2025_904_Qualification_Form.pdf

Little Elk WMA Timber Stand Improvement 1 of 2 Prime Contractor Response Qualification Form Solicitation # 2025-904 4/30/25

Little Elk WMA Timber Stand Improvement Solicitation # 2025-904

CONTRACTOR QUALIFICATION FORM

VERSION: Original

BOTH pages of this Prime Contractor Response Qualification Form must be fully completed and 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 A solicitation response received without this form, or with an outdated version, may be rejected.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 each 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 substantially completed as a Prime Contractor, NOT as a subcontractor, the work for at least ONE (1) written and verifiable contract for similar scope of work within the past twenty-four (24) months. This contract MUST have had a value of $10,000.00 or greater and have consisted of five (5) or more acres of hand-cutting and chemical treatment of woody invasive species.

Fill in the required information for your previous project(s) relating to Qualification Requirement #1: (Only one is required, but Contractors are encouraged to share a second if it meets these requirements)

*Property Owner:

Property Owner Contact Person & Telephone:

Dollar Amount of Contract:

Acres:

Substantial Completion Date:

Contract substantially completed under (check one):

☐ Current Company Name ☐ Previous Company Name

*Property Owner:

Property Owner Contact Person & Telephone:

Dollar Amount of Contract:

Acres:

Substantial Completion Date:

Contract substantially completed under (check one):

☐ Current Company Name ☐ Previous Company Name

Little Elk WMA Timber Stand Improvement 2 of 2 Prime Contractor Response Qualification Form Solicitation # 2025-904 4/30/25

*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.

2. Project requires current MN Commercial Pesticide Applicators Licensing.

Please provide license holder name(s) and license number for each in the spaces below:

NAME LICENSE NUMBER

3. 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

Certification

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

Authorized Signature: Date:

Printed Name: Telephone:

Company Name: Title: