16-Form - Qualifications Questionnaire.pdf
PDF 76 KB Posted
- Solicitation number
- 2027009
- Issued by
- Indian River County, Florida
About this file
This is a Qualifications Questionnaire form for a state and local contract opportunity issued by Indian River County, Florida, for the North County Aquatic Center Commercial Pool Spray Feature Replacement project. The questionnaire serves as the evaluation instrument for qualified and licensed contractors bidding on this construction project. Contractors are required to provide comprehensive information demonstrating their experience and capability, including the number of years they have been providing relevant services, their Florida state registration number(s), and detailed references from government agencies and private firms with whom they have completed similar work. Each reference must include the agency or firm name, address, contact person information, email, phone number, description of services provided, and dates of service. Additionally, contractors must list all subcontractors, their respective license numbers, and the type of work each will perform. Contractors must also provide their e-Verify.gov registration date and disclose any litigation cases in which they have been a named party during the past three years, including the year filed, case number, venue, and case description.
Bidders submitting this questionnaire must attach supporting documentation including an Occupational License or Business Tax Receipt, proof of current liability insurance, and a completed W-9 form. The questionnaire does not specify pricing terms, set-asides, incumbent contractors, or award and contract term information within the document itself. This form functions as a pre-qualification or evaluation tool to assess contractor eligibility and qualifications prior to bid award determination for the pool spray feature replacement project.
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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 .