5-Statement of Contractor Qualifications.pdf
PDF 119 KB Posted
- Attached to
- Park Site Furnishings
- Solicitation number
- 26-008
- Issued by
- Jackson County, Missouri
About this file
Summary: Statement of Contractor Qualifications Form
This document is a Statement of Contractor Qualifications form used by a government contracting agency to evaluate bidder eligibility and capability for procurement awards. The form requires bidders to provide comprehensive information regarding their business structure, operational history, and relevant experience. Bidders must complete sections detailing their business classification (corporation, partnership, or sole proprietorship), including incorporation dates, state of incorporation, and principal officers for corporations or partner information for partnerships. The form requests documentation of the percentage of work to be performed by the bidder's own staff, number of permanent employees, geographical operating limits, and years in business. Additionally, bidders must disclose whether they have previously operated under different business names, withdrawn from contractual obligations, or faced breach of contract litigation, requiring explanations for any affirmative responses.
The form also requires bidders to list completed contracts from the past three years and current active contracts with corresponding amounts, provide customer references with contact information, and identify any planned subcontractors with their contract amounts and associated work items. The document includes a Disadvantaged Business Enterprise (DBE) status section where bidders can claim eligibility as Minority-Owned Businesses (MBE), Women-Owned Businesses (WBE), or Small Businesses, with specified subcategories for MBE classification including African American, Latino, Native American, Asian, and Pacific Islander ownership. Bidders claiming DBE status must attach supporting governmental entity or Minority Supplier Council certifications. The form requires completion and signature by an authorized representative with printed name, title, and date, and must be submitted as part of the proposal response.
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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 .