Prime_Contractor_Response_Form.pdf

Qualification Form

SUMMER GRAVEL PIT CRUSHING & STOCKPILING

2027-019

PRIME CONTRACTOR RESPONSE

QUALIFICATION FORM

This Prime Contractor Response Qualification Form must be submitted with your solicitation response. A solicitation response received without this form, or with an outdated version, may be rejected. Prime contractors are responsible for checking all addenda for the final version of this form.

Each responder must answer every question and provide all information requested on this form. Failure to meet this requirement may result in the rejection of the entire solicitation response as non-responsive.

The State (or its representative) reserves the right to clarify the required qualification information submitted on this form before an award is made. The solicitation response will be rejected if qualifications are not met.

Qualification Requirements

Vendor shall provide employee certificate of annual refresher training and hazard awareness, MSHA Part 46 training plans

1. Responding company has completed as a Prime Contractor, not as a subcontractor, the work for at least 2 contracts which have achieved Substantial Completion since June 2022 for similar scope of work. Each of these contracts MUST have had a construction value of $50,000 or greater.

Fill in the required information for your previous projects relating to Qualification Requirement #1:

*Property Owner:

Property Owner Contact Person: Contact Person’s Telephone #:

Dollar Amount of Contract: Substantial Completion Date:

Contract substantially completed under (check one):

☐ Current Company Name ☐ Previous Company Name

Dollar Amount of Contract: Substantial Completion Date:

Contract substantially completed under (check one):

*The term “Property Owner” means the person or entity identified as the owner of the property where the work referenced for Qualification Requirement #1 was performed.

The State (or its representative) reserves the right to contact the references listed above for Qualification Requirement #1 or to request the Responder to provide additional reference projects for review. The solicitation response will be rejected if the State, in its sole discretion, receives information that indicates the responder is non-responsible. Information considered includes, but is not limited to: 1) project milestones (meeting substantial and final completion dates); 2) communication with project owner and subcontractors; 3) on-site supervision;

4) coordination of subcontractors; 5) violation of Minnesota prevailing wage law; and 6) nonpayment of subcontractors.

2. Project Manager and Job Superintendent responsible for this project EACH has had at least 2 years of experience with gravel crushing similar in scope and value to this project. Each of these contracts must have had a construction value of $50,000 or greater.

Project Manager Name____________________________________ Present position _______________________

List below the required information for individuals who will be responsible for this project:

Years of Experience Type of Work In What Capacity

Fill in the required information for Project Manager’s previous projects relating to Qualification Requirements #1 & #2:

Dollar Amount of Contract: Substantial Completion Date:

Contract substantially completed under (check one):

Dollar Amount of Contract: Substantial Completion Date:

Contract substantially completed under (check one):

*The term “Property Owner” means the person or entity identified as the owner of the property where the work referenced for Qualification Requirement #1 was performed.

The State (or its representative) reserves the right to contact the references listed above for Qualification Requirement #2 or to request the Responder to provide additional reference projects for review. The solicitation response will be rejected if the State, in its sole discretion, receives information that indicates the responder is non-responsible. Information considered includes, but is not limited to: 1) project milestones (meeting substantial and final completion dates); 2) communication with project owner and subcontractors; 3) on-site supervision;

4) coordination of subcontractors; 5) violation of Minnesota prevailing wage law; and 6) nonpayment of subcontractors.

Job Superintendent Name ______________________________ Present Position ________________________

Years of Experience Type of Work In What Capacity

Certification

By signing this form, I certify the information provided is complete and accurate.

Authorized Signature: Date:

Printed Name: Telephone:

Company Name: Title: