ATTACH_9_-_QualStmt.pdf

CONTRACTOR'S QUALIFICATIONS STATEMENT

Complete in full and submit with your offer. Failure to submit this information will not be cause for rejection of your offer. However, if your firm is in line for a contract award, this information will be requested and is required to enable this office to make a determination of responsibility to consummate the award process. Use additional sheets if needed.

1. Name and Permanent Place of Business:

Name:

Address:

City: State: Zip:

Phone No: Duns No:

2. Equipment

(a) All equipment shall be in satisfactory operating condition, capable of safely and efficiently performing the work required, and of a size commensurate with the work to be performed. Qualified operating personnel shall be provided by the Contractor for the operation of this equipment. All equipment shall be listed on the Contractor’s Qualification Statement (attachment 9).

(b) The Contractor shall furnish and install all fuel, grease, cables, repair parts, tools, methane monitors, welders, and all other miscellaneous supplies and parts necessary for efficient and safe operation. Repairs and replacements shall be made by the Contractor at the Contractor's own expense, within 48 hours from the time of breakdown.

(c) The Contracting Officer or the COR may at any time inspect the Contractor's equipment on the job site. If said equipment is deemed inadequate or any part thereof improper, the Contractor shall replace or make repairs in a manner consistent with paragraph (b) above.

List all equipment to be utilized in performing work covered by the solicitation. Contractor must show evidence of firm commitment in writing for equipment not owned by contractor.

Type of Model/ Size/ Age/ Lien Equipment Manufacturer Capacity Condition Holder

3. Contractor's Experience

List and describe experience with previous and current work similar to this project.

Project Name: Owner's Name:

Project Location: Owner's Address:

Owner's Engineer in Charge:

Phone No: Date of Work: Cost:

Description of Work:

Owner's Engineer in Charge:

Owner's Engineer in Charge:

Owner's Engineer in Charge:

4. Offeror's Proposed Superintendent and Experience

Name: Work Phone:

Address: Home Phone:

List and describe superintendent's experience with work similar to this project. The on-site superintendent is required to have experience supervising earthwork and concrete construction.

Owner's Engineer in Charge:

Owner's Engineer in Charge:

Owner's Engineer in Charge:

5. Subcontractors

Offeror proposes to use the following subcontractors for the noted items of work.

Subcontractor Name & Address Description of Proposed Work

6. Subcontractor's Experience in Work Comparable to Proposed Work

Subcontractor's Name:

Project Location: Owner's Address:

Owner's Engineer in Charge:

Project Location: Owner's Address:

Owner's Engineer in Charge:

Project Location: Owner's Address:

Owner's Engineer in Charge:

7. Bonding (when applicable)

Offeror proposes to obtain a Payment Guarantee with the following corporate surety and agent within the time specified in this Invitation for Bid.

Surety

Agency

Address

8. Principals

List full names and permanent addresses of persons and firms involved in the attached offer as principals.

Name: Title:

Name: Title:

9. List all outstanding court judgments, mechanics liens, and other civil or criminal actions pending against offeror or principals.

Signature:

Name (printed):

Title: Date: