2-Responsible Contractor Verification Form (PDF signed).pdf

This is a Responsible Contractor Act Verification Form for the State of Minnesota, specifically for the John Marshall High School Coffee Shop renovation project. The form certifies that the bidding company complies with the minimum criteria established under Minnesota Statute 16C.285, subdivision 3, as of the bid submission date. The project involves renovating an existing cafeteria room into a new coffee shop, with mechanical work including removal of an existing hood and vent, relocation of finned tube radiation, and modifications to water, waste, and vent piping systems. Electrical scope encompasses demolition of existing wall devices, installation of new devices for food service equipment, removal and reinstallation of ceiling fixtures, and installation of a new dedicated electrical panel. The form requires submission of signed verifications from all first-tier subcontractors at the time of bid, with any subsequently retained subcontractors required to submit compliance verification within 14 days of being retained.

The verification form must be notarized and signed by an owner or officer of the company. Companies are required to list all first-tier subcontractors intended for the project and confirm that these subcontractors have provided the required verification of compliance with Minnesota Statute 16C.285, subdivision 3(7). For subcontractors not yet determined at the time of bid submission, companies must obtain and submit signed verifications confirming compliance within 14 days of retaining those subcontractors. The form serves as a certification mechanism to ensure contractor responsibility and compliance with state requirements prior to contract award.