2025-581_Contractor_Qualification_Form.pdf

Qualification Form

Contractor Qualification Form

Warroad Area Power Shovel Contract Solicitation No. 2025-581

VERSION: Original

This Contractor Qualification Form must be submitted with your solicitation response. A solicitation response received without this form, or with an outdated version, may be rejected. Prime contractors are responsible for checking all addenda for the final version of this form.

Each responder must answer every question and provide all 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

1. Responding company has been in business under current business name or current Federal Employer ID Number for a minimum of two (2) years from the solicitation response due date. (Responder must check YES or

NO)

☐ YES

If company name changed within the last two years from solicitation response due date, but Federal Employer ID remains the same, then list Previous Company Name:______________________________

☐ NO

Responding “NO” acknowledges that the entire solicitation response will be rejected for not meeting the minimum two years condition stated in Qualification Requirement #1.

2. Responding company has completed as a Prime Contractor, not as a subcontractor the work for at least 2 contracts which have achieved Substantial Completion since January 1, 2021 for similar scope and type of power shovel work. Each of these contracts MUST have had a construction value of $8,000.00 or greater.

Fill in the required information for your previous projects relating to Qualification Requirement #2:

*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

Dollar Amount of Contract: Substantial Completion Date:

Contract substantially completed under (check one):

*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.

3. Operator responsible for this project has had at least 500 hours of experience with operating a power shovel similar in scope and value to this project. Each of these contracts must have had a construction value of $8,000.00 or greater.

Operator Name __________________________________ Present position _______________________

4. List below the required information for individuals who will be responsible for this project:

Years of Experience Type of Work In What Capacity

5. Fill in the required information for Project Manager’s previous projects relating to Qualification Requirements.

Project Manager has worked for at least 2 contracts which have achieved Substantial Completion since January 1, 2021, for similar scope and type of power shovel work. Each of these contracts MUST have had a construction value of $8,000.00 or greater.

Fill in the required information for your previous projects relating to Qualification Requirement #5:

Dollar Amount of Contract: Substantial Completion Date:

Contract substantially completed under (check one):

Dollar Amount of Contract: Substantial Completion Date:

Contract substantially completed under (check one):

*The term “Property Owner” means the person or entity identified as the owner of the property where the work referenced for Qualification Requirement #5 was performed.

The State (or its representative) reserves the right to contact the references listed above for Qualification Requirement #5 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.

6. 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

7. 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: