. The Evaluation Committee will evaluate the proposals and may conduct interviews with Offerors applying for selection. The evaluation criteria to be used by the Evaluation Committee and the corresponding point value for each criterion are as follows:


13

Evaluation Criteria

Maximum Points

Available

1.

Company - Offeror will be evaluated on the following:

Financial Status

Safety Program

Availability of Staff and Equipment

Quality Control Plan

Project Team

250

2.

Experience - Offeror will be evaluated on the following:

General Company Experience

Key Project Personnel

Specific Experience In Dam Embankments

Specific Experience In Stream Diversion and Reservoir Control

Specific Experience In Geosynthetic Liner Installation

350

3.

Schedule - Offeror will be evaluated on scheduling as follows:

Overall Project Schedule

Milestone Dates Within the Overall Schedule

100

4. Cost Proposal 300

B. EVALUATION FACTORS

The completed Statement of Qualification forms will be reviewed by the Evaluation Committee for

accuracy and completeness. Each prospective Offeror must answer all of the questions and provide all

requested information, where applicable. Any Offeror failing to do so may be deemed not responsive

and not responsible with respect to this qualification at the sole discretion of OSE. Prime Contractors

are hereby informed that in making evaluations and determinations, OSE is not restricted to the

minimum information required for Qualification Statements and that any relevant information regarding

performance from reliable sources may be considered.

A brief explanation of each evaluation category is listed below.

1. Company (Maximum 250 points):

a. Financial Status – Does the firm have adequate bonding capacity, does the firm have outstanding claims from previous work, what are the firms claims, and finance or surety history.

b. Safety Program – Does the firm have a Health and Safety management program, what is the firm’s Experience Modification Rating (EMR).

c. Availability of Staff and Equipment – Does the firm demonstrate that they have adequate resources to perform the Work in the time allotted. What is the availability of key personnel and equipment relative to other work currently under contract.

d. Quality Control Plan – How will construction be organized, managed, and administered to meet project and schedule requirements. Does the firm exhibit an understanding of access, staging, and delivery challenges associated with the project.

e. Project Team – What are the qualifications of the project team (firm, key staff, and key subcontractors).

2. Experience (Maximum 350 points):


14

a. General Company Experience – Does the firm have experience with projects of similar

size and complexity?

b. Key Project Personnel – Do key personnel have experience in similar construction?

c. Specific Experience In Dam Embankments – Does the firm have experience in embankment dam construction?

d. Specific Experience In Stream Diversion and Reservoir Control – Does the firm have experience in stream diversion and reservoir control for projects of similar size and complexity.

e. Specific Experience In Geosynthetic Liner Installation – Does the firm have experience in installation of geosynthetic liners?

3. Schedule (Maximum 100 points):

a. Overall Project Schedule – Does the overall schedule meet the project requirements?

Provide a graphic representation of the proposed project schedule.

b. Milestone Dates Within the Overall Schedule – Are milestone dates reasonable relative to the overall schedule provided.

4. Cost Proposal (Maximum 300 points):

The Cost Proposal Score of each Offeror shall be determined by applying the following mathematical formula: Price of Lowest Offeror X Maximum Price Score = Cost Score of this Price of this Offeror Offeror

*Required by New Mexico State statute (§ 13-1-120.B NMSA 1978).

ITEM POSSIBLE POINTS

SCORE

Resident Business - must provide valid resident

business certificate. Points awarded are based on percent of

Total Points Possible in

(5%)

Written Evaluation Criteria 50 Points

Resident Veteran Business - must provide valid

resident veteran business certificate. Points awarded are

based on percent of Total Points Possible in the Written

Evaluation Criteria

(7%, 8%, or 10%)

Written Evaluation Criteria (Only) 70, 80 or 100 Points

*Points awarded to an Offeror for Resident Business Preference or Resident Veteran Business Preference (required by Senate Bill 1, 2011) are based on total possible points as indicated above and are added to the total score awarded to that Offeror.


15

5. Resident Business Preference or Resident Veteran Business Preference: Points will be awarded based on Offeror’s ability to provide a copy of a current Resident Business

certificate or Resident Veteran Business certificate.

5.1 Resident Business Preference

For the Offeror to receive a Resident Business Preference, the business shall submit, with

this proposal, a copy of a valid Resident Business certificate issued by the New Mexico

Taxation & Revenue Department. The application for preference may be downloaded at the

following website: http://www.tax.newmexico.gov/forms-and-publications/pages/recently-

updated.aspx.

Five (5) percent (%) of the total possible points may be awarded to an Offeror who qualifies

as a Resident Business. These points are added to the total points received for the

Evaluation Criteria (page 13).

5.2 Resident Veteran Business Preference

For the Offeror to receive a Resident Veteran Business Preference, the business shall

complete, sign, and include with the proposal the attached certification form, along with a

copy of a valid Resident Veteran Business Preference certificate issued by the New Mexico

Taxation & Revenue Department. The application for preference may be downloaded at the

following website: http://www.tax.newmexico.gov/forms-and-publications/pages/recently-

updated.aspx.

Offerors seeking a Resident Veteran Business Preference will be evaluated as follows:

A. Resident Veteran Businesses with annual revenues of $1M or less are to receive a 10%

preference on their proposals.

B. Resident Veteran Businesses with annual revenues of more than $1M but less than $5M are

to receive an 8% preference on their proposals.

C. Resident Veteran Businesses with annual revenues of more than $5M are to receive a 7%

preference on their proposals.

The 7%, 8%, or 10%, as indicated above, will be to the total points received for the Written

Evaluation Criteria.

The Resident Veteran Business Preference is separate from the Resident Business

Preference and is not cumulative with that preference. However, Resident Veteran

Businesses can still receive the Resident Business Preference once the Resident Veteran

Business Preference cap is exceeded.

Example: The RFP has a total value of 1,000 points. Five proposals are received: one from a

Resident Business, one from a Resident Veteran Business with an 8% preference, and three non-

resident businesses. The Resident Business would receive 50 points and the Resident Veteran

Business would receive 80 points which would be added to their already evaluated scores, thereby

making it possible for the highest score to be 1,080.

Note: Neither the Resident Business Preference nor the Resident Veteran Business Preference can

be awarded for any project/contract if it includes federal funds.

E N D O F R E Q U E S T F O R P R O P O S A LS

http://www.tax.newmexico.gov/forms-and-publications/pages/recently-updated.aspx




GENERAL CONTRACTOR’S STATEMENT OF QUALIFICATIONS

General Contractor Statement of Qualifications

State of NM, OSE RFP 10-550-00-00529 1 of 13

PART 1 1. ORGANIZATION

a. Name of Contact Person: _____________________________________________________________ b. Address, Place, Phone and Fax Number, and Email Address of Contact Person:

___________________________________________________________________________________

___________________________________________________________________________________ c. Principal Office Contact Information: ______________________________________________________ d. Business Form:

[ ] Corporation [ ] Partnership [ ] Sole Proprietorship [ ] Joint Venture

[ ] Other ____________________________________________________________ e. Longevity:

i. How many years has your organization been in business as a Contractor? _______ ii. How many years has your organization been in business under its present business name? _______ iii. Under what other or former names has your organization operated? _____________ ______________________________________________________________________

______________________________________________________________________

2. LICENSING a. Name of license holder (or qualifying party) exactly as on file with the State of New Mexico Construction

Industries Division:

__________________________________________________________________ b. License Classification: _____________________ License Code: _____________ c. License Number: ___________________

d. Issue Date: ____________________ Expiration Date: _____________________

e. Is the firm’s contractor’s license free of ever being suspended or revoked by the CID or by the appropriate

licensing agency in any other State? [ ] Yes, Free of suspension or revocation [ ] No (attach explanation)

f. Does your firm hold all applicable business licenses required by State (New Mexico) or Local (Taos

County) Law?

License Number: ____________________ Jurisdiction: _____________________ Name of License Holder, exactly as it appears on file with jurisdictional authorities. ___________________________________________________________________ Issue Date: _____________________ Expiration Date: _____________________




License Number: ___________________ Jurisdiction: ______________________ Name of License Holder, exactly as it appears on file with jurisdictional authorities: ___________________________________________________________________ Issue Date: _____________________ Expiration Date: _____________________ License Number: ___________________ Jurisdiction: ______________________ Name of License Holder, exactly as it appears on file with jurisdictional authorities: ___________________________________________________________________ Issue Date: _____________________ Expiration Date: _____________________

g. Is your firm registered with the State of New Mexico, State Purchasing Department with a Resident

Preference Number? (See Instructions to Offerors).

Resident Preference Number: ________________ Issue Date: ____________ Name of Number holder, exactly as it appears on file with State Purchasing.

________________________________________________________________

h. Is your firm free from formal debarment from public works, Federal, State, or local jurisdictions?

[ ] Yes [ ] No (attach explanation)

3. LABOR CODE VIOLATIONS

a. Has your firm, during the past ten (10) years, been free of any determinations by a court or an administrative agency of repeated or willful violations of laws and/or regulations pertaining to the payment of prevailing wages or employment of apprentices of public works projects?


b. Please provide documentation to substantiate this (Attachment J). c. Is the firm free of all Sub-contractor Fair Practices Act violations for the past ten (10) years?

[ ] Yes [ ] No (attach explanation) 4. AFFIRMATIVE ACTION POLICY a. Does your firm have an active Affirmative Action Policy? [ ] Yes [ ] No b. Provide one (1) copy of the current policy (Attachment K).

5. SURETY

a. Firm’s current surety company: __________________________________________

Will this surety be used for the construction contract for this project? [ ] Yes [ ] No (attach explanation) Contact Agent: Name: _________________________ Telephone: ______________




Years utilizing this surety: _______________ Maximum Capacity: ______________ Aggregate Total of current surety in force: ______________

b. Is the surety company to be used on this project licensed to do business in the State of New Mexico?


c. Is your firm free of having any construction contracts taken over by a surety for completion in the past ten (10) years? [ ] Yes [ ] No (attach explanation)

d. Has your firm used other surety companies since 2005? [ ] Yes (list below) [ ] No ____________________________________ ___________________________

Surety company Contact

____________________________________ ___________________________ Surety company Contact

____________________________________ ___________________________ Surety company Contact e. Is your firm able to obtain bonding in the amount required for the completion of this project? Please

provide a notarized declaration from the surety identified above, stating the amount of bonding capacity available to your firm for this project at Attachment F. [ ] Yes [ ] No (attach explanation)

6. INSURANCE & CLAIMS HISTORY

a. Is your firm free from any court judgments, pending litigation, arbitration and final agency decisions filed within the last ten (10) years in a construction related matter in which the contractor, or any officer, is or was party?


b. Has your firm during the past ten (10) years been free of a determination by a court of competent

jurisdiction that it filed a false claim with any Federal, State, or local government entity? [ ] Yes [ ] No (attach explanation)

c. Does your firm have the ability to provide the required insurance in the limit stated in the project

documents (General Liability and Comprehensive Auto at $1M per occurrence and $5M in the aggregate)? [ ] Yes [ ] No (attach explanation)

d. Please provide a letter from an insurance carrier stating that the firm is able to obtain insurance in the

limits stated as Attachment H.

7. SAFETY a. Does your firm have a written safety program compliant with current State regulations? Provide one (1)

copy of your firm’s written safety program at Attachment G. [ ] Yes [ ] No (attach explanation)




b. Provide a list of key safety personnel, including the designated safety manager who will be assigned to

this project, and list specific duties. Name and Title: Specific Duties: ______________________ ___________________________________________

___________________________________________________________________ ______________________ ___________________________________________ ___________________________________________________________________ ______________________ ___________________________________________ ___________________________________________________________________ ______________________ ___________________________________________ ___________________________________________________________________

c. Submit a letter from your insurance carrier listing your company’s Workmen’s Compensation Experience Modification Rate (EMR) for the most recent three-year policy period average. Include as Attachment H. Additionally, provide the EMR for the past five (5) years below: 2015________ / 2014________ / 2013_________ / 2012_________ / 2011____________

d. Provide the information requested below for the years shown using U.S. Bureau of Labor Statistics Guidelines to determine record ability and lost workdays from your firm’s OSHA 300 logs. Total Recordable Injury/Illness Case Rate: 2015:______ 2014:______ 2013:______ 3-year average: _______ Lost Workday Case Rate: 2015:______ 2014:______ 2013:______ 3-year average: ________

e. Is your firm free of committing serious or willful violations of Federal or State safety laws as determined by a final non-appealable decision of a court or government agency? [ ] Yes [ ] No (attach explanation)

f. List OSHA citations received in the last three years:

_____________________________________________________________________________

8. CAPACITY AND CAPABILITY TO PERFORM THE WORK a. Resources:

(1) Total number of current employees:

Project Managers: __________ Estimators: __________ Superintendents: __________ Foremen: __________




Tradesmen: __________ Administration: __________ Others: __________

(2) Provide a list of major equipment relevant to work to be performed by firm; including, type of

equipment, manufacturer and model, number owned, average age, etc.

(3) Does your firm have the immediate capacity to perform the Work required for this project? [ ] Yes [ ] No

b. Please list all projects currently under contract valued over $500,000 with scheduled completion dates.

(Attachment E)

[ ] See Attachment [ ] None

9. QUALITY CONTROL PLAN

On a separate sheet, please describe your general Quality Control Plan and how you would manage this project,

including staffing and technical approach to the project, should you be awarded this construction project. What

challenges do you see on this project? Do you see any opportunity for value engineering and the estimated cost

savings, and accelerating the schedule? Explain.

Please comment on how your team would describe success in this effort (Attachment L).

10. PROJECT TEAM

a. List projects where key personnel have worked together. Include project descriptions and roles for

personnel listed. Project: __________________________________________________________

Project: __________________________________________________________

Project: __________________________________________________________

b. List projects where your firm has worked with major subcontractors. Include project descriptions.

Project: __________________________________________________________

Project: __________________________________________________________

Project: __________________________________________________________

11. EXPERIENCE a. Has your firm completed one (1) or more dam construction or rehabilitation projects of similar complexity

since 2005? Complete Attachment A for five (5) maximum projects listed. [ ] Yes Number: _____ [ ] No

Project 1 Name: __________________________________________________________

Project 2 Name: __________________________________________________________

Project 3 Name: __________________________________________________________




Project 4 Name: __________________________________________________________

Project 5 Name: __________________________________________________________ b. State the average annual amount of construction work performed during the past five years: _________ c. Also on Attachment A, list major construction projects your organization has in progress, giving the name

of the project, owner, architect, contract amount, percent complete, and scheduled completion date. d. List the categories of work that your organization normally performs with its own forces.

12. KEY PERSONNEL EXPERIENCE Please note that more consideration will be given to those meeting or exceeding the required qualifications stated below.

a. List the individuals your firm will assign as your Project Management Team, and the roles/functions each

individual will perform during the construction/occupancy phase: (1) Project Manager: __________________________ Years with your firm: _____ Present Position/Job Title: ___________________ Years in this Position: _____ List other project(s) this person has had a similar role for the past ten (10) years. _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________

Does your assigned Project Manager have the following minimum qualifications and experience? (Attach resume in format shown at Attachment C).

(a) At least ten (10) years experience in the construction industry? [ ] Yes Number Years: __________ [ ] No (b) Experience on at least three (3) dam construction or liner installation projects? [ ] Yes Number Projects: _________ [ ] No

(c) Experience as a Project Manager on three (3) or more dam construction or liner installation projects valued at $500,000 or more?

[ ] Yes Number Projects: _________ [ ] No

Is your Project Manager a Principal or Officer of the firm? [ ] Yes [ ] No




(2) Superintendent: ___________________________ Years with your firm: ______ Present Position/Job Title: ___________________ Years in this Position: _____ List other project(s) this person has had a similar role for the past ten (10) years. _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________

Does your assigned Project Superintendent have the following minimum qualifications and experience? (Attach resume in format shown at Attachment C).

(a) At least ten (10) years’ experience in the construction industry? [ ] Yes Number Years: __________ [ ] No (b) Experience on at least three (3) dam construction or liner installation projects? [ ] Yes Number Projects: _________ [ ] No

(c) Experience as a Project Superintendent on three (3) or more dam construction projects valued at $500,000 or more?

[ ] Yes Number Projects: _________ [ ] No Is your Project Superintendent a Principal or Officer of the firm? [ ] Yes [ ] No (3) Safety Manager: __________________________ Years with your firm: ______ Present Position/Job Title: ___________________ Years in this Position: _____ List other project(s) this person has had a similar role for the past ten (10) years. _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________




Does your assigned Safety Manager have the following minimum qualifications and experience? (Attach resume in format shown at Attachment C).

(a) At least ten (10) years’ experience in a safety management role? [ ] Yes Number Years: __________ [ ] No (b) Experience on at least one (1) dam construction or liner installation project? [ ] Yes Number Projects: _________ [ ] No Is your Safety Manager a Principal or Officer of the firm? [ ] Yes [ ] No (4) QA/QC Manager: _________________________ Years with your firm: ______ Present Position/Job Title: ___________________ Years in this Position: _____ List other project(s) this person has had a similar role for the past ten (10) years. _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Is your QA/QC Manager a Principal or Officer of the firm? [ ] Yes [ ] No (5) Please include a wire organizational diagram (Attachment D) of the management team that will be

assigned to this project. Identify relationships, duties and responsibilities, and key roles of each individual.

13. DAMS EXPERIENCE

a. List projects where your firm performed construction activities for an earth embankment dam for water storage (exclusive of flood control dams) in the past 10 years. List a general description of the project and activities performed by the firm.

Project: ______________________________________________________________

Project: ______________________________________________________________

Project: ______________________________________________________________

Project: ______________________________________________________________

Project: ______________________________________________________________




14. EARTHWORK EXPERIENCE

Will earthwork be performed by a subcontractor? [ ] Yes [ ] No

a. If yes, then prepare Subcontractor’s Statement of Qualifications. If no, list projects where your firm performed earthwork construction activities for embankment dams in the past 10 years. List a general description of the project and activities performed by the firm.

Project: ______________________________________________________________

Project: ______________________________________________________________

Project: ______________________________________________________________

Project: ______________________________________________________________

Project: ______________________________________________________________

15. STREAM DIVERSION AND RESERVOIR CONTROL EXPERIENCE

Will stream diversion and reservoir control be performed by a subcontractor? [ ] Yes [ ] No

a. If yes, then prepare Subcontractor’s Statement of Qualifications. If no, list projects where your firm performed stream diversion and reservoir control in the past 10 years. List a general description of the project and activities performed by the firm.

Project: ______________________________________________________________

Project: ______________________________________________________________

Project: ______________________________________________________________

Project: ______________________________________________________________

Project: ______________________________________________________________




16. GEOSYNTHETIC LINER EXPERIENCE

Will geosynthetic liner installation be performed by a subcontractor? [ ] Yes [ ] No

a. If yes, then prepare Subcontractor’s Statement of Qualifications. If no, list projects where your firm performed construction activities for geosynthetic liner installation in the past 10 years. List a general description of the project and activities performed by the firm.

Project: ______________________________________________________________

Project: ______________________________________________________________

Project: ______________________________________________________________

Project: ______________________________________________________________

Project: ______________________________________________________________

17. PROJECT SCHEDULING

a. Does your firm use computerized scheduling? [ ] Yes [ ] No b. If yes, which programs and versions are used? Please list.

___________________________________________________________________ ___________________________________________________________________

c. Has the firm been involved with a construction project within the past ten (10) years where the schedule was not met?

[ ] Yes [ ] No

d. If yes, please indicate the projects (refer to Attachment A). (1) Project: ________________________________________________________ Reason for Delay: ________________________________________________ _______________________________________________________________

(2) Project: ________________________________________________________ Reason for Delay: ________________________________________________ _______________________________________________________________ (3) Project: ________________________________________________________ Reason for Delay: ________________________________________________

_______________________________________________________________

e. Has the firm been assessed liquidated damages due to scheduling for any project in the past ten (10) years? (refer to Attachment A).

[ ] Yes [ ] No




f. If Yes, list projects:

___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________

g. Provide project schedule including milestone dates. 18. CLARIFICATIONS/EXPLANATIONS (if necessary)

a. Please provide further explanation of items indicated requiring explanation, or other additional information to further explain any of the questions asked in this Qualification Statement (Attachment M).




By signing this Statement form, the undersigned Offeror certifies that all of the Qualification information

submitted with this form is true and correct. By submitting for review its qualifications as a prospective

contractor, the undersigned waives any claim against the OSE, the Engineer, and the State of New Mexico

that may arise with respect to any decisions regarding a prospective contractor’s qualifications. The

undersigned hereby authorizes and requests any public official, engineer, architect, surety company, bank,

depository, material or equipment manufacturer, or distributor or any other person, firm, or corporation, to

furnish any pertinent information requested by the Evaluation Committee to verify the information on this

form or regarding the competence and general reputation of the Offeror. The undersigned understands that

all information in this proposal provided in response to this Questionnaire will be held as confidential except

as provided by law. The undersigned agrees to furnish qualifying information at the request of the OSE.

The undersigned understands that price proposals for the project must be accompanied by a bond or

cashier’s check in the amount of 5-percent of the cost proposal; and that a performance bond and a payment

bond, each in the amount of 100 percent of the contract amount, must be provided in addition to insurance

certificates, prior to entering into a contract for the Work.

___________________________ ____________________________________

Name and Title Firm Name

____________________________ ____________________________________

Signature Address of Firm

____________________________ _____________________________________

E-mail Address City, State, Zip Code

____________________________

Telephone

General Contractors are reminded to include a copy of each requested sub-contractor’s Statement of Qualifications with this Qualification Document.




ATTACHMENTS INCLUDED: (Please check all attachments included in this Submittal) [ ] A Project Experience of Similar Complexity and Scope [ ] B NOT USED [ ] C Resumes of Key Project Personnel [ ] D Project Management Organizational Chart [ ] E Current Active Project List Valued over $500,000 [ ] F Notarized Declaration from Surety [ ] G Written Safety Program [ ] H Letter(s) From Insurance Carrier(s) for EMR and Ability to Insure [ ] I NOT USED [ ] J Affidavit of Non-violation of Labor Codes [ ] K Written Affirmative Action Policy [ ] L Quality Control Plan [ ] M Clarifications and Explanations [ ] N NOT USED

--------------------------------- END OF QUALIFICATION STATEMENT -------------------------------


ATTACHMENT A

ATTACHMENT A

Project Experience of Similar Complexity and Scope

SUBMIT: ONE (1) FORM FOR EACH PROJECT LISTED ON THE QUESTIONNAIRE (MAXIMUM 5) TO DEMONSTRATE EXPERIENCE IN DAM CONSTRUCTION, DAM REHABILITATION, OR GEOSYNTHETIC

LINER INSTALLATION OF SIMILAR COMPLEXITY SINCE 2005. PROJECT DESCRIPTION

Project Type: ______________________________ Contact Title: Project Name: _________________ Contact Name: Owner: Contact Phone No: DESIGN PROFESSIONAL Name: Phone Number: Contact: Title: Project Start Date: Completion Date: Original Contract Amount: $ Original Contract Duration (days): Final Contract Amount Final Contract Duration (days) With all Change Orders: $ With All Time Extensions: PROJECT EXECUTION

Were Liquidated Damages Assessed on this Project? [ ] No [ ] Yes days _____ $ Percentage of Work Subcontracted: % Contract Type: [ ] Competitive Bid Lump Sum [ ] Negotiated Lump Sum Major Subcontractors: [ ] Guaranteed Maximum Price [ ] Other (Describe) Activities: __________________________________________________________________________ __________________________________________________________________________ Activities Performed by Firm: Cubic Yards of Earthwork: ________

Square Yards of Geosynthetic Liner: ________

Other: __________________________


ATTACHMENT B

ATTACHMENT B (Not Used)


ATTACHMENT C

ATTACHMENT C

Resume of Key Project Personnel

SUBMIT: ONE (1) PAGE RESUMES OF THE PROPOSED PROJECT MANAGER, PROJECT SUPERINTENDENT, SAFETY PROGRAM MANAGER, AND OTHER KEY PERSONNEL (OPTIONAL).

1.0 EDUCATION

High school, college, trade schools, trade seminars, trade/management specialized courses, etc.

2.0 RELATED EXPERIENCE

Related experience should include the position/title, duties and responsibilities, major accomplishments, and number of personnel supervised.

3.0 PROJECT EXPERIENCE

Identify project experience. Include the project title and location.

4.0 Other information that demonstrates the individual’s strengths for this project. 5.0 Project professionals and project owner reference may be included.


ATTACHMENT D

ATTACHMENT D

Project Management Organizational Chart

SUBMIT: ONE (1) COPY OF THE PROJECT MANAGEMENT ORGANIZATIONAL CHART

1. Indicate the relationship between the Project Manager/Superintendent of the Subcontractors and the

General Contractor Project Manager/Superintendent. 2. Indicate the relationship of the Safety Manager of the Subcontractors and General Contractor, and the

relationship of the Safety Manager with others on the job site.

3. Indicate the relationship between the QA/QC Manager with other personnel on the job site.

FIRM POSITION

NAME

FIRM POSITION

NAME

FIRM POSITION

NAME

ORGANIZATIONAL CHART SHOULD INCLUDE THE ENTIRE PROJECT TEAM,

SUBCONTRACTOR KEY PERSONNEL, AND SUPERVISION.


ATTACHMENT E

ATTACHMENT E

Current Active Project List Valued over $500,000

SUBMIT: ONE (1) COPY OF THE CURRENT ACTIVE PROJECT LIST FOR CONTRACTS VALUED OVER $500,000.

PROJECT TITLE & LOCATION

START DATE ESTIMATED PERCENT

COMPLETE

PROJECTED COMPLETION


ATTACHMENT F

ATTACHMENT F

Notarized Declaration from Surety

SUBMIT: ONE (1) COPY ON LETTERHEAD OF SURETY ORGANIZATION.


ATTACHMENT G

ATTACHMENT G

Written Safety Plan

SUBMIT: ONE (1) COPY OF FIRM’S WRITTEN SAFETY PLAN.


ATTACHMENT H

ATTACHMENT H

Letter(s) from Insurance Carrier(s) for EMR and Ability to Insure

SUBMIT: ONE (1) COPY ON LETTERHEAD OF LETTER(S) FROM THE INSURANCE CARRIER(S) FOR EMR AND ABILITY TO INSURE.


ATTACHMENT I

ATTACHMENT I

(Not Used)


ATTACHMENT J

ATTACHMENT J

Affidavit of Non-violation of Labor Codes

SUBMIT: ONE (1) COMPLETE AFFIDAVIT OF NON-VIOLATION OF LABOR CODES.

Name of Firm: Address: Project: Construction of the Cabresto Dam and Reservoir Liner Project, near Questa, New Mexico. Reference: Request for Proposals for Construction Request for Proposal No:

Construction of the Cabresto Dam and Reservoir Liner Project Affidavit of Non-violation of Labor Codes

TO: Office of the State Engineer, Dam Safety Bureau

State of New Mexico The undersigned officer of ______________________________________________hereby states that __________________________________________ has, during the past five years, been free of any determinations by a court or an administrative agency, of repeated or willful violations of laws and/or regulations pertaining to the payment of prevailing wages or employment of apprentices of public works projects. ___________________________________ Name ___________________________________ Title ___________________________________ Signature NOTARY State of ) ) County of ) Signed or attested before me on _______________ by ____________________________ seal My Commission Expires: _______________


ATTACHMENT K

ATTACHMENT K

Written Affirmative Action Policy

SUBMIT: ONE (1) WRITTEN COPY OF FIRM’S AFFIRMATIVE ACTION POLICY.


ATTACHMENT L

ATTACHMENT L

Quality Control Plan

SUBMIT: ONE (1) COPY OF FIRM’S QUALITY CONTROL PLAN.


ATTACHMENT M

ATTACHMENT M

Clarifications and Explanations Additional written explanations or comments required for clarification of items contained in the Statement of Qualifications. ITEM REF NUMBER COMMENTS


ATTACHMENT N

ATTACHMENT N

(Not Used)

SUBCONTRACTOR’S STATEMENT OF QUALIFICATIONS

Subcontractor’s Statement of Qualifications


PART 2

RESPONSIBILITIES: _____________________________________________________________

1. ORGANIZATION Name: ______________________________________________________________ Address: ____________________________________________________________ Principal Office: _______________________________________________________

[ ] Corporation [ ] Partnership [ ] Sole Proprietorship [ ] Joint Venture

[ ] Other ____________________________________________________________

a. How many years has your organization been in business as a Contractor? ______ b. How many years has your organization been in business under its present business name? ________ c. Under what other or former names has your organization operated? ________________

______________________________________________________________________

2. LICENSING

a. Name of license holder (or qualifying party) exactly as on file with the State of New Mexico Construction

Industries Division:

__________________________________________________________________ b. License Classification: _____________________ License Code: _____________ c. License Number: ___________________ d. Issue Date: ____________________ Expiration Date: _____________________ e. Is the firm’s contractor’s license free of ever being suspended or revoked by the CID or by the appropriate

licensing agency in any other State? [ ] Yes, Free of suspensions or revocation [ ] No (attach explanation) f. Does your firm hold all applicable Business licenses required by State (New Mexico) or Local

(Taos County) Law? License Number: ____________________ Jurisdiction: _____________________

Name of License Holder, exactly as it appears on file with jurisdictional authorities. ___________________________________________________________________ Issue Date: _____________________ Expiration Date: _____________________ License Number: ___________________ Jurisdiction: ______________________




Name of License Holder, exactly as it appears on file with jurisdictional authorities: ___________________________________________________________________ Issue Date: _____________________ Expiration Date: _____________________ License Number: ___________________ Jurisdiction: ______________________ Name of License Holder, exactly as it appears on file with jurisdictional authorities: __________________________________________________________________ Issue Date: _____________________ Expiration Date: _____________________

g. Is your firm registered with the State of New Mexico, State Purchasing Department with a Resident

Preference Number? (See Instructions to Offerors).

Resident Preference Number: ________________ Issue Date: ____________ Name of Number holder, exactly as it appears on file with State Purchasing: ________________________________________________________________

h. Is your firm free from formal debarment from public works, Federal, State, or local jurisdictions?


3. LABOR CODE VIOLATIONS

a. Has your firm, during the past ten (10) years, been free of any determinations by a court or an administrative agency of repeated or willful violations of laws and/or regulations pertaining to the payment of prevailing wages or employment of apprentices of public works projects? [ ] Yes [ ] No

b. Please provide documentation to substantiate this (Attachment J).

c. Is the firm free of all Sub-contractor Fair Practices Act violations for the past ten (10) years?


4. INSURANCE & CLAIMS HISTORY

a. Is your firm free from any court judgments, pending litigation, arbitration and final agency decisions filed within the last ten (10) years in a construction related matter in which the contractor, or any officer, is or was party? [ ] Yes [ ] No (attach explanation)

b. Has your firm during the past ten (10) years been free of a determination by a court of competent

jurisdiction that it filed a false claim with any Federal, State, or local government entity? [ ] Yes [ ] No (attach explanation)




c. Does your firm have the ability to provide the required insurance in the limit stated in the project documents (General Liability and Comprehensive Auto at $1 Million per occurrence and $4Million in the aggregate)?


d. Please provide a letter from an insurance carrier stating that the firm is able to obtain insurance in the limits stated as Attachment H.

5. SAFETY

a. Does your firm have a written safety program compliant with current State regulations? Provide one (1)

copy of your firm’s written safety program at Attachment G. [ ] Yes [ ] No (attach explanation)

b. Provide a list of key safety personnel, including the designated Safety Manager who will be assigned to this project, and list specific duties. Name and Title: Specific Duties: ______________________ ___________________________________________ _____________________________________________________________________ ______________________ ___________________________________________ _____________________________________________________________________ ______________________ ___________________________________________ _____________________________________________________________________ ______________________ ___________________________________________ _____________________________________________________________________

c. Provide the Experience Modification Rate for the past five (5) years and the most recent three-year policy period average: 2015________ / 2014________ / 2013_________ / 2012_________ / 2011____________

d. Provide the Recordable Incident Rate for the past calendar year: ______________ e. Is your firm free of committing serious or willful violations of Federal or State safety laws as determined by

a final non-appealable decision of a court or government agency? [ ] Yes [ ] No (attach explanation)

6. CAPACITY AND CAPABILITY TO PERFORM THE WORK

a. Resources:

(1) Total number of current employees: Project Managers: __________

Estimators: __________ Superintendents: __________




Foremen: __________ Tradesmen: __________ Administration: __________ Others: _______________________

(2) Equipment: List equipment relevant to the project.

____________________________________________________

(3) Does your firm have the immediate capacity to perform the work required for this project?

[ ] Yes [ ] No b. Please list all projects currently under contract valued over the $500,000 with scheduled completion

dates. (Attachment E).

[ ] See Attachment [ ] None

7. EXPERIENCE

a. Has your firm completed three (3) or more projects of similar complexity since 2005 as the Cabresto Dam

and Reservoir Liner Project? Complete Attachment A for three (3) maximum projects listed.

[ ] Yes Number: ____________ [ ] No

Project 1 Name: _____________________________________________________ Project 2 Name: _____________________________________________________ Project 3 Name: _____________________________________________________

8. KEY PERSONNEL EXPERIENCE

Please note that more consideration will be given to those meeting or exceeding the required qualifications stated below.

a. List the individuals your firm will assign as your Project Management Team and the roles/functions each

individual will perform during the construction phase. (1) Project Manager: __________________________ Years with your firm: ______

Present Position/Job Title: ___________________ Years in this Position: _____ List other project(s) this person has had a similar role for the past ten (10) years. _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________




b. Does your assigned Project Manager have the following minimum qualifications and experience? (Attach resume in format shown at Attachment C). (1) At least ten (10) years experience in the construction industry?

[ ] Yes Number Years: __________ [ ] No (2) Experience on at least three (3) construction type as the Cabresto Dam Rehabilitation Project? [ ] Yes Number Projects: _________ [ ] No Experience as a Project Manager on one (1) or more projects requiring construction coordination of a project valued at a total construction cost of $500,000 or more?

[ ] Yes Number Projects: _________ [ ] No Is your Project Manager a Principal or Officer of the firm? [ ] Yes [ ] No (3) Project Superintendent: ________________________ Years with your firm: ______

Present Position/Job Title: ___________________ Years in this Position: _____ List other project(s) this person has had a similar role for the past ten (10) years. _______________________________________________________________ _______________________________________________________________ _______________________________________________________________

c. Does your assigned Project Superintendent have the following minimum qualifications and experience?

(Attach resume in format shown on Attachment C). (1) At least ten (10) years experience in the construction industry? [ ] Yes Number Years: __________ [ ] No (2) Experience on at least three (3) construction type projects as the Cabresto Dam and Reservoir Liner

Project? [ ] Yes Number Projects: _________ [ ] No (3) Experience as a Project Superintendent on one (1) or more projects requiring construction

coordination of a project valued at a total construction cost of $500,000 or more?

[ ] Yes Number Projects: _________ [ ] No Is your Project Superintendent a Principal or Officer of the firm? [ ] Yes [ ] No

9. CONTRACTOR’S COMMENTS

a. Please provide further explanation of items indicated requiring explanation or other additional information to further explain any of the questions asked in this Qualification Statement (Attachment M).




By signing this Statement form, the undersigned certifies that all of the Qualification information submitted with this

form is true and correct. By submitting for review its qualifications as a prospective subcontractor, the undersigned

waives any claim against the OSE, the Engineer, and the State of New Mexico that may arise with respect to any

decisions regarding a prospective subcontractor’s qualifications. The undersigned hereby authorizes and requests

any public official, engineer, architect, surety company, bank, depository, material or equipment manufacturer, or

distributor or any other person, firm, or corporation, to furnish any pertinent information requested by the Evaluation

Committee to verify the information on this form or regarding the competence and general reputation of the

subcontractor. The undersigned understands that all information in this proposal provided in response to this

Questionnaire will be held as confidential except as provided by law. The undersigned agrees to furnish qualifying

information at the request of the OSE.

_________________________________ ____________________________________

Name and Title Firm Name

_________________________________ ____________________________________

Signature Address of Firm

_________________________________ _____________________________________

E-mail Address City, State, Zip Code

__________________________________ Telephone




Subcontractor are reminded to include a copy of this Statement of Qualifications with each General Contractor submitting Qualification Documents.

Attachments Included: (Please check all attachments included in this Submittal) [ ] A Project Experience of Similar Complexity and Scope [ ] B NOT USED [ ] C Resumes of Key Project Personnel [ ] D NOT USED [ ] E Current Active Project List Valued over $500,000 [ ] F NOT USED [ ] G Written Safety Program [ ] H Letter(s) From Insurance Carrier(s) for EMR and Ability to Insure [ ] I NOT USED [ ] J Affidavit of Non-violation of Labor Codes [ ] K NOT USED [ ] L NOT USED [ ] M Clarifications and Explanations [ ] N NOT USED


ATTACHMENT A

ATTACHMENT A

Project Experience of Similar Complexity and Scope

SUBMIT: ONE (1) FORM FOR EACH PROJECT LISTED ON THE QUESTIONNAIRE (MAXIMUM 5) TO DEMONSTRATE EXPERIENCE IN DAM CONSTRUCTION, DAM REHABILITATION, OR GEOSYNTHETIC

LINER INSTALLATION OF SIMILAR COMPLEXITY SINCE 2005. PROJECT DESCRIPTION

Project Type: ______________________________ Contact Title: Project Name: _________________ Contact Name: Owner: Contact Phone No: DESIGN PROFESSIONAL Name: Phone Number: Contact: Title: Project Start Date: Completion Date: Original Contract Amount: $ Original Contract Duration (days): Final Contract Amount Final Contract Duration (days) With all Change Orders: $ With All Time Extensions: PROJECT EXECUTION

Were Liquidated Damages Assessed on this Project? [ ] No [ ] Yes days _____ $ Percentage of Work Subcontracted: % Contract Type: [ ] Competitive Bid Lump Sum [ ] Negotiated Lump Sum Major Subcontractors: [ ] Guaranteed Maximum Price [ ] Other (Describe) Activities: __________________________________________________________________________ __________________________________________________________________________ Activities Performed by Firm: Cubic Yards of Earthwork: ________

Square Yards of Geosynthetic Liner: ________

Other: __________________________


ATTACHMENT B

ATTACHMENT B

(Not Used)


ATTACHMENT C

ATTACHMENT C

Resume of Key Project Personnel

SUBMIT: ONE (1) PAGE RESUMES OF THE PROPOSED PROJECT MANAGER, PROJECT SUPERINTENDENT, AND OTHER KEY PERSONNEL (OPTIONAL).

1.0 EDUCATION

High school, college, trade schools, trade seminars, trade/management specialized courses, etc.

2.0 RELATED EXPERIENCE

Related experience should include the position/title, duties and responsibilities, major accomplishments, and number of personnel supervised.

3.0 PROJECT EXPERIENCE

Identify project experience. Include the project title and location. 4.0 Other information that demonstrates the individual’s strengths for this project. 5.0 Project professionals and project owner reference may be included


ATTACHMENT D

ATTACHMENT D

(Not Used)


ATTACHMENT E

ATTACHMENT E

Current Active Project List Valued over $500,000

SUBMIT: ONE (1) COPY OF THE CURRENT ACTIVE PROJECT LIST FOR CONTRACTS VALUED OVER $500,000.

PROJECT TITLE & LOCATION

START DATE ESTIMATED PERCENT

COMPLETE

PROJECTED COMPLETION


ATTACHMENT F

ATTACHMENT F

(Not Used)


ATTACHMENT G

ATTACHMENT G

Written Safety Plan

SUBMIT: ONE (1) COPY OF FIRM’S WRITTEN SAFETY PLAN.


ATTACHMENT H

ATTACHMENT H

Letter(s) from Insurance Carrier(s) For EMR and Ability to Insure

SUBMIT: ONE (1) COPY ON LETTERHEAD OF THE LETTER(S) FROM INSURANCE CARRIER(S) FOR EMR AND ABILITY TO INSURE.


ATTACHMENT I

ATTACHMENT I

(Not Used)


ATTACHMENT J

ATTACHMENT J

Affidavit of Non-violation of Labor Codes

SUBMIT: ONE (1) COMPLETE AFFIDAVIT OF NON-VIOLATION OF LABOR CODES.

Name of Firm: Address: Project: Construction of the Cabresto Dam and Reservoir Liner Project, near Questa, New Mexico. Reference: Request for Proposals for Construction Request for Proposal No:

Construction of the Cabresto Dam and Reservoir Liner Project Affidavit of Non-violation of Labor Codes

TO: Office of the State Engineer, Dam Safety Bureau State of New Mexico

The undersigned officer of ______________________________________________hereby states that __________________________________________ has, during the past five years, been free of any determinations by a court or an administrative agency, of repeated or willful violations of laws and/or regulations pertaining to the payment of prevailing wages or employment of apprentices of public works projects. ___________________________________ Name ___________________________________ Title ___________________________________ Signature NOTARY State of ) ) County of ) Signed or attested before me on _______________ by ____________________________ seal

My Commission Expires: _______________


ATTACHMENT K

ATTACHMENT K

(Not Used)


ATTACHMENT L

ATTACHMENT L

(Not Used)


ATTACHMENT M

ATTACHMENT M

Clarifications and Explanations Additional written explanations or comments required for clarification of items contained in the Statement of Qualifications. ITEM REF NUMBER COMMENTS


ATTACHMENT N

ATTACHMENT N

(Not Used)

---------------------------------END OF QUALIFICATION QUESTIONNAIRE-------------------------------

SUBCONTRACTOR LISTING FORM

Subcontractor Listing Form

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________________________________________________________________________

_____________________________________________________________________________ SUBCONTRACTOR LISTING REQUIREMENTS This form was developed in conjunction with the New Mexico Branch Association of General Contractors, to help clarify requirements under the “Sub-Contractors Fair Practices Act” of 1988, Sections 13-4-31 to 13-4-42 NMSA 1978, and subsequent changes thereto. Architects, State Agencies and Local Public Bodies are encouraged to use it when soliciting Public Works Projects, as that term is defined in the procurement code, Sections 13-1-66.1 and 13-1-91 NMSA 1978.

Date: ___________ Project No.: ________________________ Bid No.: ____________________ Project Name:

_____________________________________________________________________________ Contractor:

_____________________________________________________________________________ Authorized Signature:

_______________________________________________________________ In accordance with the “Subcontractor Fair Practices Act”, the following listing is required to be submitted with this bid:

1) Name of each subcontractor who will be performing work or rendering service on the public works project and whose total contract will be the greater of:

A. $5,000.00; or B. $ 20,000.00 which represents one/half of one percent of the total

project (to be estimated by the Engineer of record).

2) Location of place of business (city or county). 3) Type of work and/or service to be performed by the subcontractor.

NOTE: YOUR BID MAY BE DEEEMED NON-RESPONSIVE IF ALL (3) ITEMS ABOVE ARE NOT ADDRESSED Note: The Statute Does Not Require the Following Listings:

(1) 2nd tier subcontractors (2) Material, suppliers (3) Subcontractors whose contract is less than the greater of A or B above.



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Be advised, the Engineer may require additional information By signing this document, the contractor and/or subcontractor agrees that any and all claims which the firm may have or may inure to it for overcharges resulting from antitrust violations as to goods, services and materials purchased in connection with the above referenced project are hereby assigned to the State of New Mexico, but only to the extent that such overcharges are passed on to the State. It is agreed that the firm retains all rights to any such antitrust claims to the extent of any overcharges not passed on to the State, including the right to any treble damages attributable thereto. List of Subcontractors: (Please do not include suppliers) Name & License No. Address (City or County) Work to be performed _____________________________________________________________________________ Name & License No. Address (City or County) Work to be performed _____________________________________________________________________________ Name & License No. Address (City or County) Work to be performed _____________________________________________________________________________ Name & License No. Address (City or County) Work to be performed _____________________________________________________________________________ Name & License No. Address (City or County) Work to be performed _____________________________________________________________________________ Name & License No. Address (City or County) Work to be performed _____________________________________________________________________________ Name & License No. Address (City or County) Work to be performed _____________________________________________________________________________ Name & License No. Address (City or County) Work to be performed _____________________________________________________________________________ Name & License No. Address (City or County) Work to be performed _____________________________________________________________________________ Name & License No. Address (City or County) Work to be performed



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List of Subcontractors: (Please do not include suppliers) Name & License No. Address (City or County) Work to be performed _____________________________________________________________________________ Name & License No. Address (City or County) Work to be performed _____________________________________________________________________________ Name & License No. Address (City or County) Work to be performed _____________________________________________________________________________Name & License No. Address (City or County) Work to be performed _____________________________________________________________________________Name & License No. Address (City or County) Work to be performed _____________________________________________________________________________ Name & License No. Address (City or County) Work to be performed _____________________________________________________________________________ Name & License No. Address (City or County) Work to be performed _____________________________________________________________________________ Name & License No. Address (City or County) Work to be performed _____________________________________________________________________________ Name & License No. Address (City or County) Work to be performed _____________________________________________________________________________ Name & License No. Address (City or County) Work to be performed _____________________________________________________________________________ Name & License No. Address (City or County) Work to be performed

ASSIGNMENT OF ANTITRUST CLAIMS

TO BE EXECUTED BY GENERAL CONTRACTORS, SUBCONTRACTORS,SUPPLIERS, AND SUBSUBCONTRACTORS OF CONTRACTORS ON STATE CONTRACTS.

FIRM NAME: PROJECT: ADDRESS: PROJECT NO: PHONE NO.: agrees that any and all claims which it may have or may inure to it for overcharges resulting from antitrust violations as to goods, services, and materials purchased in connection with the above-referenced project are hereby assigned to the State of New Mexico, but only to the extent that such overcharges are passed on to the State. It is agreed that the undersigned retains all rights to any such antitrust claims to the extent of any overcharges not passed on to the State, including the right to any treble damages attributable thereto. FIRM: BY: Signed by Individual empowered to obligate Suppliers, Subcontractors, or Subsubcontractors TITLE: