5-Statement of Contractor Qualifications.pdf
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- Solicitation number
- 25-037
- Issued by
- Jackson County, Missouri
About this file
This document is a Statement of Contractor's Qualifications form designed for businesses to provide comprehensive details about their organizational structure, business history, and capabilities when bidding on a contract opportunity. The form requires detailed information across multiple sections, including business type (corporation, partnership, or sole proprietorship), years in business, number of permanent employees, geographical operational limits, and past contractual performance.
The form seeks extensive background information from potential contractors, including completed and current contracts, customer references, and planned subcontractors. Additionally, it includes a section for Disadvantaged Business Enterprise (DBE) status verification, allowing businesses to indicate if they are minority-owned (specifying ethnicity), women-owned, or qualify as a small business. To be considered for these designations, businesses must attach certification from a governmental entity or Minority Supplier Council. The document provides space for contractors to explain any historical contractual issues, such as withdrawals, defaults, or legal disputes, and to provide supplemental information about their credentials, responsibility, and capabilities.
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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Has contractor ever withdrawn or defaulted on a contractual obligation: Yes No (Check one) If Yes, state where and why: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 .