Attachment B- Bidder Status Form.pdf

Bidder Status Form

You must submit the completed form to the governmental body requesting bids per 875 Iowa Administrative Code Chapter 156. This form has been approved by the Iowa Labor Commissioner.

309-6001 (09-15)

My company is not a subsidiary of another business entity or my company is a subsidiary of another business entity that would qualify as a resident bidder in Iowa.

Part A To be completed by all bidders Please answer “Yes” or “No” for each of the following:

If you answered “Yes” for each question above, your company qualifies as a resident bidder. Please complete Parts B and D of this form.

If you answered “No” to one or more questions above, your company is a nonresident bidder. Please complete Parts C and D of this form.

My company has been conducting business in Iowa for at least 3 years prior to the first request for bids on this project.

My company is authorized to transact business in Iowa.

(To help you determine if your company is authorized, please review the worksheet on the next page).

NoYes

My company has an office to transact business in Iowa.NoYes My company’s office in Iowa is suitable for more than receiving mail, telephone calls, and e-mail.NoYes

NoYes

NoYes

Part B To be completed by resident bidders

My company has maintained offices in Iowa during the past 3 years at the following addresses:

Dates: to/ / / / Address:

City, State, Zip:

You may attach additional sheet(s) if needed.

Part C To be completed by non-resident bidders

1. Name of home state or foreign country reported to the Iowa Secretary of State:

2. Does your company’s home state or foreign country offer preferences to resident bidders, resident labor force preferences or any other type of preference to bidders or laborers? NoYes

3. If you answered “Yes” to question 2, identify each preference offered by your company’s home state or foreign country and the appropriate legal citation.

Dates: to/ / / / Address:

City, State, Zip:

Dates: to/ / / / Address:

City, State, Zip:

You may attach additional sheet(s) if needed.

Part D To be completed by all bidders

I certify that the statements made on this document are true and complete to the best of my knowledge and I know that my failure to provide accurate and truthful information may be a reason to reject my bid.

Firm Name:

Signature: Date:

This worksheet may be used to help complete Part A of the Resident Bidder Status form. If at least one of the following describes your business, you are authorized to transact business in Iowa.

Worksheet: Authorization to Transact Business

My business is currently registered as a contractor with the Iowa Division of Labor.NoYes

My business is a sole proprietorship and I am an Iowa resident for Iowa income tax purposes.NoYes

My business is a general partnership or joint venture. More than 50 percent of the general partners or joint venture parties are residents of Iowa for Iowa income tax purposes.

NoYes

My business is an active corporation with the Iowa Secretary of State and has paid all fees required by the Secretary of State, has filed its most recent biennial report, and has not filed articles of dissolution.

NoYes

My business is a corporation whose articles of incorporation are filed in a state other than Iowa, the corporation has received a certificate of authority from the Iowa secretary of state, has filed its most recent biennial report with the secretary of state, and has neither received a certificate of withdrawal from the secretary of state nor had its authority revoked.

NoYes

My business is a limited liability partnership which has filed a statement of qualification in this state and the statement has not been canceled.

NoYes

My business is a limited liability partnership which has filed a statement of qualification in a state other than Iowa, has filed a statement of foreign qualification in Iowa and a statement of cancellation has not been filed.

NoYes

My business is a limited partnership or limited liability limited partnership which has filed a certificate of limited partnership in this state, and has not filed a statement of termination.

NoYes

My business is a limited partnership or a limited liability limited partnership whose certificate of limited partnership is filed in a state other than Iowa, the limited partnership or limited liability limited partnership has received notification from the Iowa secretary of state that the application for certificate of authority has been approved and no notice of cancellation has been filed by the limited partnership or the limited liability limited partnership.

NoYes

My business is a limited liability company whose certificate of organization is filed in Iowa and has not filed a statement of termination.

NoYes

My business is a limited liability company whose certificate of organization is filed in a state other than Iowa, has received a certificate of authority to transact business in Iowa and the certificate has not been revoked or canceled.

NoYes

309-6001 (09-15)