Qualification_Form_.pdf

Qualification Form

PRIME CONTRACTOR RESPONSE

QUALIFICATION FORM

VERSION: Original

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 A solicitation response received without this form, or with an outdated version, may be rejected.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

1. Responding company has completed as a Prime Contractor or as a Subcontractor, the work for at least 2 contracts which have achieved Substantial Completion since September 2020 for installing bituminous parking lots, roads, or trails; OR for at least 2 contracts which have achieved Substantial Completion since September 2020 for spreading/grading/compacting gravel. Each of these contracts MUST have had a construction value of $25,000 or greater.

OR

In lieu of Responding company’s projects, Responder may provide on the form below up to 2 qualifying projects completed by the Project Manager while employed by others which have achieved Substantial Completion since September 2020 for installing bituminous parking lots, roads, trails, or for spreading/grading/compacting gravel, and have had a construction value of $25,000 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

*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

*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.

Qualification Form

2. Project Manager responsible for this project must have at least 5 years of experience with bituminous work similar in scope and value to this project.

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

Certification

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

Authorized Signature: Date:

Printed Name: Telephone:

Company Name: Title: