12-Form - Qualifications Questionnaire.pdf
PDF 76 KB Posted
- Attached to
- Round Island Shelters Columns Replacement
- Solicitation number
- 2027006
- Issued by
- Indian River County, Wilton Manors City, Florida
About this file
This is a Qualifications Questionnaire for a state and local contract opportunity with the State of Florida related to the Round Island Shelters Columns Replacement project in Vero Beach, Florida. The questionnaire requests prospective contractors provide documentation of their years of experience providing similar services, Florida state registration numbers, and a detailed history of completed projects with government agencies and private firms, including contact information for references. Additionally, contractors must identify any subcontractors they plan to utilize, specify their subcontractors' license numbers, and provide their e-Verify.gov registration date. The project involves replacing thirty deteriorated poured-concrete structural columns at five existing picnic pavilions located at Round Island Park, with all work required to comply with approved construction plans, issued permits, Florida Building Code requirements, and applicable federal, state, and local regulations.
Contractors responding to this opportunity must submit the completed qualifications questionnaire along with supporting documentation including their occupational license or business tax receipt, proof of current liability insurance, and completed W-9 form. The questionnaire also requires contractors to disclose all litigation cases from the past three years in which they have been a named party, providing the year filed, case number, venue, and description of each case. This comprehensive qualification evaluation process allows the State of Florida to assess contractor experience, financial stability, legal standing, and capacity to execute the column replacement project successfully.
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Text version
Qualifications Questionnaire
1. How many years has your organization been providing these services? ________
2. List State of Florida Registration Number(s):
3. List government agencies and private firm(s) with whom you have completed similar work:
Agency/Firm Name:
Address:
Contact Name: Title: _______________________________ E-Mail: Phone: _____________________________ Services Provided:
Dates of Service:
Agency/Firm Name:
Address:
Contact Name: Title: _______________________________ E-Mail: Phone: _____________________________ Services Provided:
Dates of Service:
Agency/Firm Name:
Address:
Contact Name: Title: _______________________________ E-Mail: Phone: _____________________________ Services Provided:
Dates of Service:
Agency/Firm Name:
Address:
Contact Name: Title: _______________________________ E-Mail: Phone: _____________________________ Services Provided:
Dates of Service:
Agency/Firm Name:
Address:
Contact Name: Title: _______________________________ E-Mail: Phone: _____________________________ Services Provided:
Dates of Service:
4. Subcontractors:
Type of Work Subcontractor Name License Number
5. Date Registered with e-Verify.gov:
6. List all ligation cases during the past three (3) years in which the Contractor has been a named party. Use additional sheets, as necessary.
Year filed
Case number Venue Description
Attach Occupational License/Business Tax Receipt, proof of current liability insurance and W-9.
File details come from the government source that posted it. Updated .