2025_432_Qualification_Form.pdf

Qualification Form Two Harbors Area Road Spraying FY25

Contractors are responsible for checking all addenda for the final version of the Qualification Form. Responses which include an outdated version of the Qualification Form may be rejected.

This form must be submitted with your response to this solicitation. If the solicitation response is received without the qualification form the response may be rejected.

Each Respondent must answer all of the questions and provide all requested information contained herein. Because answering all of the questions and providing all of the requested information is a requirement, any Respondent failing to meet this requirement may be deemed to be non-responsive at the sole discretion of the State. If a respondent is deemed to be non-responsive, their response may be rejected.

Before an award is made the State (or its representative) reserves the right to clarify/verify qualification information submitted to determine that all qualifications listed below have been met.

If the qualification requirements listed below are not met, either on the face of the submitted information or after such clarification/verification as the State may request, then the Contractor’s response may be rejected.

CHECK THE FOLLOWING THAT APPLY.

1. Requirement: Contractor must have a minimum of 2 years’ experience in broadcast forest herbicide application, or roadside and rights-of-way application, using ground equipment.

I (contractor) ____ “HAVE” ____ “DO NOT HAVE” a minimum of 2 years’ experience in broadcast forest herbicide application, or roadside and rights-of-way application, using ground equipment.

2. Requirement: Contractor’s on-site herbicide applicator(s) must have minimum of 1 year of experience in herbicide application, using ground equipment.

On-site applicator(s)____ “HAVE” ____ “DO NOT HAVE” a minimum of 1 year of experience in herbicide application, using ground equipment.

3. Requirement: Contractor and all on-site applicators must be able to identify the target invasive plants.

Contractor and all on-site applicator(s)____ “DO” ____ “DO NOT HAVE” the ability to identify the target invasive plants.

4. Requirement: Each applicator must have a license recognized by the Minnesota Department of Agriculture to commercially apply herbicides (MN Category A, plus G or J, or equivalent), and must have in possession a current card or license. Proof of licensure must be submitted with the bid*.

NAME Position Years of Experience Type of Work MN License

Category(s) Applicator License

Number

CERTIFICATION – By signing this statement, I certify that the information provided above is complete and accurate.

Contractor Company Name

Authorized Signature