2026-570_Qualification_Form.pdf

PRIME CONTRACTOR RESPONSE

QUALIFICATION FORM

Forest Lake #2 PWA – Parking Lot Reclaim and Repave Solicitation # 2026-570

Version: Original

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 A solicitation response received without this form, or with an outdated version, may be rejected.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. Responder has substantially completed, as a prime contractor not a subcontractor, the work for at least 2 written and verifiable contract since January 1, 2021, for reclaiming, repaving, and striping of parking lot or similar scope to the project described in this solicitation. These contracts must have had a project size of 8,000 square feet or greater, and a value of $15,000 or greater.

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

*Property Owner and Contact Person:

Contact Person Phone #: Size of Project (Sq Ft or Acres):

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 #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.

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

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.