QUALIFICATION_SUBMITTAL_FORM_6.26.pdf

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Attached to
Fire Protection System Inspections and Repair
Solicitation number
26-0261-ITB
Issued by
Pinellas County, Florida

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Qualification Submittal Form Summary

This is a Minimum Qualification Submittal Form for Pinellas County, Florida's Fire Protection System Inspections and Repair procurement. The form establishes qualification requirements for vendors bidding on fire system services, including testing, maintenance, inspection, certification, and repair of fire protection components such as fire pumps, valves, backflow preventers, piping, sprinkler heads, standpipes, chemical suppression systems, fire and smoke detection devices, alarm systems, fire panels, and deluge valves across multiple County locations. Bidders must demonstrate successful completion of a minimum of three (3) contracts of similar size and scope performed for public or private entities within the past seven (7) years. The form requires submission of detailed information for up to four (4) projects, including project descriptions, owner and project manager contact information, total contract amounts, and completion dates for each project.

The Qualification Submittal Form also includes the Bid Submittal Officers Form, which requires vendors to provide company ownership and organizational structure information. For corporations, vendors must list the names, titles, and business addresses of the President, Secretary, and Treasurer, along with the corporate seal and Florida registration or certificate number. Non-corporate entities must provide names and business addresses of owners, partners, or joint venturers. All bids must be signed by an authorized representative and submitted within 10 calendar days after receipt of notice of intent to award. Additionally, bidders are required to submit a minimum of four (4) professional contract references from entities of similar size and scope, which will be validated by a County designee prior to award. All references and work experience documentation will undergo formal validation by the County.

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MINIMUM QUALIFICATION SUBMITTAL FORM

QUALIFICATION SUBMITTAL FORM

Vendor must demonstrate successful completion of a minimum of three (3) contracts of similar size and scope within the past seven (7) years performing work for a public or private entity. Vendor must submit prior to award a minimum of four (4) professional contract references from a public or private entity of a similar size and scope.

All references and work experience will be validated by a County Designee.

Company Name: Please include below

Project 1 Description (of similar scope and size)

Owner of Project - Contact Information

Name

Address

Telephone Number and Email Address:

Project/Contract Manager - Contact Information

Name

Address

Telephone Number and Email Address:

Total Contract Amount: $

Completion Date

QUALIFICATION SUBMITTAL FORM (continued)

Company Name: Please include below

Project 2 Description (of similar scope and size)

Owner of Project - Contact Information

Name

Address

Telephone Number and Email Address:

Project Manager - Contact Information

Name

Address

Telephone Number and Email Address:

Company Name: Please include below

Project 3 Description (of similar scope and size)

Owner of Project - Contact Information

Name

Address

Telephone Number and Email Address:

Project Manager- Contact Information

Name

Address

Telephone Number and Email Address:

Company Name: Please include below

Project 4 Description (of similar scope and size)

Owner of Project - Contact Information

Name

Address

Telephone Number and Email Address:

Project Manager- Contact Information

Name

Address

Telephone Number and Email Address:

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 it is a corporation, the name and address 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/her own name and the corporate seal.

The Bidder further agrees to execute the Agreement within 10 calendar days after receipt of notice of intent to award.

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

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

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

Corporate Name:________ ___________________________________

By Title

***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

QUALIFICATION SUBMITTAL FORM
STEP ONE
FDOT pre-qualified requirements:
Non-FDOT pre-qualified requirements:
QUALIFICATION SUBMITTAL FORM
Project 1 Description (of similar scope and size)
Owner of Project - Contact Information
Project Manager - Contact Information
Design Professional/Engineer Estimate:
Scheduled Completion Date
Project 2 Description (of similar scope and size)
Owner of Project - Contact Information
Project Manager - Contact Information
Design Professional/Engineer Estimate:
Scheduled Completion Date
Project 3 Description (of similar scope and size)
Owner of Project - Contact Information
Project Manager- Contact Information
Design Professional/Engineer Estimate:
Scheduled Completion Date
Project 4 Description (of similar scope and size)
Owner of Project - Contact Information
Project Manager- Contact Information
Design Professional/Engineer Estimate:
BID SUBMITTAL OFFICERS FORM
PRESIDENT ADDRESS:
SECRETARY ADDRESS:
TREASURER ADDRESS:
Name ADDRESS:
Name ADDRESS:
Name ADDRESS:
Company Name Please include below 1:
Company Name Please include below 2:
Company Name Please include below 3:
Project 1 Description of similar scope and size 1:
Project 1 Description of similar scope and size 2:
Project 1 Description of similar scope and size 3:
Owner of Project Contact Information:
Name:
Address:
Project Manager Contact Information:
Name_2:
Address_2:
Company Name Please include below 1_2:
Company Name Please include below 2_2:
Company Name Please include below 3_2:
Project 2 Description of similar scope and size 1:
Project 2 Description of similar scope and size 2:
Project 2 Description of similar scope and size 3:
Owner of Project Contact Information_2:
Name_3:
Address_3:
Project Manager Contact Information_2:
Name_4:
Address_4:
Company Name Please include below 1_3:
Company Name Please include below 2_3:
Company Name Please include below 3_3:
Project 3 Description of similar scope and size 1:
Project 3 Description of similar scope and size 2:
Project 3 Description of similar scope and size 3:
Owner of Project Contact Information_3:
Name_5:
Address_5:
Project ManagerContact Information:
Name_6:
Address_6:
Company Name Please include below 1_4:
Company Name Please include below 2_4:
Company Name Please include below 3_4:
Project 4 Description of similar scope and size 1:
Project 4 Description of similar scope and size 2:
Project 4 Description of similar scope and size 3:
Owner of Project Contact Information_4:
Name_7:
Address_7:
Project ManagerContact Information_2:
Name_8:
Address_8:
The Contractors address and principal place of business is 1:
The Contractors address and principal place of business is 2:
The Contractors address and principal place of business is 3:
Printed Name:
ADDRESS 1:
ADDRESS 2:
Printed Name_2:
ADDRESS 1_2:
ADDRESS 2_2:
Printed Name_3:
ADDRESS:
undefined_7:
Title_6:
Qualifying Agent:
Contractors Registration or Certificate No:
Printed Name_4:
ADDRESS_2:
undefined_8:
Printed Name_5:
ADDRESS_3:
Printed Name_6:
ADDRESS_4:
undefined_9:
The said company or business entity is a sole proprietorship partnership or joint venture and:
Company Name:
Name of Firm or Qualifying Agent:
Contractors Registration or Certification No issued by the State of Florida:
Total Contract Amount:
Completion Date:

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