21-Statement of Bidders Qualifications.pdf

STATEMENT OF BIDDER'S QUALIFICATIONS

All questions/items below must be answered, and the date given must be clear and comprehensive. This statement must be notarized. If necessary, questions may be answered on separate, attached sheets.

The bidder may submit any additional information he/she desires.

1. Name of bidder:

2. Permanent main office address:

3. When organized:

4. If a corporation, where incorporated:

5. How many years have you been engaged in the contracting business under your present firm or trade name?

6. Contracts on hand: (Schedule these, showing amount of each contract and the appropriate anticipated dates of completion.)

7. General character of work performed by your company:

8. Have you ever failed to complete any work awarded to you? If so, where and why?

9. Have you ever defaulted on a contract? If so, where and why?

10. List the more important projects recently completed by your company, stating the approximate cost for each, and the month and year completed:

11. List your major equipment available for this contract:

12. Experience in construction work similar in importance to this Project:

13. Background and experience of the principal members of your organization, including the officers:

14. Credit Available: $

15. Give bank reference:

16. Will you, upon request, fill out a detailed financial statement and furnish any other information that may be required by the (OWNER)?

17. The undersigned certifies for itself, it has no unsatisfied tax liabilities or other Commonwealth obligations.

18. The undersigned certifies for itself and all of its subcontractors and suppliers that it is not under suspension or debarment by the Commonwealth or any governmental entity, instrumentality, or authority.

19. The undersigned hereby authorizes and requests any person, firm, or corporation to furnish any information requested by the (OWNER) in verification of the recitals comprising this Statement of Bidder's Qualifications.

Dated at this day of , 20 .

(Name of Bidder)

By:

Title:

State of )

County of )

, being a duly sworn representative of deposes and says that all statements herein contained are true and correct.

Subscribed and sworn to before me this day of , 20 .

Notary Public

My commission expires , 20 .

STATEMENT OF BIDDER'S QUALIFICATIONS (continued)

Certifications:

I, , certify that

I am the of the Corporation named as

CONTRACTOR herein; that who signed this Agreement on behalf of the CONTRACTOR, was the of said Corporation;

that said Agreement was duly signed for and in behalf of said Corporation by authority of its governing body, and is within the scope of its corporate powers.

Title:

(Corporate Seal)