5-Form - Qualifications Questionnaire.pdf
PDF 76 KB Posted
- Attached to
- Annual Bid for Liquid Carbon Dioxide
- Solicitation number
- 2026023
- Issued by
- Indian River County, Florida
About this file
This is a Qualifications Questionnaire form required for a Florida state and local contract opportunity for the annual procurement of liquid carbon dioxide. The questionnaire requests bidders to provide documentation of their experience, qualifications, and business credentials. Respondents must indicate the number of years their organization has provided the relevant services, provide their State of Florida Registration Number(s), and document at least five references from government agencies or private firms where they have completed similar work. Each reference entry requires the agency or firm name, address, contact person information, email, phone number, description of services provided, and dates of service.
The form additionally requires bidders to identify all subcontractors involved in service delivery, including the type of work and license numbers. Bidders must provide their e-Verify.gov registration date and disclose any litigation cases in which the contractor has been a named party during the past three years, including the year filed, case number, venue, and case description. Supporting documentation must accompany the completed questionnaire, including a current Occupational License or Business Tax Receipt, proof of current liability insurance, and a completed W-9 form. This information establishes the bidder's capability, compliance status, and financial standing for potential contract award.
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Text version
Qualifications Questionnaire
1. How many years has your organization been providing these services? ________
2. List State of Florida Registration Number(s):
3. List government agencies and private firm(s) with whom you have completed similar work:
Agency/Firm Name:
Address:
Contact Name: Title: _______________________________ E-Mail: Phone: _____________________________ Services Provided:
Dates of Service:
Agency/Firm Name:
Address:
Contact Name: Title: _______________________________ E-Mail: Phone: _____________________________ Services Provided:
Dates of Service:
Agency/Firm Name:
Address:
Contact Name: Title: _______________________________ E-Mail: Phone: _____________________________ Services Provided:
Dates of Service:
Agency/Firm Name:
Address:
Contact Name: Title: _______________________________ E-Mail: Phone: _____________________________ Services Provided:
Dates of Service:
Agency/Firm Name:
Address:
Contact Name: Title: _______________________________ E-Mail: Phone: _____________________________ Services Provided:
Dates of Service:
4. Subcontractors:
Type of Work Subcontractor Name License Number
5. Date Registered with e-Verify.gov:
6. List all ligation cases during the past three (3) years in which the Contractor has been a named party. Use additional sheets, as necessary.
Year filed
Case number Venue Description
Attach Occupational License/Business Tax Receipt, proof of current liability insurance and W-9.
File details come from the government source that posted it. Updated .