5-Statement of Contractor Qualifications.pdf
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- Attached to
- T-Shirts & Wearing Apparel
- Solicitation number
- 25-050
- Issued by
- Jackson County, Missouri
About this file
This is a Statement of Contractor's Qualifications form used by government agencies to evaluate bidder eligibility and capability for contract awards. The form requires comprehensive disclosure of bidder information including business structure (corporation, partnership, or sole proprietorship), organizational details, and key personnel identification. Bidders must provide their Federal Tax ID number, number of permanent employees, years in business, geographical operational limits, and the percentage of work to be performed by their own staff. The form requires documentation of the bidder's contracting history, including completed contracts from the past three years, current active contracts, and customer references with contact information. Additionally, bidders must disclose any history of contract withdrawal, default, or breach of contract litigation. The form mandates identification of all planned subcontractors with their names, phone numbers, work items, and contract amounts, along with their minority or women-owned business enterprise (MBE/WBE) status.
The Statement of Contractor's Qualifications includes a section for disadvantaged business enterprise (DBE) status claims, requiring bidders to indicate if they qualify as Minority Owned Businesses (MBE), Women Owned Businesses (WBE), or Small Businesses, with specific category options including African American, Latino, Native American, Asian, and Pacific Islander ownership. Bidders claiming MBE, WBE, or Small Business status must attach copies of relevant governmental entity or Minority Supplier Council certifications. The form must be completed in full with typed or printed information, signed by an authorized representative, and include the preparer's title and date of submission. This form serves as a standard evaluation tool to assess contractor qualifications, financial stability, experience, compliance history, and commitment to utilizing certified minority and women-owned subcontractors.
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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 .