APP H - Bidders List.docx
DOCX document 35 KB Posted
- Attached to
- 2025 Medford SRT*
- Solicitation number
- 2025 1
- Issued by
- Vernon County, Mattoon Village, Wisconsin
About this file
The attached document is a Bidders List Appendix H required by the Wisconsin Department of Transportation (WisDOT) for DOT-assisted contracts. It outlines the requirement for all firms (prime contractors, subcontractors, including DBEs and non-DBEs) that bid or quote on DOT-assisted prime contracts and subcontracts to complete this form. The form collects information on the type of work, NAICS codes, contact details, annual gross receipts, DBE status, age of firm, race, and gender for the prime contractor/consultant as well as any subcontractors/subconsultants.
The document provides instructions on completing the form and defines the required information. Vendors must submit this form with all bids and/or proposals. The form is used by WisDOT to develop and maintain a list of firms that bid/quote on DOT-assisted contracts as required by 49 CFR Part 26.11.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 2025 Medford SRT.docx | DOCX document | |
| 2025 Medford SRT A1.docx | DOCX document | |
| Appendix A - Pricing Proposal.xlsx | XLSX spreadsheet | |
| Appendix I - Federal Clauses for Federal_.pdf | ||
| Amendment Notice 1.docx | DOCX document |
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Text version
Bidders List Appendix H
Background
49 CFR Part 26.11 requires the Wisconsin Department of Transportation (WisDOT) to develop and maintain a list of firms that bid/quote on DOT-assisted contracts. All firms (prime contractors and subcontractors, including DBEs and non-DBEs) that bid or quote on DOT-assisted prime contracts and subcontracts must complete this form. This form should include subcontractors/subconsultants that contacted the prime expressing an interest to work as a subcontractor/subconsultant on the DOT assisted project.
Instructions
Vendors must complete and submit this form with all bids and/or proposals. Attach additional pages, as needed.
Terms/Definitions
Type of Work – List the type of work and/or all the work activities the firm is sought to perform in its bid.
NAICS Codes – List all North American Industry Classification System (NAICS) Codes applicable to the scope of work activities the firm is sought to perform in its bid. A NAICS Codes is available at https://www.naics.com/search/
Prime Contractor and Consultant - Complete all data fields for the firm’s majority owner.
Name of Prime Contractor/Consultant:
Contact Name:
| Annual Gross Receipts |
| DBE Status |
| ☐ Yes |
☐ No
Email:
| ☐ |
| Less than $500,000 |
Phone:
| ☐ |
| $500,000 - $1 million |
Address:
Include Zip Code
| ☐ |
| $1 million - $2 million |
| Age of Firm: |
| ☐ |
| $2 million - $5 million |
| Race: |
| ☐ |
| $5 million and above |
| Gender: |
Type of Work:
NAICS Code(s):
Subcontractors and Subconsultants – Complete all data fields for the Prime’s subcontractors/subconsultants.
List additional subcontractors/subconsultants on page 2.
Name of Subcontractor/Subconsultant:
Contact Name:
| Annual Gross Receipts |
| DBE Status |
| ☐ Yes |
☐ No
Email:
| ☐ |
| Less than $500,000 |
Phone:
| ☐ |
| $500,000 - $1 million |
Address:
| ☐ |
| $1 million - $2 million |
| Age of Firm: |
| ☐ |
| $2 million - $5 million |
| Race: |
| ☐ |
| $5 million and above |
| Gender: |
Type of Work:
NAICS Code(s):
Bidders List (continued) Subcontractors and Subconsultants – Complete all data fields for the Prime’s subcontractors/subconsultants.
Name of Subcontractor/Subconsultant:
Contact Name:
| Annual Gross Receipts |
| DBE Status |
| ☐ Yes |
☐ No
Email:
| ☐ |
| Less than $500,000 |
Phone:
| ☐ |
| $500,000 - $1 million |
Address:
| ☐ |
| $1 million - $2 million |
| Age of Firm: |
| ☐ |
| $2 million - $5 million |
| Race: |
| ☐ |
| $5 million and above |
| Gender: |
Type of Work:
NAICS Code(s):
Name of Subcontractor/Subconsultant:
Contact Name:
| Annual Gross Receipts |
| DBE Status |
| ☐ Yes |
☐ No
Email:
| ☐ |
| Less than $500,000 |
Phone:
| ☐ |
| $500,000 - $1 million |
Address:
| ☐ |
| $1 million - $2 million |
| Age of Firm: |
| ☐ |
| $2 million - $5 million |
| Race: |
| ☐ |
| $5 million and above |
| Gender: |
Type of Work:
NAICS Code(s):
Name of Subcontractor/Subconsultant:
Contact Name:
| Annual Gross Receipts |
| DBE Status |
| ☐ Yes |
☐ No
Email:
| ☐ |
| Less than $500,000 |
Phone:
| ☐ |
| $500,000 - $1 million |
Address:
| ☐ |
| $1 million - $2 million |
| Age of Firm: |
| ☐ |
| $2 million - $5 million |
| Race: |
| ☐ |
| $5 million and above |
| Gender: |
Type of Work:
NAICS Code(s):
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