2025-251_Qualification_Form.pdf

Attachment PRIME Contractor Response Qualification Form

Lac Qui Parle WMA Shelstad Unit Wetland Restoration Solicitation #2025-251

This Prime Contractor Response Qualification Form must be submitted with your solicitation response. A solicitation response received without this form, or with an outdated version, may be rejected.

Each responder must answer every question and provide all the information requested on this form. Failure to meet this requirement may result in the rejection of the entire solicitation response as non-responsive.

The State (or its representative) reserves the right to clarify the required qualification information submitted on this form before an award is made. The solicitation response will be rejected if qualifications are not met.

Qualification Requirements

• Qualification #1: Responder has substantially completed, as a prime contractor not a subcontractor, the work for at least TWO written and verifiable contracts since September, 2021 for wetland enhancement or restoration of similar scope and activity. ONE contract must have had a value of $50,000 or greater, and ONE contract must have had a value of $30,000 or greater.

Fill in the required information for your previous projects relating to Qualification Requirement #1:

*Property Owner:

Property Owner Contact Person: Contact Person’s Telephone #:

Dollar Amount of Contract: Substantial Completion Date:

Contract substantially completed under (check one):

☐ Current Company Name ☐ Previous Company Name

*Property Owner:

Property Owner Contact Person: Contact Person’s Telephone #:

Dollar Amount of Contract: Substantial Completion Date:

Contract substantially completed under (check one):

☐ Current Company Name ☐ Previous Company Name

*The term “Property Owner” means the person or entity identified as the owner of the property where the work referenced for Qualification Requirement #1 was performed.

The State (or its representative) reserves the right to contact the references listed above for Qualification. Requirement #1 or to request the Responder to provide additional reference projects for review. The solicitation response will be rejected if the State, in its sole discretion, receives information that indicates the responder is non- responsible. Information considered includes but is not limited to: 1) project milestones (meeting substantial and final completion dates); 2) communication with project owner and subcontractors; 3) on-site supervision; 4) coordination of subcontractors; 5) violation of Minnesota prevailing wage law; and 6) nonpayment of subcontractors.

• Qualification #2: Has your Company been found in default or had a contract terminated for cause in the last 36 months? It is required that your Company has not had this occur. NOTE: If this question is answered as “yes”, your solicitation response will be rejected.

□ YES □ NO

• Qualification #3: Has your Company received from OSHA any willful or repeated safety citations for which a final order has been issued within the last 36 months? It is required that your company has not had this occur. NOTE: If this question is answered as “yes”, your solicitation response will be rejected.

□ YES □ NO

Certification By signing this form, I certify the information provided is complete and accurate.

Authorized Signature: _________________ Date: ________

Printed Name: Telephone: ________

Company Name: _________________________________Title: _________________________________

*The term “Property Owner” means the person or entity identified as the owner of the property where the work referenced for Qualification Requirement #1 was performed.