QUALIFICATION_SUBMITTAL_FORM_5-21.pdf

QUALIFICATION SUBMITTAL FORM

STEP 1

PART A

If you are currently a pre-qualified construction contractor with FDOT in the applicable work type found in the Special Conditions Section, please check box and fill out OpenGov Fillable-Final and return with signed and filled out, PART A & B and provide a bonding letter from surety indicating the maximum amount your company can bond for.

I am Pre-qualified with FDOT in the work class(s) as referenced in the Special Conditions Section and attach my FDOT qualification letter/forms

Signature by Contractor for: _____________________________________________________________ Print name and email address: ___________________________________________________________ The invitation to bid for this Project requires that this qualification submittal be included with the bid and Part A & B must be completed in its entirety.

PART B

Non FDOT qualified.

A component of the Pre-Qualification of Bidder process is background check and review. Please provide the following documentation and include with Qualification Submittal Forms by Step One due date referenced in the Notice Section.

1. Provide a bonding letter from surety indicating the maximum amount your company can bond for.

2. Please complete and return the OpenGov Fillable-Final.

3. Provide your experience on Qualification Submittal Forms below outlining projects of a similar size and scope.

4. Provide a minimum of three reference letters from companies that you have performed projects of a similar size and scope.

**If any of the above conditions are not met, your company will be disqualified from moving forward with Step Two.**

Applicable for all contractors. The invitation to bid for this Project requires that this qualification submittal be included with the bid and completed in its entirety.

NOTE: BIDDER SHALL SUBMIT QUALIFICATION SUBMITTAL ON THE FORM PROVIDED HEREIN

TO PROVIDE THE QUALIFICATION REQUIREMENTS AS SPECIFIED IN

Company Name: Please include below

Project 1 (of similar type) Description

Owner of Project - Contact Information

Name

Address

Telephone Number and Email Address:

Project Manager - Contact Information

Name

Address

Telephone Number and Email Address:

Project Award Amount: $

Final Project Total Amount: $

Design Professional/Engineer Estimate:

$ Change Orders $

Scheduled Completion Date

Actual Completion Date

QUALIFICATION SUBMITTAL FORM (continued)

Company Name: Please include below

Project 2 (of similar type) Description

Owner of Project - Contact Information

Name

Address

Telephone Number and Email Address:

Project Manager - Contact Information

Address

Telephone Number and Email Address:

Project Award Amount: $

Final Project Total Amount: $

Design Professional/Engineer Estimate:

$ Change Orders $

Company Name: Please include below

Project 3 (of similar type) Description

Owner of Project - Contact Information

Address

Telephone Number and Email Address:

Project Manager- Contact Information

Address

Telephone Number and Email Address:

Project Award Amount: $

Final Project Total Amount: $

Design Professional/Engineer Estimate:

$ Change Orders $

Company Name: Please include below

Project 4 (of similar type) Description

Owner of Project - Contact Information

Name

Address

Telephone Number and Email Address:

Project Manager- Contact Information

Name

Address

Telephone Number and Email Address:

Project Award Amount: $

Final Project Total Amount: $

Design Professional/Engineer Estimate:

$ Change Orders $

Applicable only for contractors who are not pre-qualified with FDOT

The invitation to bid for this Project requires that this qualification submittal be included with the proposal and completed in its entirety.

Vendor Information Firm Name:

Street Address:

City:

State:

ZIP:

Additional Info:

Officer/Director Information

Officer/Director/Member:

Title:

DOB:

Notes:

Officer/Director/Member

Additional Information: (On Vendor or Contract Requirements)

QUALIFICATION FORMS – BID SUMMARY

BID SUBMITTAL OFFICERS FORM

Each Bid by an individual or firm shall state the name and address of each person who owns an interest therein, and, if any corporation, the name and addresses of its officers, or if an LLC, the name and address of its members. Bids shall be signed by the person or member of the firm making the same, and if a corporation, by an authorized officer or agent, subscribing the name of the corporation, together with his own name and the corporate seal.

The Bidder further agrees to execute the Agreement within 10 calendar days after receipt of notice of award, and within the time frame of the Agreement.

The Bidder further agrees to bear the full cost of maintaining all Work until the final acceptance.

Accompanying the Bid is a Bid Guarantee, meeting the requirements described in the Instruction to Bidders.

The Contractor’s address and principal place of business is:

If Contractor is a Corporation, list the names, titles and business addresses of its President, Secretary and Treasurer.

PRESIDENT ADDRESS:

Printed Name

SECRETARY ADDRESS:

Printed Name

TREASURER ADDRESS:

Printed Name

QUALIFICATION FORMS – BID SUMMARY

Said Corporation is qualified to do business in the State of Florida.

By Corporation Name President

***CORPORATE SEAL***

Qualifying Agent

Contractor's Registration or Certificate No.

issued by the State of Florida

If Contractor is not a corporation, list the name(s) and business address(es) of its owner(s), joint venturers or partners:

Name ADDRESS:

Printed Name

Name ADDRESS:

Printed Name

Name ADDRESS:

Printed Name

The said company or business entity is a sole proprietorship, partnership, or joint venture and is trading and doing business as

Company Name

By:

Name of Firm or Qualifying Agent

Contractor’s Registration or Certification No. issued by the State of Florida