7-Form - Qualifications Questionnaire.pdf
PDF 76 KB Posted
- Attached to
- Indian River County West Regional / Glendale Wastewater Treatment Facility Metal Roof Panel Replacement
- Solicitation number
- 2027004
- Issued by
- Indian River County, Florida
About this file
This is a Qualifications Questionnaire form for a contractor bidding on the Indian River County West Regional/Glendale Wastewater Treatment Facility Metal Roof Panel Replacement project in Florida. The project requires the contractor to furnish all labor, supervision, materials, equipment, tools, transportation, permits, insurance, disposal fees, and incidentals necessary to remove and replace the existing metal roofing system and associated components at the maintenance building located at the West Regional Wastewater Treatment Facility.
The questionnaire requires prospective contractors to provide: years of experience providing similar services; State of Florida Registration Number(s); a minimum of five references from government agencies and private firms with whom they have completed comparable work, including contact information and dates of service; identification of all subcontractors and their license numbers; e-Verify.gov registration date; and documentation of any litigation cases during the past three years in which the contractor was a named party. Supporting documentation required with the submission includes an Occupational License or Business Tax Receipt, proof of current liability insurance, and a completed W-9 form.
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Text version
Qualifications Questionnaire
1. How many years has your organization been providing these services? ________
2. List State of Florida Registration Number(s):
3. List government agencies and private firm(s) with whom you have completed similar work:
Agency/Firm Name:
Address:
Contact Name: Title: _______________________________ E-Mail: Phone: _____________________________ Services Provided:
Dates of Service:
Agency/Firm Name:
Address:
Contact Name: Title: _______________________________ E-Mail: Phone: _____________________________ Services Provided:
Dates of Service:
Agency/Firm Name:
Address:
Contact Name: Title: _______________________________ E-Mail: Phone: _____________________________ Services Provided:
Dates of Service:
Agency/Firm Name:
Address:
Contact Name: Title: _______________________________ E-Mail: Phone: _____________________________ Services Provided:
Dates of Service:
Agency/Firm Name:
Address:
Contact Name: Title: _______________________________ E-Mail: Phone: _____________________________ Services Provided:
Dates of Service:
4. Subcontractors:
Type of Work Subcontractor Name License Number
5. Date Registered with e-Verify.gov:
6. List all ligation cases during the past three (3) years in which the Contractor has been a named party. Use additional sheets, as necessary.
Year filed
Case number Venue Description
Attach Occupational License/Business Tax Receipt, proof of current liability insurance and W-9.
File details come from the government source that posted it. Updated .