2026_648_Qualification_Form.pdf

Qualification Form

PRIME CONTRACTOR RESPONSE

QUALIFICATION FORM

General Andrews Nursery Knapweed Treatment FY26

Pine County/Near Willow River Solicitation # 2026-648

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 A solicitation response received without this form, or with an outdated version, may be rejected.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

1. Qualification Requirements

• Current Minnesota Commercial Pesticide Applicators License.

• Crew lead must have at least 2 years’ experience applying the contracted treatments.

• Ability to identify target invasive plant(s) at the targeted growth stage.

Name of Vendor Personnel MN Commercial Pesticide Applicator License #

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

Years of Experience Type of Work In What Capacity

Ability to identify target invasive species at target growth stage

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

Qualification Form

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:__________________________________