5-Statement of Contractor Qualifications.pdf
PDF 118 KB Posted
- Attached to
- Employee Service Pins
- Solicitation number
- 25-046
- Issued by
- Jackson County, Missouri
About this file
This document is a Statement of Contractor's Qualifications form designed for businesses seeking to bid on a contract opportunity. The form requires comprehensive details about the bidding entity's organizational structure, business history, and qualifications, allowing potential contractors to provide information about their business type (corporation, partnership, or sole proprietorship), years in operation, number of employees, and geographical operational limits.
The form includes sections for disclosing critical business background information, such as whether the contractor has previously done business under a different name, withdrawn from a contract, been sued, or defaulted on contractual obligations. Additionally, the document includes a detailed DBE (Disadvantaged Business Enterprise) status section where contractors can indicate if they are a Minority Owned Business (MBE), Woman Owned Business (WBE), or Small Business, with options to specify minority subgroups. The form requires contractors to list completed and current contracts, planned subcontractors, customer references, and provides space for additional relevant information about the company's credentials 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Has contractor ever withdrawn or defaulted on a contractual obligation: Yes No (Check one) If Yes, state where and why: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 .