Attachment D - Statement of Qualifications.pdf
PDF 120 KB Posted
- Attached to
- 2025 Chipseal Projects
- Solicitation number
- IFB-GC-RB-05-25
- Issued by
- Gilpin County, Colorado
About this file
This document is a Statement of Qualifications (Attachment D) for the 2025 Chipseal Projects issued by Garfield County, Colorado. The form is designed for potential bidders to provide comprehensive company information and background details for a competitive sealed bid solicitation for chipseal road maintenance projects. The county is seeking qualified contractors to complete all work by August 31, 2025, with bidders required to disclose their business history, previous work experience, references, and legal standing.
The qualification form requires detailed company information including legal name, contact details, business tenure in Colorado and Garfield County, and responses to critical background questions such as past legal actions, public procurement disqualifications, and bankruptcy proceedings. Prospective bidders must provide references, confirm their experience with similar county projects, and certify the accuracy of their submitted information through an authorized company representative's signature. The document serves as a critical screening mechanism to ensure only qualified and reputable contractors are considered for the chipseal project contract.
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Text version
ATTACHMENT D
STATEMENT OF QUALIFICATIONS
IFB-GC-RB-05-25
2025 CHIPSEAL PROJECTS
COMPANY INFORMATION
Legal Name of Company:
Trade Name, if any, of Company:
Street Address:
City, State & Zip Code:
Principal Owner/Officer Name:
Title:
Federal Employer Identification Number: ______
Telephone Number:
Facsimile Number:
Company E-mail Address:
Primary Contact and Title:
Contact E-mail Address:
COMPANY HISTORY
If a Colorado corporation or limited liability company, is the company in “good standing” with the Colorado Secretary of State? yes no
If a foreign corporation or limited liability company, is the foreign corporation or limited liability company registered to do business in Colorado and in “good standing” with the Colorado Secretary of State? yes no
How long has the company been in business in Colorado? years
How long has the company been in business in Garfield County? years
Has the company, or any officer or director acting in an official capacity, ever been successfully sued? yes no
If yes, complete the chart below, and any additional pages if necessary:
Court Case Number Year Judgment Amount
Has the company, or any of its officers or directors, ever been disbarred, suspended, or disqualified from any public procurement? yes no
Agency Agency Number Year Length of Disqualification
Has the company, or any of its officers or directors, ever been involved in a voluntary or involuntary bankruptcy proceeding? yes no
Court Case Number Year Judgment Amount
(Attach additional sheets if needed to fully respond to the above questions.)
PREVIOUS WORK EXPERIENCE
Has your company ever provided goods or services similar to the goods or services that are the subject of this solicitation for Garfield County? yes no
If yes, what was the total dollar amount of that contract? $___________ __________________
REFERENCES
Name Telephone Number Company Name Relationship
CERTIFICATION
The undersigned, as an authorized representative of the company, states that the undersigned has actual authority to sign this Statement of Qualifications; and, to the best of my knowledge, information, and belief, the information submitted in this Statement of Qualifications is true and accurate as of the date of this Statement of Qualifications is submitted.
By:
Printed Name:
Legal Title:
Date: ______________________________
File details come from the government source that posted it. Updated .