Appendix 4

Contractor’s Statement of Experience and
Financial Condition

	

CONFIDENTIAL Contractor’s Statement of Experience and Financial Condition  (Updated ____ 2014)

To be submitted to the Shasta Regional Transportation Agency (SRTA)

Submitted by:	__________________________________________________________________________________ 		Name of Firm

Address: 	__________________________________________________________________________________ 		Street or P.O. Box
	
	__________________________________________________________________________________ 		City						State			ZIP Code

Contractor Primary Point of Contact:	_____________________________________________
Telephone: ____________________________  Email: __________________________________________________ 	(Area Code) xxx-xxxx

Contract No.: ___________________________________
Contract Bid Amount: ____________________________  Project CIP No.:__________________________________
Bid Date: ______________________________________
Submittal Date: _________________________________

All pages of the questionnaires and financial statements should be marked “CONFIDENTIAL”.

Shasta Regional Transportation Agency 1255 East Street, Suite 202 Redding, CA 96001

TABLE OF CONTENTS

CONTENTS
Instructions……………………………………………………………………………………………………………………….
For Submitting…………………………………………………………………………………………………………………...
	Frequency of Submission……………………………………………………………………………………………….  	Evaluation of CSOEFC………………………………………………………………………………………………....  	Age of Financial Information……………………………………………………………………………………………  	Data Required…………………………………………………………………………………………………………...  	Affidavits………………………………………………………………………………………………………………..  	Accountant’s Certificate………………………………………………………………………………………………...   	Licensing………………………………………………………………………………………………………………..  	Completeness……………………………………………………………………………………………………………  	Bidding Information…………………………………………………………………………………………………….  	Review Process………………………………………………………………………………………………………….  	SRTA Qualification Regulations…………………………………………………………………………………….

TABLE OF EXHIBITS
EXHIBIT No.	DESCRIPTION	PAGE No.	
1	CONTRACTOR’S STATEMENT OF EXPERIENCE		
2	AFFIDAVIT		
3	INDEPENDENT AUDITOR’S REPORT		
4	CONTRACTOR’S FINANCIAL STATEMENT		
5	SUBORDINATION OF NOTES OR ACCOUNTS PAYABLE		
6	GENERAL STATEMENT OF BANK CREDIT		

INSTRUCTIONS FOR SUBMITTING
Contractor’s Statement of Experience and Financial Condition (CSOEFC)

FREQUENCY OF SUBMISSION
A new CSOEFC will be required each time a bidder responds to an invitation for bid for a SRTA project
containing a requirement for submission of a CSOEFC. The CSOEFC will no longer be valid for one year. It shall be the contractor’s responsibility to ensure that the CSOEFC will be applicable to the project for which the CSOEFC is being submitted and that all information in the CSOEFC is up to date and accurate.

EVALUATION OF CSOEFC
For Invitations for Bids (IFBs), SRTA shall only evaluate the CSOEFC of the apparent lowest bidder. If the
apparent low bidder does not meet the required qualifications, only then will SRTA evaluate the next apparent lowest bidder.

AGE OF FINANCIAL INFORMATION
SRTA reserves the right to reject statements in which the financial condition shown is twelve months or more prior to the date the CSOEFC was required to be submitted.

DATA REQUIRED
All applicable portions of the form should be filled out completely, with schedules being attached if the space
provided is not sufficient.

It will be acceptable, in lieu of completing the specific schedules in the financial portion of the statement, for the
contractor to submit the customary accountant’s report and schedules, provided that they include all of the
information specifically requested in the form.

It is essential that the questions regarding construction experience be completed as such experience is a major
consideration in establishing qualifications.

AFFIDAVITS
The appropriate affidavit must be completely executed or the statement will be returned. Where a consolidated
statement is submitted to obtain joint qualification of several organizations, an appropriate affidavit must be executed for each entity that is a part of the joint venture. If firms are bidding or responding as a joint venture and have no consolidated statement, each partner in the joint venture must submit their own CSOEFC.

ACCOUNTANT’S CERTIFICATE
The certificate of a Certified Public Accountant or Public Accountant will be required in all cases. A
suggested form of unqualified certificate is included which may be used if appropriate. However, it will be acceptable for the accountant to submit a certificate in his own words, including such qualifications as may be necessary in view of the scope of this assignment; provided that such qualifications shall not be so extensive as to nullify the value of the statement or its usefulness to SRTA.

Bearing in mind that working capital and the dollar value of previous construction projects worked on are important factors in determining the qualification of a contractor, the accountant will perform a valuation service for his or her client and at the same time assist SRTA by furnishing supplementary schedules, or as a part of his or her certificate, any information not specifically called for by the statement which in the accountant’s opinion may be properly taken into consideration.

In the event that the contractor’s job income and expenditures are accounted on a completed-contract basis and the balance sheet includes an item reflecting the excess of costs-to-date over billings-to-date, or vice versa, the elements of “Accumulated Costs” and “Billings to Date” must be shown in support of the balance sheet item.

LICENSING
Contractor requirements shall be guided by Division 3 of the Business and Professional Code
concerning the licensing of contractors.”

COMPLETENESS
All forms must be completed, or the bidder must note where the required information is reflected in the attachments.

BIDDING INFORMATION
1. Any contractor may download an Invitation for Bid (IFB) package free of charge from the SRTA website.

2. Should contractors desire to bid or respond jointly, a joint-qualification statement containing information regarding
each of the contractors must be submitted. Attention is called to the “Contractors’ License Law” with respect to the
license requirements for joint bids or responses.

REVIEW PROCESS
Qualification approvals are based on showing evidence of the availability of sufficient working capital, the dollar value of previous contracts worked on, and the successful completion of previous contracts exceeding five times the annual value of
the SRTA contract, subject to adjustment upon consideration of experience, equipment, and performance factors.

Working capital may be augmented by submission of Statement of Bank Credit (See Exhibit 6).

SRTA QUALIFICATION REGULATIONS

SRTA requires a CSOEFC for all contracts where the estimated cost exceeds $500,000. SRTA may require a
CSOEFC for projects where the estimated cost is under $500,000. When completed, the CSOEFC shall be verified
under oath by the bidder in the manner in which pleadings in civil actions are verified.

SRTA shall apply a uniform system of reviewing bidders on the basis of the CSOEFC.

In no event shall any bidder be awarded a contract if such contract award would result in the bidder having under
contract an amount of work in excess of that authorized by its qualification approval.
The CSOEFCs will be treated as confidential records.

SRTA shall furnish to each bidder a bid booklet, which shall be filled out, executed, and submitted as the bid
(Section 1.4.1). Bid proposals shall be presented on the forms furnished. SRTA shall review all bid proposals to
determine which bidder is the lowest responsive and responsible bidder. 

Contractor’s Statement of Experience and  Financial Condition

EXHIBIT 1 – CONTRACTOR’S STATEMENT OF EXPERIENCE
	A Corporation	A Copartnership	An Individual	Combination
 Name: ______________________________________________________________________________________ 	(Name Must Correspond with Contractor’s License in Every Detail)
Principal Office: ______________________________________________________________________________ 			(Street or P.O. Box)		(City)			(State)		(ZIP Code)
The signatory of this questionnaire guarantees the truth and accuracy of all statements and of all answers to Interrogatories hereinafter made.
1.	Are you licensed as a contractor to do business in California? _________ License No. __________ Type_________ 	Classification (Type) of Specialty Contractor: ________________________________________________________
2.	How many years has your organization been in business as a contractor under your present business name:________
	_____________________________________________________________________________________________
3.	How many years’ experience in ____________________ construction work has your organization had? 						(Type)
	(a) As a general contractor? ______________________ (b) As a Subcontractor? ____________________________
4.	Show the projects your organization has completed or are under construction during the last five years in the 	following tabulation.  (Attach additional sheets as needed).
To assure maximum consideration for your qualification, be specific as to the nature of the work your firm actually performed.
Year	Type of Work	Value of Work Performed	Location of Work	Project Duration (Months)	For Whom Performed and Phone Number to Contact for Verification	

						

						

						

A contractor that wishes to bid on projects handled by SRTA shall be licensed in accordance with the laws and regulations of California.  The licensing must correspond to the applicable types of work and organization.  Corporations not incorporated in the State of California must take the necessary steps to register to conduct business in the state. 

For Questions 5-13, please also provide name of owner, title of project, contract amount, location of project, date of contract, and name of bonding company as applicable (attach additional pages if needed). All references to “bidder” should be treated as a reference to “proposer” and all references to a “bid” as a reference to a “proposal” where applicable.
5.	List how many construction projects your organization will be working on in conjunction with the SRTA 	project: ______________________________________________________________________________________
	_____________________________________________________________________________________________ 
	_____________________________________________________________________________________________

6.	Bidder or proposer must submit a summary of all claims made in the last five years arising out of previous contracts 	listed (including all claims by owner against bidder or proposer or bidder or proposer against owner, and the final 	status of each claim): ____________________________________________________________________________
	_____________________________________________________________________________________________ 
	_____________________________________________________________________________________________

7.	Have you or your organization, or any officer or partner thereof, failed to complete a contract? ________ if so, give 	details: _______________________________________________________________________________________
	_____________________________________________________________________________________________ 

8.	Have you, your organization, or any officer or partner thereof, defaulted on a construction project within the last two 	years? _______________________________________________________________________________________
	_____________________________________________________________________________________________

9.	Have you or your organization, or any officer or partner thereof, ever been terminated by an owner or client, or 	rejected from bidding or responding on a public works project in the last five years? _________________________
	_____________________________________________________________________________________________
	_____________________________________________________________________________________________

10.	Has a surety ever completed any portion of work of your organization’s projects within the last five years: ________
	_____________________________________________________________________________________________
	_____________________________________________________________________________________________

11.	Have you or your organization, or any officer or partner thereof, been formally found to be a nonresponsive bidder 	by a public agency within the last two years? _________________________________________________________
	_____________________________________________________________________________________________
	_____________________________________________________________________________________________

12.	List any violation of the Apprenticeship Requirements under a State Business and Professions Code or Labor Code 	found by an appropriate authority within the last two years? _____________________________________________
	_____________________________________________________________________________________________

13.	Have you or your organization, or any officer to partner thereof, been found guilty of failure to pay required 	prevailing wages on a public contract within the last two years?__________________________________________
	_____________________________________________________________________________________________

14.	In what other liens of business are you financially interested? ____________________________________________
	_____________________________________________________________________________________________

15.	Name the persons with whom you have been associated in business as partners or business associates in each of the 	last five years? _________________________________________________________________________________
	_____________________________________________________________________________________________ 
16.	What is the construction experience of the principal individuals of your present organization?
Individual’s Name	Length of Employment	Present position or office in our organization	Has individual been involved in the same level of responsibility on successfully completed contracts during the previous five years that together exceeds the value of this SRTA contract?	Years of Construction Experience	Magnitude and Type of Work	In What Capacity?	

							

							

							

If a Corporation, answer:

Capital paid in cash,
$____________________________________

When Incorporated?

In What State?
________________________________________

President’s Name:

Secretary’s Name: ________________________________________

Treasurer’s Name:
________________________________________	If a co-partnership, answer: 

Date of organization: __________________________________________________ 

State whether partnership is general, limited, or association: ___________________ ____________________________________________________________________ ____________________________________________________________________ Name and address of each partner: _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________ _________________________________________________	
 18. 	Attach a resume for the individuals listed above, including the name, title, address, and phone number of an 	individual or organization who could verify the individual’s experience.

19.	Have you or your organization, or any officer or partner thereof, or any employee of such organization who has a 	proprietary interest in such organization ever been disqualified, removed, or otherwise prevented from bidding or 	responding on or completing a federal, state, or local government project because of a violation of a law or safety 	regulation? If so, please explain the circumstances below: 
	_____________________________________________________________________________________________
	_____________________________________________________________________________________________	_____________________________________________________________________________________________
EXHIBIT 2 – AFFIDAVIT

WHERE PREQUALIFICATION IS BASED ON A COMBINATION OF ORGANIZATIONS, THE APPROPRIATE AFFIDAVITS BELOW MUST BE EXECUTED FOR EACH MEMBER OF SUCH COMINATION 

____________________________________________________________________________________________________

AFFIDAVIT FOR INDIVIDUAL
____________________________________________________________________________________________________ (Name of Individual)
Doing business as:____________________________________________________________________________________
certifies and says:  That she/he is the person submitting the statement of experience and financial condition: that she/he has read the same, and that the same is true of his/her own knowledge; that the statement is for the purpose of inducing SRTA to supply the submittor with plans and specifications, and that any depository, vendor, or other agency therein named is hereby authorized to supply said SRTA with any information necessary to verify the statement and that furthermore, should the foregoing statement at any time cease to properly and truly represent his financial condition in any substantial respect, she/he will refrain from further bidding on SRTA work until she/he shall have submitted a revised and corrected statement.

I certify and declare under penalty of perjury that the foregoing is true and correct. 

Subscribed at ______________________________________, __________________, State of _______________________ 			(City)					    (County)			
	Note:  Statement will be returned unless affidavit		on_______________________________, 20_____ 		Is complete including the date of signature		_________________________________________ 										(Applicant must sign here)
AFFIDAVIT FOR CO-PARTNERSHIP

________________________________________________________, certifies and says: That she/he/it is a partner of

____________________________________________________________________________________________________ (Name of firm)

that said partnership submitted the statement of experience and financial condition: that she/he has read the same and that the same is true of his/her own knowledge; that the statement is for the purpose of inducing SRTA to supply the submittor with plans and specifications, and that any depository, vendor, or other agency therein named is hereby authorized to supply SRTA with any information necessary to verify the statement; and that furthermore, should the foregoing statement at any time cease to properly and truly represent the financial condition of said firm in any substantial respect, he/she/it will refrain from further bidding on SRTA work until he/she/it has submitted a revised and corrected statement. 
 I certify and declare under penalty of perjury that the foregoing is true and correct.
Subscribed at ______________________________________, __________________, State of _______________________ 			(City)				    (County)			
	Note:  Statement will be returned unless affidavit		on_______________________________, 20_____ 		Is complete including the date of signature		_________________________________________ 								          (Member of firm must sign here)
	______________________________________		__________________________________________ 	(Remaining members of firm sign here)			  		(Name of firm)
AFFIDAVIT FOR CORPORATION
_____________________________________, certifies and says: That she/he is __________________________________ 	(Name of Officer)								(Official Capacity)
Of the ______________________________________________________________________________________________ 				(Name of Firm)

the corporation submitting the statement of experience and financial condition; that she/he has read the same, and that the same is true of his/her own knowledge; that the statement is for the purpose of inducing SRTA to supply the submittor with plans and specifications, and that any depository, vendor, or other agency therein named is hereby authorized to supply said SRTA with any information necessary to verify the statement; and that furthermore, should the foregoing statement at any time cease to properly and truly represent the financial condition of said corporation in any substantial respect, it will refrain from further bidding on SRTA work until it shall have submitted a revised and corrected statement. 

I certify and declare under penalty of perjury that the foregoing is true and correct.

Subscribed at __________________________________, _________________________, State of ___________________ 			(City)					(County)

	Note:  Statement will be returned unless affidavit		on______________________, 20_______
		Is complete, including the date of signature

									___________________________________ 										(Officer must sign here)
								Note: use full corporate name and attach corporate seal 

CONTRACTOR’S COMMENTS
______________________________________________________________________________________________________________

EXHIBIT 3 – INDEPENDENT AUDITOR’S REPORT

We have audited the accompanying balance sheet of __________________________________________________ as of 
__________________________________, and the related statements of income and retained earnings and cash flows for the year then ended. These financial statements are the responsibility of the Company’s management. Our responsibility is to express an opinion on these financial statements based on our audit. 

We conducted our audit in accordance with generally accepted auditing standards. Those standards required that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement.  An audit includes examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements.  An audit also includes assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall financial statement presentation.  We believe that our audit provides a reasonable basis for our opinion.  In our opinion, the financial statements referred to above present fairly, in all material respects, the financial position of _________________________________ as of  ________________________________________,and the results of its operations and its cash flows for the year then ended in conformity with generally accepted accounting principles. 

_______________________________________________		_____________________________________
			Signature   							Date 

Special Note to Accountant:

The above Certificate of Accountant must not be made by any individual who is in the regular employ of the individual, co-partnership, or corporation submitting this statement, nor by any individual who is a member of the concern, unless she/he discloses his/her financial interest therein.  A determination will be made by SRTA if the financial interest is excessive. 

THE CERTIFICATE OF A LICENSED ACCOUNTANT WILL BE REQUIRED IN ALL CASES.

ACCOUNTANT COMMENTS

___________________________________________________________________________________________  

EXHIBIT 4 – CONTRACTOR’S FINANCIAL STATEMENT
NAME:_____________________________________________________________________________________________
Condition at close of business_____________________________________________________, 20_____________
ASSETS	DETAIL	TOTAL						
Current Assets								
1.	Cash							
2.	Notes Receivable							
3.	Accounts receivable from completed contracts							
4.	Sums earned on incomplete contracts							
5.	Other accounts receivable							
6.	Advances to construction joint ventures							
7.	Materials in stock not included in Item 4							
8.	Negotiable securities							
9.	Other current assets 							
	                TOTAL							
Fixed and Other Assets								
10.	Real Estate							
11.	Construction plant and equipment							
12.	Furniture and fixtures							
13.	Investments of a non-current nature							
14.	Other non-current assets							
	               TOTAL							
	                        Total Assets							
	LIABILITES AND CAPTIAL							
Current Liabilities								
15.	Current portion of notes payable, exclusive of equipment obligations and real estate encumbrances							
16.	Accounts payable							
17.	Other current liabilities							
	             TOTAL							
Other Liabilities and Reserves								
18.	Real estate encumbrances							
19.	Equipment obligations secured by equipment							
20.	Other non-current liabilities and non-current notes payable							
21.	Reserves							
	            TOTAL							
Capital and Surplus								
22.	Capital Stock Paid Up							
23.	Surplus (or Net Worth)							
	            TOTAL							
	      Total Liabilities and Capital							
    CONTINGENT LIABILITIES								
24.	Liability on notes receivable, discounted or sold							
25.	Liability on accounts receivable, pledged, assigned or sold							
26.	Liability as bondsman							
27.	Liability as guarantor on contracts or on accounts of others							
28.	Other contingent liabilities							
	                                                     Total Contingent Liabilities							
Note: Show details under main headings in that column, extending totals of main headings to second column. 								
1	           (a) On hand __________________________________________________  $ _______________ 
Cash:     (b) Deposited in banks named below _____________________________  $ _______________ 
           (c) Elsewhere – (state where) ___________________________________  $ _______________ 					
	Name of Bank 	Location 	Deposit in Name of 	Amount 		

						
						
2* 	                    (a) Due within one year ______________________________________ $ _______________ 
Notes Receivable:  (b) Due after one year _______________________________________ $ _______________ 
                    (c) Past Due _______________________________________________ $ _______________ 					
	Receivable From 	For What 	Date of Maturity 	How Secured 	Amount 	

						
						
3* 	Accounts receivable from completed contracts exclusive of claims not approved for payment $_______________ 					
	Receivable From 	Type of Work 	Amount of Contract 	Amount Receivable 		

						
	Have any of the above been assigned, sold, or pledged? __________ If so, state amount, to whom, and reason____						
EXHIBIT 4 (CONTINUED) – DETAILS RELATIVE TO ASSETS
4*  Sums  earned  on  incomplete contracts,  as shown  by  engineers’  or  architects’  estimates $_____________________ 				
Receivable From	Type of Work	Amount of Contract	Amount Receivable	

				

				
Have any of the above been assigned, sold, or pledged?___ If so, state amount, to whom, and reason __________________________________________________________________________________________________________________________________________________________________________________

*List separately each item amounting to 10 percent or more of the total and combine the remainder. 				

		EXHIBIT 4 -DETAILS RELATIVE TO ASSETS (Continued) 

5* 	Accounts receivable not from construction contracts ______________________________ $____________________ 			
Receivable From 	For What 	When Due 	Amount 	

				
What amount, in any, is past due? ____________________________________________ $____________________ 
Assigned, sold, or pledged ___________________________________________________ $____________________ 				

6 	Advances to construction joint ventures ______________________________ $____________________ 						
Name of Joint Venture	Type of Work 	Amount 					

							
What amount, in any, has been assigned, sold or pledged?__________________________ $____________________ 							
7 	Materials in stock and not included in Item 4
(a) For use on incomplete contracts (inventory value) ______________________________ $____________________ 
(b) For future operations (inventory value) ________________________________________$ ___________________
(c) For sale (inventory value) ___________________________________________________ $ ___________________
						
	VALUE						
Description	Quantity	For Incomplete Contracts	For Future Operations / For Sale				

							
What amount, in any, has been assigned, sold, or pledged?_______________________ If so, state amount, to whom, and reason________________________________________________________________________________
							
8> 	Negotiable Securities (List non-negotiable items under Item 13)
(a) Listed – Present market value For use on incomplete contracts (inventory value) __________ _____ $____________________ 
(b) Unlisted – Present value) ________________________________________________$ ___________________
						
	Book Value	Present Value
(Actual or Estimated)					
Issuing Company	Class	Quantity	Unit Price	Amount	Unit Price	Amount	

							
							
Who has possession?_______________________________________________________________________________________________________
If any are pledged or in escrow, state form whom and reason_____________________________________________________________________
Amount pledged or in escrow______________________________________________________________________ $________________________							
*List separately each item amounting to 10 percent or more of the total and combine the remainder.
>Important: items listed under this heading will be given no consideration as working capital unless actual or estimated market value is furnished. 
9 	Other current assets
     Bid deposits, prepaid expenses, cash value of life insurance, accrued interest, etc. ___________________           $ _____________________________ 
			
Description	Amount 			

				
10* 	Real Estate           (a) Used for business purposes __________________________________ $____________
Book Value          (b) Not used for business purposes _______________________________ $ ____________			
Location	Description	Held in Whose Name	Value	

				
11 	Construction plant and equipment __________________________________________ $ ________________________
			
11A 	What is your approximate annual income from rental of equipment owned by you,
Exclusive of such income from associated concerns having same ownership        $__________________________			
12*	Furniture and Fixtures _____________________________________________________ $ ________________________
			
13 	Investments of non-current nature                                                    $ ________________________
			
Description	Amount			

				
14 	Other non-current assests                                                              $ _______________________
			
Description	Amount			

				
	Total Assets $ _______________________

*Show book value (Cost less Depreciation) unless an appraisal schedule prepared by an independent appraiser is attached; in which case, appraised value may be shown.

EXHIBIT 4 – DETAILS RELATIVE TO ASSETS (Continued)
15 	Current portion of Notes Payable, exclusive of equipment obligations and
real estate obligations                                                                    $ ____________________ 				
	To Whom Payable 	What Security 	When Due 	Amount 	

					
16 	Accounts Payable: (a) Not past due ...................................................................................... $____________________ 
                    (b) Past due............................................................................................. $ ____________________ 				
	To Whom Payable 	What Security 	When Due 	Amount 	

					
17 	Other current liabilities .............................................................................................................. $ ____________________ 
  Accrued interest, taxes, insurance, payrolls, etc. 				
	Description	Amount			

18 	Real Estate encumbrances                                                               $ ____________________ 
				
19 	Construction Equipment obligations           (a) Total payments due within six months $____________________ 
Secured by equipment:                        (b) Total payments due after six months $____________________ 				
	To Whom Payable 	How Payable** 	Amount 		

					
20 	Other non-current liabilities and non-current notes payable                                        $____________________ 
				
	Description 	For What 	When Due 	Amount 	

					
21 	Reserves $____________________ 				
	Description 	Amount 			

					
					
22 	Capital stock paid up: 	 (a)  Common...................................................................................$_____________________ 
(b) Preferred..................................................................................$_____________________ 			
23 	Surplus (or Net Worth)                                                                                $_____________________ 
				
	                                                      Total Liabilities and Capital $_______________________ 				
EXHIBIT 5 – SUBORDINATION OF NOTES OR ACCOUNTS PAYABLE

SRTA 

Amounts owing to officers or stockholders of a corporation may be considered as advances of capital, and may be added to net worth for approval purposes, in those cases where verified subordination agreements are executed stating:

The amount of $____________________ due me from _______________________________________________
___________________________________________________________________________________________ 						(Name of Corporation)

Represents an advance of Working Capital and will not be withdrawn without prior notice to SRTA nor during the life of any contract with said SRTA on which the corporation may be the successful bidder or proposer.

___________________________________________		_____________________________________             (Signature of Creditor)							(Date)

EXHIBIT 6 – GENERAL STATEMENT OF BANK CREDIT

In connection with the prequalification of _______________________________________________________________, 								(Name of Contractor)
a contractor seeking to be awarded a contract(s) with SRTA, we hereby declare that said contractor has been extended a line of credit in a total amount exceeding $ ________________________, and that such credit will not be withdrawn or reduced without notice to SRTA.

This letter is signed with the understanding that it is a document to be used by SRTA for the purpose of determining the financial resources of said contractor available for use in performing work under contracts which may be awarded to him by SRTA during the term of his prequalification.
This General Statement of Bank Credit will EXPRIRE with the Contractor’s Statement of Experience and Financial Condition for which the line of credit was issued.
							
								__________________________________________ 									(Name of Bank)

								__________________________________________ 									(Address)

								By ________________________________________

								___________________________________________ 									(Title)

PLEASE NOTE: The above form may be used to augment you Working Capital and completed by your bank, or if they prefer, one with substantially the same provisions may be issued on their own letterhead, referencing the contract number. 

(SRTA USE ONLY)
CONTRACTOR’S STATEMENT OF EXPERIENCE AND FINANCIAL CONDITION (CSOEFC) REVIEW SHEET

1.	Contract: ________________________________________________________________________________
2.	Contract Bid Amount:  $____________________________
										      Remarks 									_____________________________________
3.	Total Working Capital			$_______________  [Current Assets – Current Liabilities]
4.	Statement of Bank Credit		$_______________  See Exhibit 6
5.	Subtotal 				$_______________
6.	Subtotal x 10 (Line 5 x 10)		$_______________
7.	Is Line 6>  Line 2? 				yes / no       (Circle one)
8.	Does the largest value of all work bidder or proposer has had under contract over a previous similar time frame as 	the subject contract meet or exceed the total amount bid?  If so, please explain.

9.	Does the dollar value of at least one of the previous individual contracts listed have at least 50 percent of the dollar 	value bid on the SRTA contract?  If so, please explain. 

10.	Has the bidder or proposer successfully completed contracts during the previous five years that together exceeds five 	times the annual value of the SRTA contract?  If so, please explain. 

SRTA USE ONLY
I have reviewed the contractor-furnished information contained in the CSOEFC and have determined that the submittal is in compliance with SRTA Policy No. ___.  Therefore, this firm can be recommended for the award of this contract.

Initial Review Completed by _____________________________, Firm Name: _____________________ Date: _________ [Enter person name, role and Firm Name here if applicable]

Experience Reviewed and Checked for Completeness by ______________________________ Date: _______________                                                  		Contracts & Procurement

Financials Approved by _________________________________	Date:________________________ Finance/Accounting Dept.

Experience Reviewed by _________________________________	Date:________________________