Form Dc 74 A – Fill Out and Use This PDF

TO BE USED ONLY FOR ORIGINAL CLASSIFICATION OR FOR RENEWAL OF CLASSIFICATION

The Financial information, as verified by the accompanying audited or reviewed Financial Statements, is accurate as of

. A combined or compilation financial statement is not acceptable.

(Use end of month date)

Submitted by

(The Applicant for Classification)

(Federal Employer Identification Number)

AN INDIVIDUAL

A PARTNERSHIP

A CORPORATION

A LIMITED LIABILITY CORPORATION

Address

E-Mail Address

Fax Number

Telephone Number (Area Code)

Exchange

Number

If the books and accounts of the organization are not at this address, show the location where they are kept.

To be completed for a partnership or limited liability corporation. Date of organization.

State whether partnership is general, limited or association.

NAMES OF PARTNERS & MANAGERS

ADDRESS

To be completed for a corporation. Date incorporated.

StateCapital paid in cash

If not incorporated in New Jersey - Date of Certificate of Authority to perform work in New Jersey

TITLE

NAME

ADDRESS

President

Vice President

Secretary

Treasurer

Registered Agent in New Jersey

The officers of a New Jersey corporation must include a President, a Secretary and a Treasurer, N.J.S.A. 14A:6-15 (1). If the by-laws of the corporation provide for other officers, attach statement listing their names, titles and addresses.

This questionnaire is submitted for:			ORIGINAL CLASSIFICATION		RENEWAL OF CLASSIFICATION
Classification Requested
			(Type of Work - See Attached WORK TYPE CLASSIFICATIONS on pages 15-21.)
For Electrical, Asbestos Removal, Landscaping, or Blasting Contractors Only
Business Permit Number					}
Electrical, Asbestos, Pesticide, or Blasting License Number(s)					} Expiring

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CONSTRUCTION EQUIPMENT SCHEDULE

THE FINANCIAL INFORMATION TO BE PROVIDED MUST BE FOR THE SAME DATE AS THE CPA STATEMENTS

2			STATEMENT OF CONSTRUCTION EQUIPMENT OWNED BY APPLICANT - (LIST INDIVIDUALLY)
Your ID Number	MAKE	DESCRIPTION		SIZE	MODEL NUMBER	SERIAL NUMBER	YEAR MFG.	Purchase Price	Accumulated	NET BOOK	Unpaid Balance -
								Year Purchased	Depreciation	VALUE	Long-Term Loa

TOTAL

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List below or attache schedule showing equipment leased for more than twelve (12) months from date of applications to perform types of work for which eligibility is requested.

Please attach a copy of the lease agreement.

3	LEASED EQUIPMENT SCHEDULE
			Lease
Quantity	Description and Capacity of Items	Age of Items	Expiration	Lessor
			Date

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NAME OF BANK							TELEPHONE NO.
ADDRESS
NEW JERSEY DEPARTMENT OF TRANSPORTATION
1035 Parkway Avenue, PO Box 605
Trenton, New Jersey 08625-0605							DATE
									(Not prior to that of the Financial Statement)
Sir/Madam:
A line of credit, in the amount of $				has been placed at the disposal of
					for use when, as and if needed during the twelve month period beginning
				, subject to the usual conditions, including the requirement that their financial and
(Not prior to that of the Financial Statement)
other conditions remain satisfactory. We have loans in the total amount of $											outstanding to this firm at the
present time against this line of credit.

The line of credit is not secured by any current assets nor construction equipment. (If secured, list assets used as collateral).

This line of credit has been given with full knowledge of the following lines of credit extended by other banks:

During the past two years the maximum use made of lines of credit extended by this bank has been:

Should any termination, reduction or increase in this line of credit occur, we shall notify you within 10 business days thereafter.

(Signature of Bank Officer)

that they are		of the	.

The bank named in and which executed the foregoing statement.

Sworn to before me this

day of

20

Notary Public

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7.How many years has your organization been in business under your present business name?

(b)As a Sub-Contractor

(a)As a Prime Contractor:

9.What is the construction experience of the principal individuals of your organization?

10.	Have you ever failed to complete any work awarded to you?	Yes	No	If so, where and why?
11.	Has any officer or partner of your organization ever failed to complete a construction contract handled in his own name?					Yes	No	if so,

state name of individual, name of owner, location and type of project , and reason for the failure to complete.

At any time during the past ten years, pay particular attention to questions 12 to 18, has the applicant:

12. Had an injunction, order or lien entered against it in favor of any governmental agency including but not limited to judgements to liens based on taxes

assessed or fines and penalties imposed by any government agency?	Yes	No If yes, provide complete details, including when, where, and why.

13.Been convicted and/or found guilty and/or pled guilty and/or found liable in any court to any of the following: antitrust statutes; racketeering statutes; environmental laws; laws banning workplace discrimination; laws governing wages, hours or labor standards; laws governing the conduct of

occupations, professions or regulated industries; and/or any law indicating a lack of business integrity or honesty?

Yes

No

If yes, provide complete details, including when, where, and why.

14.Paid a fine or otherwise paid to settle any of the allegations made by any agency of the government of any of the following: antitrust statutes; racketeering statutes; environmental laws; laws banning workplace discrimination; laws governing wages, hours or labor standards; laws governing the

conduct of occupations, professions or regulated industries; and/or any law indicating a lack of business integrity or honesty?

Yes

No

If yes, provide complete details, including when, where, and why.

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15. Been denied a license, permit or other similar authorization required to engage in the business concern's trade(s) or professional discipline(s) or had any such license, permit or similar authorization been suspended or revoked by any agency of federal, state or local government? Yes No

If yes, provide complete details including when, where and why.

16. Been suspended, debarred, disqualified or denied a classification rating or prequalification or otherwise been declared not responsible to bid on or to

perform work on any public contractor subcontract?	Yes	No If yes, provide complete details, including when, where and why.

17. Been required or agreed, pursuant to any agreement or settlement whith any governmental agency to refrain from submitting any form of prequalification,

from bidding or from proposing on any public contract?	Yes	No If yes, provide complete details, including when, where and why.

18. Has any owner, stockholder, officer, partner or employee of this organization ever been suspended, disqualified or debarred by this state or any other state

or the federal government or by any subdivision thereof?	Yes	No	If yes, provide complete details including when, where and why.

19. Our Equal Employment Oppurtunity Officer is			located at:

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Disadvantaged Business Certification

The Federal Highway Administration, under the authority of the Civil Rights Act of 1964 and Executive Order 11246, and implementing regulations 49 CFR, Part 23 and 26, requires the Department of Transportation to submit a report of the number of contracts awarded to Disadvantaged contractors (DBE's).

To obtain and maintain the necessary statistical base, this sheet is added to Form DC-74A, our classification questionnaire. Upon receipt of the form, this page will be removed before processing the application for classification.

Definitions:

1.“Disadvantaged Business Enterprise” means a Small Business Concern:

(a)Which is at least 51 percent owned by one or more socially and economically disadvantaged individuals, or in the case of any publicly owned business, at least 51 percent of the stock of which is owned by one or more socially and economically disadvantaged individuals; and

(b)Whose management and daily business operations are controlled by one or more of the socially and economically disadvantaged individuals who own it.

2.“Small Business Concern” means a small business as defined pursuant to section 3 of the Federal Small Business Act and relevant regulations promulgated pursuant thereto, except that a small business concern shall not include any concern or group of concerns controlled by the same socially and economically disadvantaged individual or individuals which company has annual average gross receipts in excess of $16.6 million averaged over the most current three-year tax period.

3.“Socially and Economically Disadvantaged Individuals” means those individuals who are citizens of the United States (or lawfully admitted permanent residents) and who are women, Black Americans, Hispanic Americans, Native Americans, Asian-Pacific Americans, or Subcontinent Asian Americans and any other minorities or individuals found to be disadvantaged by the Small Business Administration pursuant to section 8 (a) of the Small Business Act.

Disadvantaged Groups Participants are defined as follows:

CHECK AS APPLICABLE:

a.An individual who is a citizen or lawfully admitted permanent resident of the United States and who is:

1. "Black Americans," which includes persons having origins in any of the Black racial groups of Africa.

3. "Native Americans", which includes persons who are American Indians, Eskimos, Aleuts or Native Hawaiians.

6. Women.

8. None of the above.

To be considered a participant in the DBE Program, a mandatory process for verifying that DBEs are owned and controlled in both form and substance by one or more disadvantaged individuals must be made by the Division of Civil Rights.

Name of Organization

(Signature)

(Title)

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OWNERSHIP DISCLOSURE

The list below contains the names and home addresses of all persons and/or entities holding a 10 percent or greater beneficial interest of the undersigned entity. If one or more person and/or entity is itself an entity, the names and home addresses of all person and/or entities holding a 10 percent beneficial interest of that entity are also listed.

Entity Name

STAKEHOLDERS:

ADDRESS

NAME

ADDRESS

NAME

ADDRESS

NAME

ADDRESS

NAME

ADDRESS

NAME

ADDRESS

For any an all publicly traded entities holding a 10 percent or greater beneficial interest, please provide links to the websites containing the last annual filings with the Federal Securities and Exchange Commission or the foreign equivalent and the relevant page numbers of the filings that contain the information on each publicly traded entity that hold a 10 percent or greater beneficial interest.

Is the corporation applying for classification as a subsidiary of a parent entity?		Yes	No
Name of Parent Entity
	Address
(Date Incorporated - State Incorporated)
(Name and Address of Registered Agent)
Is parent entity owner of all assets of subsidiary?	Yes	No

If not, what is the division?

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Provide the Names and Home Addresses of Stockholders of Parent Entity

ADDRESS

NAME

ADDRESS

NAME

ADDRESS

NAME

ADDRESS

NAME

ADDRESS

NAME

ADDRESS

For any an all publicly traded entities holding a 10 percent or greater beneficial interest, please provide links to the websites containing the last annual filings with the Federal Securities and Exchange Commission or the foreign equivalent and the relevant page numbers of the filings that contain the information on each publicly traded entity that hold a 10 percent or greater beneficial interest.

Provide the names and addresses of all subsidiaries owned by the parent corporation or the applicant

Percent Owned

NAME ADDRESS

NAME

ADDRESS

NAME

ADDRESS

NAME

ADDRESS

NAME

ADDRESS

NAME

ADDRESS

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CORPORATION INFORMATION SHEET

This question must be completed.

As adopted by the Board of Directors, the officers and employees listed below are appointed and authorized to approve and execute on the Corporation's behalf, the following documents:

*1 - Contractor's Statement of Experience, Equipment and Financial Condition.

*2 - Contracts and Bonds

*3 - Addenda/Change Order/Supplemental Agreement

*4 - Force Account Agreement

*Specify the appropriate number(s) and TITLE(s) of each officer in designated column below.

If any changes are made in the appointee by the action of the Board of Directors during the eighteen month period from the date of the Financial information forwarded with this form, it SHALL be the sole responsibility and WILL be required of the corporation to submit an original Certified document advising of such action to the Bureau of Construction Services, Procurement, New Jersey Department of Transportation.

Name	Title	*Number(s)

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WORK TYPE CLASSIFICATIONS

1.GRADING - Work involving earthwork and drainage as defined in 1a, 1b, and 1c below:

1a Clearing - This work shall consist of clearing the site of trees and vegetation, removal of bridges, structures, culverts, sidewalks, curbs and gutters, pipes, manholes, inlets, and other conflicting structures.

1b Drainage - This work shall consist of the construction of storm drains for surface drainage, underdrains and subbase outlet drains, inlets, manholes, miscellaneous type chambers, and precast culverts.

1c Earthwork - This classification shall consist of the necessary clearing, excavation, placement and grading of various materials for embankment. This classification shall also include the placement and grading, with a motor grader, of unbound roadway subbase materials.

2.PAVING - Work involving pavements as outlined in 2a, 2b, 2c, and 2d below:

2a Apply Bituminous Material - This work shall consist of furnishing a placing of liquid bituminous and cover materials.

2b Paving Bituminous - This work shall consist of construction of various courses of bituminous concrete, with automatic controls, and the final preparation of the underlying material.

2c Paving Concrete - This work shall consist of constructing a surface course of a Portland concrete mix, with or without reinforcement, to include the installation of required expansion and or contraction joints, surface texture finish, and the final preparation of the underlying material. The underlying material can include concrete base course.

2d Bituminous Concrete Curb - Work consists of using a self-propelled automatic machine or any paver with proper attachments to place bituminous concrete curb.

3.GRADING & PAVING - This work shall consist of a combination of grading, as defined in 1 above, and paving (Bituminous and Concrete) as defined in:

3a Grading & Bituminous Paving - This work shall consist of a combination of grading, as defined in 1 above, and bituminous paving as defined in 2b above.

3b Grading & Concrete Paving - This work shall consist of a combination of grading, as defined in 1 above, and concrete paving as defined in 2c above.

4.BRIDGE - This work shall consist of the construction of fixed bridges with related demolition, viaducts, trestles, cast-in-place culverts, headwalls, retaining walls, abutments, piers, deck slabs and similar structures of steel, concrete, timber, etc. and the following:

4a Bridge Fender Systems & Bulkheads - This work shall consist of construction and repair of timber, concrete and steel bulkheads, fender systems and dolphins.

4b Bridge Repair - This work shall consist of the removal and disposal of loose and disintegrated concrete; scarification of existing concrete bridge decks prior to repair and demolition; injection of an epoxy adhesive for sealing cracks and any and all bridge related repair including concrete, timber, reinforcement steel, and structural steel.

4c Caissons - This work shall consist of the construction of watertight chambers used in construction work under water or as a foundation.

4d Erection of Bridge Railing - This work shall consist of the furnishing and erection of metal railing and fences on bridges.

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6.LANDSCAPE - This classification shall consist of all work involving Landscape Architectural considerations as outlined in 6a, 6b, 6c, 6d, 6e and 6f below. The contractor performing any combination of these classifications is required, per N.J.A.C. 7:30-1-13, to be a licensed Pesticide Applicator Business, have a designated licensed Commercial Pesticide Applicator on staff and anyone applying pesticides under direction of the Commercial Pesticide Applicator shall be a licensed Pesticide Operator:

6a Chemical Vegetation Control - This work shall consist of using chemicals to remove unwanted growth or to regulate same.

6b Grubbing - This work shall consist of removing vegetation and roots from a prescribed area.

6c Mowing - This work shall consist of the cutting of grass to a prescribed length in a prescribed area.

6d Planting - This work shall consist of furnishing, delivering, and planting trees, shrubs, vines and ground cover plants.

6e Topsoiling and Seeding - This work shall consist of the preparation and placement of approved topsoil stripped from the site of the project and the furnishing, preparation and placement of topsoil required in excess of that obtained from stripping; furnishing and placing of seed mixtures and grain seed, fertilizing and mulching and furnishing and placement of slope boards as required.

6f Tree Trimming & Removal - This work shall consist of the selective removal of trees and the removal of all defective or undesirable limbs and repair of all injuries or wounds on existing trees.

7.ELECTRICAL - This classification consists of work involving traffic signals, highway lighting and sign lighting. Electrical licensing is required prior to start of work.

8.GENERAL CONCRETE - Work involving placing concrete mixtures as outlined in 8a, 8b, 8c, 8d, and 8e below:

8a Concrete Median Barrier Curb - This work shall consist of the construction of concrete barrier curb.

8b Concrete Repairs - This work shall consist of concrete repairs to existing concrete construction items such as: curbs and headers, sidewalks, culverts under five feet, headwalls, etc.

8c Curbs, Sidewalks and Miscellaneous Concrete Work - This work shall consist of the construction of concrete curbs, sidewalks, islands, and other incidental concrete work.

8d Sawing, Sealing, and Curing - This work shall consist of sawing, cleaning, and sealing of joints and cracks on concrete and bituminous pavements.

8e Paving Concrete Base - This work shall consist of constructing a base of a Portland concrete mix, with or without reinforcement, and the final preparation of the underlying material.

9.MISCELLANEOUS - This classification encompasses various specialty categories of work generally associated with highway construction. Those classified under miscellaneous will be identified by their particular work specialty. Asbestos removal licensing is required prior to starting work in type 9i below.

a. Borings	f. Grouting
b. Core Drilling	g. Natural Stone Masonry
c. Engineering	h. Rigging
d. Erection of steel plate pipe and drainage	i. Asbestos Removal
structures metal bin types retaining walls	j. Trenching
e. Bus Shelters

9k Erection of Ornamental and Light Structural Steel - This work shall consist of the furnishing and erection of ornamental and light structural steel.

9l Railroad Track Work

9m Large Diameter Cylinder Piles 3 or more feet in Diameter

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18.LONG LIFE PAVEMENT MARKINGS - This work shall consist of the placement and/or removal of pavement markings and stripes made of epoxy, thermoplastic, preformed tape, etc.

19.PNEUMATIC MORTAR OR GUNITE - This work shall consist of pneumatically applying a course of mortar or gunite on steel or concrete surfaces.

20.SAND DRAINS AND SAND FILL - This work shall consist of placing of sand drains by mandrel and hollow shaft auger methods and associated sand embankment.

21.PERMANENT SIGNS _ This work shall consist of the furnishing, assembling, and erection of permanent signs and delineators.

22.UNDERGROUND UTILITIES - This work shall consist of furnishing, installing, replacement and relocation of various types of conduit and piping for underground utilities.

23.WATERPROOFING - This work shall consist of the preparation and application of a waterproofing compound.

24.MAINTENANCE & PROTECTION OF TRAFFIC _ This work shall consist of furnishing, placing, cleaning, and maintaining construction signs and other traffic control devices in accordance with the plans and specifications.

25.MILLING - This work shall consist of the removal or cold milling and profiling of existing Portland cement concrete or bituminous pavement.

26.BLASTING _ This work shall consist of furnishing of a fully qualified and licensed blaster using standard explosives and incidental materials to drill and blast in designated areas. Proof of licensing is required prior to starting work.

27.REMOVAL OF PETROLEUM PRODUCTS, DEBRIS, AND HAZARDOUS MATERIAL - This work consists of removal and disposal of petroleum products using pumping equipment that will provide maximum protection without endangerment to health, life or property; as well as the removal and disposal of debris and hazardous material.

28.HEALTH AND SAFETY PLAN _ This work shall consist of submitting an acceptable health and safety plan for the removal of hazardous material from the job site in accordance with contract specifications and subsequent monitoring to assure compliance through the life of the contract.

29.SAMPLING AND ANALYSIS - This work shall include the sampling and analysis of soil, ground water, and stock piled material, to determine the degree and type of contamination in accordance with the rules and regulations of the New Jersey Department of Environmental Protection.

30.DESIGN SERVICES (FOR SUBCONTRACTING ONLY) - This work shall include providing a detailed set of design drawings which conform in all respects to N.J.D.O.T. design manuals and standards based upon the criteria outlined in the contract documents. Design drawings must be developed and signed by a Professional Engineer licensed by the State of New Jersey. In addition, the firm must be cost basis approved by N.J.D.O.T. A copy of the cost basis approval letter must be submitted with application.

31.Modified Design Build - This classification shall consist of a combination of Grading, Paving, and Bridge as defined in work type codes 1, 2, 3, and 4, and Design of Highway & Bridge Projects. The contractor must:

a.Be a Corporation authorized to do business in New Jersey,

b.Hold a current certification of authorization to offer professional engineering services pursuant to N.J.S. A. 45:8-56 (a current copy of the certification together with the list of New Jersey Licensed Professional Engineer(s) and/or Corporation(s) who is (are) in responsible charge of the engineering to be performed by the contractor must be submitted to the Department for review prior to prequalification approval,

c.Have an approved Title Block which shall be affixed to all plans prepared,

d.The professional design engineer may be an employee of the contractor, and

e.Be prequalified with the Bureau of Professional Services of the N.J.D.O.T.

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32.Deleted and made part of work type classification 33.

33.Intelligent Transportation Systems - This work shall consist of the combination of one or more of the following:

Controlled Traffic Signal Systems (CTSS):

This work shall consist of furnishing and installing a complete computerized traffic signal control system, which will be interconnected to a traffic operations center through a fiber optic cable or other communications media.

DMS, CCTV, WIM, TV, RWIS, TT System Installation:

This work shall consist of furnishing and installing of individual subsystems such as Dynamic Message Sign (DMS) System, CCTV System, Weigh In Motion (WIM), Roadway Weather Information (RWI) System, TVS, Vehicle Detectors/Counters and Travel Time (TT) System and shall include the connection of power service for each device and its interconnection with Traffic Operation Center (TOC) via Fiber, POT/Cable/DSL/Wireless Communication System. The interconnection and installation of subsystem components shall require expertise in each of these subsystems. The CCTV (Video) subsystem work shall require expertise with CODECS, Slow Scan and Real Time installations as well as, switching and monitoring devices. The TTS work shall require expertise in collecting/analyzing real time data and converting to estimated travel time. The WIM system work shall require expertise in installation of WIM stations with data collection and communication.

Communication Systems:

This work shall consist of furnishing and installing a complete and operational Intelligent Transportation System which will utilize computer software, through fiber optic communication, or other communication media to analyze traffic conditions and activate on demand intelligent traffic surveillance, incident detection and incident management subsystems. Software expertise shall be required to provide complete working systems between the Traffic Operation Center computers and all subsystem components, interfacing equipment and all other required components to provide a fully operational system. Expertise shall also be required for installing a complete fiber optic communications system (multiplexers/demultiplexers, splicing, termination, and communication hubs) and all interconnects required for the installation of and communications with Closed Circuit Television Cameras, Dynamic Message Signs and Vehicle Detectors.

Previous experience on projects of equal magnitude will be required for the entire fiber optic installation including equipment interconnections, multiplexers/demultiplexers, splicing, termination, etc. and communication techniques other than fiber optics: including spread spectrum radio microwave, cable and DSL service.

System Integrator:

This work shall consist of the successful installation, completion, testing and integration of the various systems, subsystems, and system components as outlined under Intelligent Transportation System Classification. The Systems Integrator shall assume full responsibility to ensure that all of the subsystems achieve and maintain interoperability; this shall include software, hardware, and firmware, as outlined in the project. The contractor must demonstrate a successful track record of Intelligent Transportation System work with at least one similar project within the last three years -OR- have on their payroll two individuals with the following credentials:

ØProject Manager who meets the above qualifications.

AND

ØConstruction Superintendent who meets the above qualifications.

34.Deleted and made part of work type classification 33.

35.Rumble Strips - This work shall consist of making transverse saw cut grooves perpendicular or radial to the existing lane striping in accordance with the contract documents.

36.Rehabilitation of Movable Bridge Houses - This work shall consist of the complete renovation and related demolition for the exterior and interior of the operator's and machinery houses. This work includes, but is not limited to the installation of doors, windows, insulation, floor tiling, partitions, metal lockers, electrical wiring, plumbing and electrical fixtures, siding, roof repair, painting, safety railing, walkways and ladder enclosures.

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37.Machine Sweeping. - This work shall consist of the removal of dirt, debris, and other road waste from the roadway surface, in areas where the pavement meets curb, barrier curb, or berm by use of a mechanical sweeper.

38.Corrective Action Work - This work will include all work on Resident Engineer's corrective action inspection punch list to prepare the project for final acceptance.

39.Precast Segmental Bridge Construction - This work shall consist of construction of a precast segmental box girder superstructure and associated bridge work. The construction shall be performed by cantilever construction and/or span-by-span construction methods. The contractor must demonstrate experience in having constructed at least one segmental bridge within the last fifteen years OR have on their payroll:

•One (1) Project Manager or Assistant Project Manager who has constructed segmental box superstructure in the past fifteen years,

AND

•One (1) Erection Superintendent or Assistant Erection Superintendent who has erected precast segmental box superstructure in the past fifteen years.

40.Environmental Dredging - This work shall consist of removal of contaminated sediment from a body of water using precision equipment and material handling technique with minimal resuspension. The equipment may include mechanical, hydraulic, pneumatic, and hybrid dredges and methods with sufficient operational control to meet requirements.

41.Movable Bridge Installation/Rehabilitation - This work shall consist of furnishing and installing complete electrical and mechanical systems including, but not limited to counterweight and operating wire ropes, counterweight and deflector sheaves, counterweights, auxiliary counterweight systems, balance chains, trunnions and trunnions bearings, movable spans and leaves, span drive motors, motor control centers, span drives, programmable logic control and relay control systems, span locks, motor and machinery brakes, drive machinery, warning gates and barrier gate systems. Electrical licensing is required to perform any electrical work. The contractor must demonstrate a successful track record of all mechanical and electrical work on movable bridges on at least one or more projects within the last ten years OR have on their payroll:

•One (1) Project Manager or Assistant Project Manager with the above project experience and can demonstrate successful track record of mechanical and electrical work on movable bridges on at least one or more projects within the last ten years,

AND

•One (1) Construction Superintendent or Assistant Construction Superintendent with the above project experience and can demonstrate successful track record of mechanical and electrical work on movable bridges on at least one or more projects within the last ten years.

*Detailed documentation describing movable bridge experience must be submitted for approval to the New Jersey Department of Transportation.

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42.Complex Truss Rehabilitation - This work shall consist of the structural rehabilitation of an existing multi-span complex truss bridge structure located within a tightly constrained and highly urbanized area while the structure remains operational.

The work includes design and erection of temporary shoring towers and similar structures to support primary and secondary truss members during staged demolition and replacement; design and installation of temporary systems to remove/redistribute forces from primary and/or secondary truss members to allow for demolition, repair and/or replacement; design and installation of structural monitoring systems to continuously measure structural loading conditions of truss members affected by construction activities; fabrication of fracture critical steel truss components; construction of micropile foundations under limited headroom conditions; and replacement of complex fracture critical truss members consisting of riveted and pinned connections under accelerated and high intensity construction cycles while carrying active live load.

Prior to being qualified by NJDOT to furnish a bid for the work described herein, the Contractor must prepare and submit a prequalification package which demonstrates relevant similar successful experience of the contracting entity, including primary construction personnel and subcontractors, for the subject work on past contracts that included replacement and/or rehabilitation of primary fracture critical truss members on long multi-span truss structures (minimum length of 150 feet per span) under full live load.

The prequalification package shall include the following:

1.Work descriptions of a minimum of two (2) separate and successfully completed projects within the past 15 years. For each project, include a brief description of each project and the client reference contact name, email address and direct phone number; the reference must be able to verify the role and satisfactory completion of the submitted project.

2.Resumes of full-time employees of the contracting entity for primary personnel noted below that shall be committed to the project. Resume experience shall include a minimum of one of the projects listed in Item 1 and performing similar work in the same role.

a.Superintendent

b.Iron Worker Foreman

c.Temporary Works Design Engineer: Person shall be a professional engineer licensed in the State of New Jersey and shall have a minimum of 10 years' experience in the design and construction of temporary shoring and jacking systems used on similar complex truss rehabilitation projects.

Staff provided as a part of the Contractor's prequalification package shall maintain their roles and responsibilities throughout the duration of the project. Substitute staff may be proposed by the Contractor to the NJDOT for review and approval if primary staff cannot complete the work.

NJDOT will review the prequalification package, check references and decide as to the adequacy of relevant similar experience, primary personnel and acceptable performance. Approval of the contractor's prequalification request will be in the sole opinion of NJDOT. All judgements are final.

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"CHECKLIST"

Applicant have you?

*Included a cover letter signed by the individual who can respond to future inquiries for additional information.

*Do not submit an Accountant's Compilation Report.

Page 1	-	Included date of close of business and used end of month date.
	- Listed by number the classifications you desire.
	-	Listed Corporate Officers, especially President, Secretary and Treasurer, with their full home addresses.
	-	The date of the financial information provided in the questionnaire must be the same date as the CPA
		financial statements.
Page 2	-	Schedule 1	- Responded to all information requested by column headings. Be guided by the following
		legends: Columns “A” minus “B” minus “F” equals column “G”. Also columns “B” minus “C” minus
		“D” equals “E”. Any attachments should follow exactly the format of Schedule 1.
Page 3	-	Schedule 2	- Listed the net book value as cost minus accumulated depreciation, for each piece of
		equipment. Included only those items used directly on construction projects. Did not include real estate,
		buildings, boats (pleasure craft), automobiles, airplanes, furniture and fixtures, and expense items such
		as small tools or shop equipment. Responded to all column headings. (Any attachments should be a
		reproduction of original schedule). Special attention should be paid to accumulated depreciation.
Page 4	-	Schedule 3	- Listed leased construction equipment and included copies of the lease agreement.
Page 5	-	Schedule 4	- The Department would prefer that this schedule be completed by your banking institution,
		as there is specific information needed to determine acceptance.
Page 6	-	Schedule 5	- Provided all the required information.
Page 7	-	Schedule 6	- Included information in this schedule which has a direct relationship with those traded
		classifications you desire. Completed all columns and provided complete addresses and phone numbers
		of those engineers or persons who can give an evaluation of your performance.
Pages 8 & 9	-	Completed all lines, paying particular attention to questions 10, 11, 12, 13, 14, 15, 16, 17, and 18.
Page 10	-	Completed all sections.
Page 11	-	Responded to all sections.
Page 12	-	Responded to all sections, where applicable.
Page 13	-	Corporation Information Sheet. Read carefully and responded where appropriate.
Page 14	-	Read carefully and responded where appropriate, affixing corporate seal and completed the Notary
		Public section.
Pages 15 - 23	-	Please RETAIN for your information and records.

In summary, adhere to the above checks will reduce many delays and correspondence between this Department and the applicant.

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