5-Statement of Contractor Qualifications.pdf
PDF 121 KB Posted
- Solicitation number
- 25-031
- Issued by
- Jackson County, Missouri
About this file
This document is a Statement of Contractor's Qualifications form designed to collect comprehensive business and organizational information from potential bidders for a contract opportunity. The two-page form requires detailed disclosure about the bidding entity's business structure (corporation, partnership, or sole proprietorship), including incorporation details, leadership, years in business, operational scope, and past performance history.
The form requests specific information about the contractor's qualifications, including percentage of work to be performed by internal staff, number of permanent employees, geographical operating limits, and previous business names. Additionally, the document includes sections for disclosing past contract performance, completed and current contracts, potential subcontractors, and diversity status (Minority-Owned Business, Woman-Owned Business, Small Business). Contractors must provide details about any contract defaults, lawsuits, or other relevant historical information. The form also requires documentation of minority or small business certifications and includes space for a signature and preparation details.
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Text version
STATEMENT OF CONTRACTOR'S QUALIFICATIONS
(Complete in full, Use attachments if necessary)
Name of Bidder:
Address with Zip Code:
Federal Tax I.D. Number:
Check One: Corporation Partnership Sole Proprietorship
If SOLE PROPRIETORSHIP, state name, address, and phone number of owner:
If CORPORATION:
Date of Incorporation:
Name of State(s) in which incorporated:
President's Name:
Vice-President's Name:
Secretary's Name:
Treasurer's Name:
If PARTNERSHIP:
Is the Partnership: General Limited Association (Check one)
Date of Organization:
Name and addresses of all partners:
1.
2.
3.
GENERAL INFORMATION:
Percent of work to be done under the proposed contract by your own staff:
No. of Permanent Employees:
Geographical Limits of Operation:
No. of years in business:
Have you ever done business under a different name: Yes No (Check one)
If Yes, give Name and Location:
Has contractor ever withdrawn or defaulted on a contractual obligation: Yes No (Check one)
If Yes, state where and why:
STATEMENT OF CONTRACTOR'S QUALIFICATIONS - Continued
Has Contractor ever been sued for breach of any contract? Yes No (Check one)
If Yes, Explain:
List Completed Contracts within the Past Three Years, Including Amount of Each:
List of Current Contracts, Including Amount of Each:
Customer Reference (state name, address, and phone number):
List each subcontractor you plan to use if awarded the contract. If no, so state.
SUBCONTRACTOR'S NAME & PHONE
ITEM OF WORK $ AMOUNT OF CONTRACT MBE/WBE
State any other relevant information concerning Contractor's history, credentials, responsibility, and capabilities (If none, so state):
DBE STATUS Indicate status claimed:
1. Minority Owned Business (MBE) YES____ NO____
African American____ Latino____ Native American____ Asian____ Pacific Islander____
2. Woman Owned Business (WBE) YES____ NO____
3. Small Business YES____ NO____
For consideration as an MBE, WBE or Small Business, a copy of any governmental entity or Minority Supplier Council certification must be attached.
Prepared by (print or type):
Title:
Signature:
Date:
File details come from the government source that posted it. Updated .