ADV_Bidders Qualifications Form.doc
DOC document 82 KB Posted
- Attached to
- Natchez Trace Parkway Project MS NP NATR 3F26
- Solicitation number
- 693C73-27-B-000001
About this file
This is a Bidders Qualifications Form required for submission with bids on the Natchez Trace Parkway Project MS NP NATR 3F26, Solicitation Number 693C73-27-B-000001, a Department of Transportation Federal Highway Administration project located in Chickasaw County, Mississippi. The project involves resurfacing approximately 10-12 million dollars of Parkway infrastructure, including ramps, bridges, intersections, and parking/pull-off areas through milling, asphalt overlay, shoulder widening, spot reconstruction, and pavement markings.
Prospective bidders must complete and return this form with their sealed bid by the deadline specified in the SF 1442, Block 13a of the Solicitation. The form requires comprehensive company information including SAM Unique Entity ID, DUNS number, and EIN; business organization type and size classification; ownership and key personnel details with resumes; documentation of active contracts with contact information; the five largest relevant projects completed in the last five years with completion dates and contract amounts; contract termination history; debarment and suspension status; and descriptions of work performed as general contractor, subcontractor, and types of work subcontracted. All prospective contractors must maintain active Federal Government contracts registration in SAM at time of bid submission. Bid documents are available for download at https://www.sam.gov beginning on or about September 17, 2026, and all questions should be directed to eflhd.contracts@dot.gov including the solicitation number and project details.
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INSTRUCTIONS: Answer all questions on this form inserting "none" or "not applicable" where appropriate. If more space is required attach additional sheets. Return the signed, dated and completed form with the bid to the address shown in the Invitation For Bids on or before the time set for the bid opening. The prospective bidder shall provide any additional information requested by the Government during evaluation of the bids.
If the prospective bidder is a joint venture or general partnership, a separate Bidder's Qualifications form shall be provided individually for each joint venture participant or partner.
1. Project Name:
MS NP NATR 3F26
Solicitation No.: 693C73-27-B-000001 Natchez Trace Parkway
2. Name and address of business:
Contractor’s SAM Unique Entity ID
Company Name
Contractor’s DUNS #
Street
Contractor’s Employer ID # (EIN)
City
State
Zip Code
County
Telephone Number (Include Area Code)
Fax Number (Include Area Code)
E-mail Address
Web site address
3. a. Type of organization (check appropriate box):
□ Individual
□ Non-profit organization
□ Corporation
□ Partnership
□ Joint Venture
State
Incorporated in: __________
□ Limited Liability Company (LLC)
If a foreign entity:
□ Individual
□ Non-profit organization
□ Corporation
| □ Partnership |
| □ Joint Venture |
b. Size of Business Concern (check appropriate boxes):
□ Large Business Concern
□ Small Business Concern
□ Emerging Small Business
Concern
□ Small Disadvantaged
Business Concern
□ Women-Owned Small
Business Concern
□ SBA 8(a) Certified SDBC
□ HUBZone Small Business
Concern
□ Veteran-owned Small
Business Concern
□ Service-Disabled Veteran Owned Small Business Concern
{See FAR Clauses 52.219-1 and 52.219-19 for small business definitions.}
4. If a joint venture or general partnership:
a. Provide the name under which the project will be bid, the home office address, and name of the principal who will represent the company with regard to this project if different from "1." above.
Principal
SAM Unique Entity ID
Business Name
DUNS #
Employer ID # (EIN)
b. Provide the name and home office addresses of each of the joint venture partners; indicate which partner is the sponsoring partner. Attach a separate sheet for additional partners.
Sponsoring Partner
Other Partner
5. Date business established: _________________________
6. Name of succeeded business, if any: _________________________
7. How many years have you been in business as:
a. General contractor: _______ Years.
b. Subcontractor: _______ Years.
8. a. Furnish the following information concerning the owner, partners, officers and directors:
| Name |
| Title |
| Percent of Business Owned |
| Years of |
Business Experience
| Contracting |
| Other |
b. Attach resumes of these key personnel as well as the on-site project manager(s) and superintendent(s), and specifically identify the following:
-Present position, responsibility, and length of employment.
-Amount and type of construction experience.
-Amount and type of highway construction experience, including position, responsibility, and a brief project description of each period of employment.
-Formal education and training, professional or technical registrations or licenses.
9. a. Active Contracts (Attach additional sheets if necessary) Must be completed. Provide contact person(s), phone numbers and e-mail addresses.
| Project Name and Contract Numbers |
| Owner's Name & Address |
Contact Person, Telephone Number, &
E-mail address Scope of Work Performed
By Your Company
| Contract Amount |
| Estimated Completion Date |
| Name of Surety |
b. Are there any unresolved claims or lawsuits associated with these projects? If so, state the amount in dispute, parties involved, nature and circumstances of the dispute, and status of the matter on a separate sheet.
10. a. List no more than five of the largest jobs you have completed in the last five years which are relevant in project work scope to this project.
(Attach additional sheets if necessary) Must be completed. Provide contact person(s), phone numbers and e-mail addresses.
| Project Name and Contract Numbers |
| Owner's Name & Address Contact Person, Telephone Number; & E-mail address |
| Scope of Work Performed By Your Company |
| Original and Final Contract Amounts |
| Original and Final Completion Dates |
| Names of On-site Project Manager and Superintendent |
| Name of Surety |
b. Are there any unresolved claims or lawsuits associated with these projects? If so, state the amount in dispute, parties involved, nature and circumstances of the dispute, and status of the matter on a separate sheet.
11. Termination:
a. Has your firm ever had a contract terminated for any reason? ________
b. If the answer is yes, identify the project and owner for each termination, and explain the circumstances surrounding each termination. Attach additional sheet if necessary.
12. Debarment and Suspension:
a. Has your firm or any of the principals been suspended or debarred from bidding by any agency? ______
b. If the answer is yes, identify the agency by which debarred or suspended, and date of reinstatement. Attach additional sheet if necessary.
13. What types of work do you perform as general contractor?
14. What types of work do you perform as subcontractor?
15. What types of work do you generally subcontract?
16. Affidavit:
Certification: For the purpose of establishing construction capabilities, we furnish the above as a true and correct statement of our construction experience and further certify that all other statements are true and correct.
By (Signature of Authorized Official)
Date
Title
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