5-Statement of Contractor Qualifications.pdf
PDF 118 KB Posted
- Attached to
- Resale Fishing Equipment, Products, & Supplies
- Solicitation number
- 25-042
- Issued by
- Jackson County, Missouri
About this file
The document is a "Statement of Contractor's Qualifications" form designed for potential bidders to provide comprehensive information about their business when applying for a contract opportunity. The two-page form requires detailed information about the contractor's business structure (corporation, partnership, or sole proprietorship), including incorporation dates, key personnel, years in business, geographical operational limits, and percentage of work to be performed by their own staff.
The form also requests critical background information such as previous business names, contract defaults or withdrawals, legal history including contract breach lawsuits, completed and current contracts, and customer references. Additionally, the document includes a section for declaring Disadvantaged Business Enterprise (DBE) status, specifically asking about Minority Owned Business (MBE), Woman Owned Business (WBE), and Small Business classifications. Contractors claiming such status must attach governmental or Minority Supplier Council certification. The form provides spaces for listing potential subcontractors, their work items, contract amounts, and MBE/WBE status, allowing for a comprehensive review of the contractor's capabilities, history, and professional credentials.
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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Has contractor ever withdrawn or defaulted on a contractual obligation: Yes No (Check one) If Yes, state where and why: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 .