Randolph Construction Services, Inc.
116 West Bonneville, Pasco, WA 99301

Phone: (509) 545-5404



*Please note the following submittal requirements and instructions as indicated below:

By submitting the following information, you are attesting to the accuracy of all information contained herein and verify your firm meets the qualifications required.
Click here for requirements

All required supporting documents and data can be forwarded via any of the following manners:

  • Emailed to: Randolph Construction Services, Inc. - Attn: Contracts: contracts@randolphcs.com
  • Faxed to: (509) 547-8390; Randolph Construction Services, Inc.; Attn: Contracts
  • Mailed to: Randolph Construction Services, Inc.; Attn: Contracts; PO Box 1009; Pasco, WA 99301

Meeting RCS Requirements

Contractor Qualification Statement

Click Here To View Instructions
PART 1 – General & Financial Summary
BUSINESS NAME:   INVITATION NO:  
1.   General Information   
Person(s) Name to Contact  
Telephone Number Fax Number:
Email Address  
     

2.   Licensing – indicate licenses you hold that are required for you to perform your services
License Type / Name State Number
     
3.   Performance Classification

General Contractor
Sub-tier Contractor Supplier
     
4.  Areas of Specialization {By CSI (Construction Specification Institute) Division}
     
5.   Industry Classification Codes and Numbers
NAICS
SIC
CAGE
DUNS
   
     
6.   Financials – ATTACH your most current financial statement (only if anticipated contract values are over $250,000)
Bank Reference
Contact Person Phone
Bonding Company
Contact Person Phone
Bond Limit per Project Aggregate Bond Limit
Gross Revenue Last Year Current Backlog
Indicate the % of Government
Work Performed Last Year		 Current DUNS Rating
 
Attach Narrative Explanation as required to YES answers:
Has your firm ever failed to complete any work awarded?
Are their any judgments, claims, arbitrations or suits pending or outstanding against your company? yes no
Has your firm filed any law suit, or requested arbitration against a contract within the last 3 years? yes no
Can your Accounting system adequately separate cost for Change Order or Time and Material Work? yes no
 
7.   Size and Classification (mark all that apply)
Small Business SDVOSB verified
Woman Owned (greater than 51%) VOSB verified
8(a) Hub Zone    
 
8. Volume History (record total sales for each of the last three years)
$ $ $
2009 2008 2007
 
Part 2 – Contractor Performance History
 
1.   Project Name
A. Date Completed
B. Client Name
C. Phone Number
D. Dollar Value of Project
E.  Description of Project
   
2.   Project Name
A. Date Completed
B. Client Name
C. Phone Number
D. Dollar Value of Project
E.  Description of Project
   
3.   Project Name
A. Date Completed
B. Client Name
C. Phone Number
D. Dollar Value of Project
E.  Description of Project
   
4.   Project Name
A. Date Completed
B. Client Name
C. Phone Number
D. Dollar Value of Project
E.  Description of Project
     
Part 3 – Environmental, Safety, Health and Quality
 
1.   Experience Rating and Work Hour Summary
EMR:  List your Company’s Experience Modification Rate (EMR) or Workman’s Compensation Risk Rating, the average number of employees and the total number of hours worked for the three most recent completed years, Including year to date numbers for the current year.  Additionally, provide the average number of employees and the total hours worked by all employees on an annual basis each of the last three (3) years and total hours worked and a three (3) average in each category.
  Average 2010 YTD 2009 2008 2007
A.  EMR
B.  Total Hours Worked
3-year Incidence Rates (from OSHA 300 Logs):      
  2009 2008 2007
A.  Total Recordable Cases
(Total # of  injuries and illnesses x 200,000, divided by # of hours worked by all employees = Total Recordable Case Rate)      
  2009 2008 2007
B.  DART – Days, Away, Restricted or Transferred

(# of entry’s in column H + column I x 200,000, divided by #

of hours worked by all employees = DART Case Rate)		      
2.   OSHA/WISHA Citation (Violation) History:
Submit copies of all citations your company has received in the last 3 years:
  2009 2008 2007
A. Serious
B. Willful
C. Repeat
D. Number of Fatalities
E. Number of Hours Worked

3.   Key Supervisory Personnel: 
List the key Environmental, Safety, Health and Quality personnel planned for this project. 

Name Position
4.   General Questions:
4.1   Safety Meetings
A. Do you hold site safety meetings for field employees both Manual and Non-Manual?
B.   How Often? Weekly Bi-Weekly Monthly Less Often, As needed
4.2   Safety Inspections
A. Do you conduct project safety inspections? : YES NO
B. If yes, who conducts this inspection? 
C.   How Often? Weekly Bi-Weekly Monthly Less Often, As needed
4.3   How are Accident Report distributed? No Yes Monthly Quarterly Annually
A. Project Superintendent/Site Manager.
B. Vice President/Manager of Construction
C. Safety Director
4.4   How are Accident Reports totaled? No Yes Monthly Quarterly Annually
A. Accidents totaled for the entire company
B.  Accidents totaled by project
(1)  Subtotaled by superintendent
(2)  Subtotaled by foreman
4.5   Cited Environmental, Safety and Health Violations: 
A. Have you had any citations, violations or other formal non-compliance correspondence from OSHA, EPA or other regulatory organizations during the previous three (3) years? YES NO
B. If yes, provide details. 
4.6   New Hire Orientation: 
A. Do you have an orientation program for new hires? YES
NO
B. Does it include instruction on the following?  
  YES NO   YES NO
(1) Head protection (9) First aid facilities
(2) Eye protection (10) Emergency Preparedness
(3) Hearing protection (11) Toxic substances
(4) Respiratory protection (12) Trenching and excavation
(5) Fall Protection (13) Signs, barricades, flagging
(6) Scaffolding (14) Electrical safety
(7) Housekeeping (15) Rigging and crane safety
(8) Fire protection (16) Road Safety (Driving)
      (17) Environmental Protection (Waste)
5.   Environmental, Safety and Health Program Compliance
The Contractor agrees to abide by the latest version of the RCS Safety and Health Program Guide and adopt all it provisions for all work performed on this Contract. YES NO
If NO, submit a copy of your written Program for evaluation. 
 
6.  Quality Assurance  
6.1 Does your company have a written Quality Assurance Program? YES NO
6.2 Does your Company have a Quality Assurance Manager? YES NO
If YES, identify the:  
A.  Name of the QA Manager or person responsible for QA systems within your Company?
B. How long the QA manager position has been part of your Companies Organizational Structure:
C. How many years has the named individual held the QA Manager position?
D. How many total years of experience does your named QA Manager have in Construction Quality Assurance?
6.3   Has your Company’s written Quality Assurance Program been approved by any Government Agencies or Private Clients? YES NO
If YES:  
A. Who approved your Program?
B. Date Approved?
C. What Consensus Standard or Project Standard was your Program approved to?
6.4  Indicate the Quality Standard that your Company applies:  
ASTM NEN 2646 BS5750 MIL-I-45028
ISO-9000 ASME NQA-1 Corp of Engineers Others
6.5  Identify the number of Certified Inspectors within your employ,
the disciplines they are certified to inspect and the certification criteria they were tested to.
Quantity Discipline Certification Criteria
     
 

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