Dane County Public Works

Best Value Contracting Application

Step 1 : Proof of Responsibility

Please select (click/tap) all statements that apply.

My firm acknowledges that in doing work under any County Public Works Contract, it will be required to use as subcontractors only those contractors that are also qualified with the County or become so ten (10) or more days before beginning any work.

My firm acknowledges that in doing work under any County Public Works Contract, it will be required to use as subcontractors only those contractors that are also qualified with the County or become so ten (10) or more days before beginning any work.
My firm possesses all technical qualifications and resources, including equipment, personnel and financial resources, necessary to perform the work required for any project or obtain the same through the use of responsible, qualified subcontractors.

My firm possesses all technical qualifications and resources, including equipment, personnel and financial resources, necessary to perform the work required for any project or obtain the same through the use of responsible, qualified subcontractors.
My firm will possess all valid, effective licenses, registrations or certificates required by federal, state, county, or local law, which are necessary for the type of work to be performed including, but not limited to, those for any type of trade work or specialty work.

My firm will possess all valid, effective licenses, registrations or certificates required by federal, state, county, or local law, which are necessary for the type of work to be performed including, but not limited to, those for any type of trade work or specialty work.
My firm will meet all bonding requirements as required by applicable law or contract specifications.

My firm will meet all bonding requirements as required by applicable law or contract specifications.
My firm will meet all insurance requirements as required by applicable law or specifications, including general liability insurance, workers compensation insurance and unemployment insurance requirements.

My firm will meet all insurance requirements as required by applicable law or specifications, including general liability insurance, workers compensation insurance and unemployment insurance requirements.
My firm will maintain a substance abuse policy for employees hired for public works contracts that comply with Wis. Stats. Sec. 103.503.

My firm will maintain a substance abuse policy for employees hired for public works contracts that comply with Wis. Stats. Sec. 103.503.
My firm's employees who will perform work on a Public Works project will be covered under a current workers compensation policy and be properly classified under such policy.

My firm's employees who will perform work on a Public Works project will be covered under a current workers compensation policy and be properly classified under such policy.
My firm’s employees who will perform work on a Public Works project will have the opportunity to enroll in minimum essential coverage and not be subject to an enrollment period of more than 60 days per the federal Affordable Care Act, sec 1513.

My firm’s employees who will perform work on a Public Works project will have the opportunity to enroll in minimum essential coverage and not be subject to an enrollment period of more than 60 days per the federal Affordable Care Act, sec 1513.
My firm will fully abide by the equal opportunity and affirmative action requirements of all applicable laws, including County ordinances.

My firm will fully abide by the equal opportunity and affirmative action requirements of all applicable laws, including County ordinances.

All items on this page must be checked to move forward with the application process. Please contact Todd Draper with any questions or concerns.

Step 2 : Background Information

Select all statements that are true.

In the past three (3) years has your firm has done any of the following:

Has your firm been the subject of any order or judgement from any State or Federal Agency or court concerning employment practice, including but not limited to: classification of employees under state unemployment or workers compensation laws; minimum wage, overtime pay, recordkeeping, and child labor standards imposed by federal or state law; and employment discrimination or unfair labor practices prohibited by federal or state law. (Attach copies of any order or judgement)*

Has your firm been the subject of any order or judgement from any State or Federal Agency or court concerning employment practice, including but not limited to: classification of employees under state unemployment or workers compensation laws; minimum wage, overtime pay, recordkeeping, and child labor standards imposed by federal or state law; and employment discrimination or unfair labor practices prohibited by federal or state law. (Attach copies of any order or judgement)*
Is your firm authorized or registered to transact business in the state by the Department of Financial Institutions in compliance with Wis. Stat. chs. 178, 179, 180, 181, or 183?

Is your firm authorized or registered to transact business in the state by the Department of Financial Institutions in compliance with Wis. Stat. chs. 178, 179, 180, 181, or 183?
In the past three (3) years, has your firm had control or has another corporation, partnership or other business entity operating in the construction industry controlled it? If so, please attach a statement explaining the nature of the firm relationship?*

In the past three (3) years, has your firm had control or has another corporation, partnership or other business entity operating in the construction industry controlled it? If so, please attach a statement explaining the nature of the firm relationship?*
In the past three (3) years, has your firm had any type of business, contracting or trade license, certification or registration revoked or suspended? *

In the past three (3) years, has your firm had any type of business, contracting or trade license, certification or registration revoked or suspended? *
In the past three (3) years, has your firm been debarred by any federal, state or local government agency? *

In the past three (3) years, has your firm been debarred by any federal, state or local government agency? *
In the past three (3) years, has your firm defaulted or failed to complete any contract?*

In the past three (3) years, has your firm defaulted or failed to complete any contract?*
In the past three (3) years, has your firm committed a willful violation of federal, state or local government safety laws as determined by a final decision of a court or government agency authority.*

In the past three (3) years, has your firm committed a willful violation of federal, state or local government safety laws as determined by a final decision of a court or government agency authority.*
In the past three (3) years, has your firm been in violation of any law relating to your contracting business where the penalty for such violation resulted in the imposition of a penalty greater than $10,000?*

In the past three (3) years, has your firm been in violation of any law relating to your contracting business where the penalty for such violation resulted in the imposition of a penalty greater than $10,000?*
Is your firm an active Wisconsin Trade Trainer as determined by the Wisconsin Bureau of Apprenticeship Standards?

Is your firm an active Wisconsin Trade Trainer as determined by the Wisconsin Bureau of Apprenticeship Standards?
My firm is claiming an exemption to the Wisconsin Trade Trainer qualification because we will perform work that does not apply to an apprenticeable trade.*

My firm is claiming an exemption to the Wisconsin Trade Trainer qualification because we will perform work that does not apply to an apprenticeable trade.*
Contractor has been in business less than one year?

Contractor has been in business less than one year?

* Indicates documentation required

Attach Documentation

Please attach the needed documention (Up to 3)

Select File Change ×

Step 3: Apprenticable Trades

Please select (click/tap) all apprenticable trades you employ.

Bricklayer

Bricklayer
Carpenter

Carpenter
Cement Mason (Concrete Finisher)

Cement Mason (Concrete Finisher)
Cement Mason (Heavy Highway)

Cement Mason (Heavy Highway)
Construction Craft Laborer

Construction Craft Laborer
Data Communications Installer

Data Communications Installer
Electrician

Electrician
Environmental Systems Technician/HVAC Service Technician/HVAC Install/Service

Environmental Systems Technician/HVAC Service Technician/HVAC Install/Service
Glazier

Glazier
Heavy Equipment Operator/Operating Engineer

Heavy Equipment Operator/Operating Engineer
Insulation Worker (Heat & Frost)

Insulation Worker (Heat & Frost)
Iron Worker

Iron Worker
Painter/Decorator

Painter/Decorator
Plasterer

Plasterer
Plumber

Plumber
Roofer/Waterproofer

Roofer/Waterproofer
Sheet Metal Worker

Sheet Metal Worker
Sprinkler Fitter

Sprinkler Fitter
Steamfitter (Service & Refrigeration)

Steamfitter (Service & Refrigeration)
Taper/Finisher

Taper/Finisher
Telecommunications (Voice,Data & Video) Installer/Technician

Telecommunications (Voice,Data & Video) Installer/Technician
Tile Setter

Tile Setter

Best Value Contracting Application

Step 1 : Proof of Responsibility

Step 2 : Background Information

In the past three (3) years has your firm has done any of the following:

* Indicates documentation required

Step 3: Apprenticable Trades

Step 4: Business Information

Business Details

Authorized Representative Details