Attachment_A_-_QUALIFICATIONS_FORM_1.pdf
PDF 110 KB Posted
- Attached to
- Waste to Energy Facility Operator
- Solicitation number
- 24-1082-RFP
- Issued by
- Pinellas County, Florida
About this file
Qualifications Form 1 is a Statement of Ownership document associated with Pinellas County, Florida's Request for Proposal (RFP) for a Waste-to-Energy Facility Operator. The document is part of a multi-phase RFP process to select a long-term operator for the county's Waste-to-Energy (WTE) Facility located in St. Petersburg. The RFP is structured in two phases, with Phase 1 requesting Statements of Qualifications (SOQ) from qualified companies. Proposers must meet and continue to meet Minimum Qualifications Criteria from submission through contract signing. Highest-ranking proposers will be invited to participate in Phase 2 of the selection process.
The specific form provided is a template requiring respondents to disclose all stockholders or partners who own 10% or more of the company's stock or partnership interest. This transparency requirement ensures full ownership disclosure, with the requirement to list owners of subsidiary corporations or partnerships that meet the 10% threshold. The form includes spaces for names, addresses, signatures, and notarization, indicating the need for formal, verified submission of ownership information as part of the qualification process for the WTE facility operation contract.
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Other files
| File | Type | Posted |
|---|---|---|
| Waste_to_Energy_Facility_Operator_(Addendum_#3_Revision).pdf | ||
| Attachment_B_-_QUALIFICATIONS_FORM_2.pdf | ||
| Attachment_C_-_QUALIFICATIONS_FORM_3.pdf | ||
| Non-Competitive_Oversight_Committee_Justification_Form.docx | DOCX document | |
| PINCO_2024_WTE_Operator_RFP-RFQ_Template_DRAFT-08202024.docx | DOCX document | |
| RFQ_Proposed_Term_Sheet_DRAFT-08202024.docx | DOCX document |
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Text version
Attachment A
QUALIFICATIONS FORM 1
STATEMENT OF OWNERSHIP
The Respondent shall set forth the names and addresses of all stockholders in the corporation who own ten percent or more of its stock of any class, or all partners in the partnership who own ten percent or greater interest therein; if none, the Respondent must state “none.” If one or more such stockholder or partner is itself a corporation or partnership, the stockholders owning ten percent or more of that corporation’s stock, or the individual partners owning ten percent or greater interest in that partnership shall also be listed; if none, the Proposer must state “none.” This disclosure shall be continued until names and addresses of every individual stockholder, and individual partner exceeding the ten- percent ownership criteria of each corporation or partnership listed has been identified.
Multiple copies of this form may be provided as required.
NAME ADDRESS
Signature of Respondent Date
Name of Respondent (Print or Type) Title
Qualifications Form 1
Attachment A (Notary Public)
State of _________________________ County of _______________________
On this ________________ day of ________________, 20____, before me appeared ____________________, personally known to me to be the person described in and who executed this _____________ and acknowledged that (she/he) signed the same freely and voluntarily for the uses and purposes therein described.
In witness thereof, I have unto set my hand and affixed my official seal the day and year last written above.
Notary Public in and for the State of ______________
(Seal) (Name Printed)
Qualifications Form 1
File details come from the government source that posted it. Updated .