1-CS26086 - DFCM Contractor Prequalification Renewal Documents, 5.6.26.docx

Contractor Prequalification Renewal Documents These documents are required for Contractors submitting for Stage I prequalification renewal who are currently on one or more of DFCM’s Prequalified Contractor lists and whose prequalification is expiring within the next 60 days. Contractors must submit their renewal documents to dfcm_vbs@utah.gov to remain eligible to bid on Stage II prequalified solicitations. DFCM reserves the right to require any or all Contractors to reapply for Stage II prequalification at any time.

Company Name (“Contractor”): Click to enter text My Company’s Prequalified Discipline(s): Click to enter text Name of Owner or Authorized Representative*: Click to enter text Title: Click to enter text Phone: Click to enter text Email: Click to enter text *Authorized representatives must have legal signature authority for the company. Documents signed by anyone without legal signature authority are not valid and may results in the Contractor losing prequalified status and being prohibited from applying for prequalification for a period of one year.

Contractor Renewal Certification Contractors currently prequalified through the Stage I Prequalification process must truthfully certify to the statements below to successfully renew their prequalified status. By checking the box next to each statement below, the Contractor is certifying to the truth of the statement. Do not check the box next to any statement you are not able to certify. Instead, attach a written explanation providing DFCM with the reason.

☐ My company remains a Responsible company, in all respects, of being capable of fully performing all requirements of the DFCM Service Contract, both currently held and those that we may be awarded in the future.

☐ My company remains financially solvent with sufficient financial resources to meet all contracts under which it is legally bound.

☐ My company will only bid/propose on work it is capable of performing and fulfilling as defined by each solicitation.

☐ My company has not undergone a change in ownership since it was originally prequalified.

☐ My company has not undergone any significant changes in leadership since it was originally prequalified.

☐ My company is not currently employing individuals not authorized to work in the United States or who cannot be cleared for work through the E-Verify system.

☐ Construction Contractors Only: Included with these documents is my active Contractor’s license with the respective classifications for the disciplines in which I am prequalified with DFCM. Renewal documents submitted without an active Contractor’s license will be considered incomplete and not accepted.

My certification to the statements on this form is made with an understanding of the penalty of perjury and that the representations provided can be verified by any reasonable audit.

Authorized Signature Date

Printed Name Title

Termination or Debarment Certification

Contractor Name: Click to enter text

The signature below certifies that the referenced Contractor is not presently debarred, suspended, proposed for debarment, declared ineligible, or are voluntarily excluded from soliciting work by any government agency. This form also certifies that they have not been terminated during the performance of a contract or withdrew from a contract to avoid termination.

Signature:

Name: Click to enter text Title: Click to enter text Date: Click to enter text

If the Contractor cannot certify to the statement above, please provide an explanation of the circumstances below.

Click to enter text

Signature:

Name: Click to enter text Title: Click to enter text Date: Click to enter text

DFCM Prequalified Contractor Renewal Documents, 5.6.2026 2 image1.jpeg