5-Statement of Contractor Qualifications.pdf
PDF 118 KB Posted
- Attached to
- Deep Core Aerifier
- Solicitation number
- 25-055
- Issued by
- Jackson County, Missouri
About this file
This is a Statement of Contractor Qualifications form required for state and local contract opportunities in Missouri, specifically for Jackson County's procurement of a Deep Core Aerifier for the Parks + Recreation Department at Fred Arbanas Golf Course. The form serves as a standardized submission document for bidders to provide comprehensive information about their business entity, operational capacity, and relevant experience. Bidders must complete all sections of the form, including company name, address, federal tax identification number, and business structure classification (corporation, partnership, or sole proprietorship). The form requests detailed information about the contractor's workforce, including the percentage of work to be performed by in-house staff and the total number of permanent employees, as well as the geographical scope of operations and years in business. Bidders must disclose any history of operating under alternative business names, withdrawals or defaults on contractual obligations, and litigation related to breach of contract. The form also requires submission of completed contracts from the past three years with corresponding contract amounts, current contracts, and customer references with contact information.
The qualifications statement additionally requires bidders to list all proposed subcontractors, including their names, phone numbers, items of work, contract amounts, and minority or women business enterprise (MBE/WBE) status. Bidders may claim status as a Minority Owned Business (MBE), Woman Owned Business (WBE), or Small Business, with supporting certification documentation from governmental entities or Minority Supplier Councils required for consideration. The form includes specific MBE designation categories including African American, Latino, Native American, Asian, and Pacific Islander ownership. The document must be completed and signed by an authorized representative with their printed name, title, and date of submission. This form is a mandatory submission requirement for bidders responding to the Jackson County procurement and serves as a critical evaluation tool for assessing contractor qualifications, experience, capacity, and diversity status.
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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 .