2026-501_Vendor_Qualification_Form.pdf

☐ YES

If company name changed within the last two years from soliciation 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 May of 2023 for similar scope and type of grading work. Each of these contracts MUST have had a construction value of at least $15,000.00 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

*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 #2 was performed.

Warroad Area Road Grading Solicitation # 2026-501

QUALIFICATION FORM

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 A solicitation response received without this form, or with an outdated version, may be rejected. 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)

The State (or its representative) reserves the right to contact the references listed above for Qualification Requirement #2 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 1000 hours of experience with operating a motor grader similar in scope and value to this project. Each of these contracts must have had a construction value of $15,000.00 or greater.

Operator Name __________________________________ Present position _______________________

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

Years of Experience Type of Work In What Capacity

Fill in the required information for Project Manager’s previous projects relating to Qualification Requirements #2 & #3:

*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 #2 was performed.

The State (or its representative) reserves the right to contact the references listed above for Qualification Requirement #3 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.

Job Superintendent Name ______________________________ Present Position __________________

Years of Experience Type of Work In What Capacity

Certification

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

Authorized Signature: Date:

Printed Name: Telephone:

Company Name: Title: