11-03 - Required Document - Qualification Statement.pdf

CONTRACTOR’S QUALIFICATIONS

ALL BIDDERS ARE NOTIFIED THAT THE FOLLOWING QUALIFICATION

STATEMENT MUST BE COMPLETED AND SUBMITTED WITH THE BID OR

PROPOSAL.

The contractor shall show they have experience with similar projects that require working in confined areas in close proximity to many physical features (fences, utility poles, guy lines, gas lines and meters, sewer manholes, cleanouts, etc.) which requires the contractor to plan work efforts and equipment needs with these limitations in mind. The contractor shall submit a list of Public Works Projects successfully completed within the last five (5) years, including the names of supervisors and type of equipment used to perform this work.

BIDDER’S QUALIFICATION STATEMENT

Project:

Contractor:

Name: Title:

Address:

Phone: Email:

Type of Business:

Sole Proprietor Partnership Corporation Joint Venture Other

State and Date of Incorporation, Partnership, Ownership, Etc.

Principal Office Address:

Principal Office Contact & Phone:

Insurance:

Insurance Agency Name:

Insurance Agency Address:

Contact Name: Phone:

Liability Insurance Provided and Limits of Coverage:

Workers Compensation Insurance Provider:

Surety Bonding Company (Performance & Payment:

Total Number of Employees to be Associated with this Job:

____ Managerial ____ Administrative ____ Professional ____ Skilled ____ Semi-Skilled ____ Other

Percentage of Work to be Done by Bidder’s Employees (Based on Dollars Bid): __________

Type(s) of Work to be Done by Bidder’s Employees (Examples: Concrete Paving, Structural Concrete, Water Lines, Sanitary Sewer Lines, Storm Pipe, Storm Inlets, Excavation, Lime, Bridge Fencing, etc.)

Access to Tools and Equipment: Percent Owned: Percent Rented:

Number of Years in Business as a Contractor on Above Types of Work:

Sub-Contractor Information (use additional sheets, if needed.):

Name: Phone:

Address:

Type of Work

List the most current completed projects like the type of work bid (use additional sheets, if necessary.)

Project:

Owner/Agency:

Year Built: Contract Price:

Equipment Used:

Contact Name: Title:

Email: Phone:

Owner/Agency:

Year Built: Contract Price:

Equipment Used:

Owner/Agency:

Year Built: Contract Price:

Equipment Used:

Trade References (attach additional sheets if needed):

Company: Contact:

Bank References (attach additional sheets if needed):

Institution: Contact Name:

Address: Phone:

Financial statements are not required as part of this bid package, however a balance sheet and income statement from the previous fiscal year shall be required from the apparent low bidder to be reviewed and approved by the Finance Director prior to contract award.

Claims and Suits (If the answer to any of the questions is yes, please attach details):

Has your organization ever failed to complete any work awarded to it? Yes No

Are there any judgments, claims, arbitration proceedings, or suits pending or outstanding against your organization or its officers? Yes No

Has your organization filed any lawsuits or requested arbitration regarding construction contracts within the last five years? Yes No

Within the last five (5) years, has any officer or principal of your organization ever been an officer or principal of another organization when it failed to complete a construction contract?

Yes No