P3-Qualifications Questionnaire Rev. 1

STATE OF NORTH CAROLINA

Request for Qualifications Questionnaire for Public Private Partnership (P3) Private Developer Teams

Due Date: (Date and time)

Submitted to: (Contact name receiving Request for Proposals)

(Department, Agency/Institution, address, phone number, email address)

Project Title: (Project title and location)

Private Developer’s Name and Principal Office serving this project:

(Include company name and address along with name of contact person with telephone number and email address)

I. Profile and Experience of Private Developer:

Under G.S. § 143.128.1C(h) the Private Developer is required to provide the following information:

  1. Evidence of financial stability. However, "trade secrets" as that term is defined in G.S. 66-152(3) shall be exempt from disclosure under Chapter 132 of the General Statutes.
  2. Experience with similar projects.
  3. Explanation of project team selection by either listing of licensed contractors, licensed subcontractors, and licensed design professionals whom the private developer proposes to use for the project's design and construction or a statement outlining a strategy for open contractor and subcontractor selection based upon the provisions of this Article 8 Public Contracts.
  4. Statement of availability to undertake the public-private project and projected time line for project completion.
  5. Any other information required by the governmental entity.

II. Financials

As an attachment, provide most recent audited financial statement (balance sheet and income statements) from the private developer, designer, and contractor. Provide project financing commitment letter (may be in the form of a debt commitment letter or equity financing structure). The private developer must submit financial data and may clearly indicate a request for confidentiality to avoid this item from becoming part of a public record.

III. Private Development Team Experience:

  1. List key team members for the proposed project including the following for each member of the team:
    1. Company Name
    2. Ownership and Location
    3. Description of services and role on listed project
    4. Firm history
    5. Key personnel for each team member who will be assigned to project.
    6. For each person listed above, describe their role and responsibility on the development team.
    7. For each person listed above, list his/her experience with firm, other prior and relevant experience with projects of similar size and scope in construction/design, and the person’s location. Attach the resumes and references for each person listed.
    8. Attach project organizational chart indicating the placement of each of the persons listed above.
  2. Provide current North Carolina licensing information for each team member as required by statute.
  3. Provide SF 330 for required information above.

IV. Examples of experience in each of these areas:

  1. The private developer shall provide no more than 5 projects of similar size, scope and complexity, P3 or otherwise. Please include references from each project. For any P3 projects provide the following:
    1. Responsibilities of the Governmental Entity and references including Government Entity, primary contact, email, phone number and mailing address.
    2. Responsibilities of the Private Developer including design, construction, financing, and operations and maintenance.
    3. Key financial performance metrics such as initial and final budget, initial and final payment, cost per bed, cost per square foot, term, etc.
    4. Key components of the agreement.
    5. List key team members company name and role(s) for the project
  2. Team members may provide up to 5 additional projects each of similar size, scope and complexity completed by team members (firms and/or personnel). Please include references from each project.
  3. Collaboration between team members (firms and/or personnel).
  4. Recommendations from Private Developer to address the following contractual elements of the project as required under 143.128.1C(b) and their relation to the Private Developers contractual responsibilities:
    1. The property interest of the governmental entity and all other participants in the development of the project.
    2. The responsibilities of the governmental entity and all other participants in the development of the project.
    3. The responsibilities of the governmental entity and all other participants with respect to financing of the project.
    4. The responsibilities to put forth a good-faith effort to recruit and select small business entities.
  5. For all P3 development team members provide annual workloads for each of the last five (5) years; number of projects, personnel, and total revenue.
  6. List projects for which the Private Development Team members are is currently committed including name and location of each project, time frame to complete, and dollar volume of each project.
  7. In the last ten years, have any private development key team members failed to complete work awarded to it? ___ Yes ___ No. If yes, explain in more detail.
  8. In the last ten years, have any private development key team members failed to substantially complete a project in a timely manner (i.e. more than 20% beyond the original contracted, scheduled completion date)? ___Yes ___ No. If yes, explain in more detail.
  9. In the last five years, have any private development key team members been involved in any suits or arbitration? ___Yes ___ No. If yes, explain in more detail.
  10. Are there currently any judgments, claims, arbitration proceedings or suits pending or outstanding against any private development key team members, its officers, owners, or agents? ___Yes ___ No. If yes, explain in more detail.
  11. In the last ten years, have any private development key team members, their officers, owners, or agents been convicted of charges relating to conflicts of interest, bribery, bid-rigging, bankruptcy, money-laundering, or fraud? ___ Yes ___ No. If yes, explain in more detail.
  12. Does your company or any team members have a potential conflict of interest with this project? ___ Yes ___ No. If yes, explain in more detail.

V. Project Approach:

Provide a brief, overall description of how the proposer will organize, finance and manage the P3 project to include the plan to comply with NCGS 143-128.1C. Describe any innovative approaches or strategies proposed for the project.

This the________ day of ________________, 20________

**PRIVATE DEVELOPER**

By: ________________________________________________

Title:________________________________________________

Attest:

________________________________________________ (Corporate Seal)

VERIFICATION

I HEREBY CERTIFY THAT THE RESPONSES OF ________________________________
ARE CORRECT AND TRUTHFUL TO THE BEST OF MY KNOWLEDGE AND FOR THOSE RESPONSES GIVEN WHICH ARE BASED ON INFORMATION AND BELIEF, THOSE RESPONSES ARE TRUE AND CORRECT BASED ON MY PRESENT BELIEF AND INFORMATION.

This the________ day of ________________, 20________

* * PRIVATE DEVELOPER **

By ________________________________________________
(Signature)

By ________________________________________________
(Printed or Typed Name & Title)
(Corporate Seal)

Witness: ________________________________________________

STATE OF ________________________________

COUNTY OF ________________________________

I, ________________________________, a Notary Public in and for the County and State aforesaid, hereby certify that ________________________________ personally came before me this day and acknowledged that he/she is secretary of ______________________________ and that by authority duly given and as the act of the corporation, the foregoing instrument was signed in its name by its president, sealed with its corporate seal, and attested by him/herself as its secretary.

Witness my hand and official seal, this the________ day of ________________, 20________

______________________________________
Official Signature of Notary

______________________________________, Notary Public
Notary’s Printed or Typed Name

(seal)

My Commission Expires: ____________________

On