5-Appendix C General Contractor Statement of Qualifications.pdf
PDF 573 KB Posted
- Solicitation number
- GA-2025-706-HHH-GB
- Issued by
- Bernalillo County, Albuquerque City, New Mexico
About this file
This document is a General Contractor Statement of Qualifications form for the GA-2025-706-HHH-GB Opioid Settlement Funds project in the State of New Mexico. The form is designed to collect comprehensive information about a contractor's business history, licensing, project scheduling capabilities, labor code compliance, and legal history. It requires detailed responses about the contractor's years in business, current business name, licensing status, scheduling software usage, project performance, labor law compliance, and any litigation or dispute history over the past five years.
The form is part of a qualification process that appears to be related to potential contracting opportunities funded by opioid settlement funds. Contractors must provide transparent information about their business practices, including any past scheduling delays, liquidated damages, labor code violations, or legal disputes. The document serves as a thorough vetting mechanism to assess a contractor's reliability, competence, and track record before being considered for project selection. The form requires certification by the contractor that all provided information is true and accurate, with spaces for signature, contact information, and other identifying details about the firm.
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Other files
| File | Type | Posted |
|---|---|---|
| 2-Appendix A-2 Services Cost Proposal Forms.xlsx | XLSX spreadsheet | |
| 4-Appendix B PROPOSAL BOND FORM.pdf | ||
| 3-Final RFP 10 million opioid (002)(SAS) eb gb714 eb gb716...pdf | ||
| 1-Appendix A-1 Construction Cost Proposal Sample Form.xlsx | XLSX spreadsheet | |
| 7-Addendum 1 GA-2025-706-HHH-GB.doc | DOC document | |
| 6-Addendum 1 GA-2025-706-HHH-GB.doc | DOC document |
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Text version
GA-2025-706-HHH-GB Opioid Settlement Funds 30
Appendix C General Contractor Statement of Qualifications
STATEMENT OF QUALIFICATIONS FOR GENERAL CONTRACTORS
Project Name:
1. OFFEROR INFORMATION
Name: _ Address:
Principal Office:
( ) Corporation ( ) Partnership ( ) Sole Proprietorship ( ) Joint Venture
( ) Other
a. How many years has your organization been in business as a Contractor?
b. How many years has your organization been in business under its present business name?
c. Under what other or former names has your organization operated?
2. LICENSING
a. Name of license holder (or qualifying party) exactly as on file with the State of New Mexico Construction Industries Division:
b. License Classification(s): _
c. License Number:
d. Issue Date: Expiration Date:
e. Is the firm’s contractor’s license free of ever being suspended or revoked by the CID or by the appropriate licensing agency in any other state?
( ) Yes - free of suspension or revocation ( ) No – Provide explanation
f. Does your firm hold all applicable Business licenses required by State of New Mexico?
License Number: _
GA-2025-706-HHH-GB Opioid Settlement Funds 31
Jurisdiction:
Fill in name of license holder, exactly as it appears on file with jurisdictional authorities:
_ _ (Name)
Issue Date:
Expiration Date:
License Number:
Fill in name of license holder, exactly as it appears on file with jurisdictional authorities:
_ (Name)
Issue Date: _ Expiration Date:
License Number:
g. Is your firm free from formal debarment from public works, federal, state or local public works jurisdictions?
( ) Yes ( ) No (Provide explanation)
3. PROJECT SCHEDULING
a. Does your firm use scheduling software? ( ) Yes ( ) No
b. If YES, which programs and versions are used? Please list:
c. Has the firm been involved with a construction project within the past five (5) years, where the schedule was not met? ( ) Yes ( ) No
d. If YES, please indicate the project
i. Project:
GA-2025-706-HHH-GB Opioid Settlement Funds 32
Reason for Delay:
ii. Project:
Reason for Delay:
iii. Project:
Reason for Delay:
e. Has the firm been assessed liquidated damages due to scheduling for any project in the past five (5) years? ( ) Yes ( ) No
If YES, please list projects
Project: _ Amount $ Reason for assessment
Project: _ Amount $ Reason for assessment
Project: _ Amount $ Reason for assessment
4. LABOR CODE VIOLATIONS
a. Has your firm during the past five (5) years, been free of any determinations by a court or an administrative agency of repeated or willful violations of laws and/or regulations pertaining to the payment of prevailing wages or employment of apprentices of public works projects?
( ) Yes ( ) No (explain)
b. Is the firm free of all Subcontractor Fair Practices Act violations for the past five
(5) years?
( ) Yes ( ) No (explain)
5. LITIGATIONS, MEDIATIONS AND ARBITRATIONS
a. List any litigation against the firm during the past 5 years, and the resolution:
GA-2025-706-HHH-GB Opioid Settlement Funds " 33
b. List all mediations/arbitrations in the last 5 years. Who initiated? What was the outcome?
THE UNDERSIGNED CERTIFIES THAT ALL OF THE QUALIFICATION
INFORMATION SUBMITTED WITH THIS FORM IS TRUE AND CORRECT.
Name and Title Firm Name
Signature Address of Firm
E-mail Address City/State/Zip
Telephone Number Fax Number
File details come from the government source that posted it. Updated .