QUALIFICATION_SUBMITTAL_FORM_8-25.pdf
PDF 167 KB Posted
- Attached to
- Palm Harbor Recreation Center Addition State and local contract opportunity
- Solicitation number
- 26-0011-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This is a Qualification Submittal Form issued by Pinellas County, Florida, for the Palm Harbor Recreation Center Addition project. The document outlines the two-step qualification and bidding process required for general contractors seeking to construct a 28,000 square foot recreation center in Palm Harbor. Step 1 qualification submissions are due November 11, 2025, with final bid submissions due November 20, 2025. A non-mandatory pre-bid conference and site visit are scheduled for October 29, 2025, and contractor questions must be submitted by November 4, 2025. The contract term is 425 consecutive calendar days from the Notice to Proceed, with liquidated damages of $487.07 per calendar day for schedule delays. The recreation center will serve dual purposes as a community facility and hurricane shelter designed to accommodate up to 800 general population shelter spaces and meet American Red Cross standards.
Contractors must meet specific qualification requirements based on their FDOT pre-qualification status. FDOT pre-qualified contractors must submit the OpenGov Fillable-Final form, provide experience documentation on similar projects, include FDOT qualification letters, and submit a bonding letter indicating maximum bonding capacity. Non-FDOT pre-qualified contractors must submit the OpenGov Fillable-Final form, provide similar project experience documentation, submit a bonding letter, and provide a minimum of three reference letters from companies on comparable projects. All contractors must complete the Qualification Submittal Form in its entirety, documenting at least four similar projects with details including project descriptions, owner and project manager contact information, award amounts, final project totals, design estimates, change orders, and scheduled versus actual completion dates. The form also requires vendor information, officer/director details, and bid submittal officer information. Failure to meet any required condition results in disqualification from Step Two. The county has established a 15% Small Business Enterprise participation goal for subcontractors.
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Text version
QUALIFICATION FORMS – BID SUMMARY
QUALIFICATION SUBMITTAL FORM
STEP 1
FDOT Pre-qualified requirements
If you are currently a pre-qualified construction contractor with FDOT in all the applicable work class, in the Special Conditions Section, please fill out/provide:
1. Please complete and return the OpenGov Fillable-Final.
2. Provide your experience on Qualification Submittal Forms, outlining projects of a similar size and scope.
3. FDOT qualification letter/forms
4. A bonding letter from surety indicating the maximum amount your company can bond for.
Non FDOT Pre-qualified requirements
If you are not pre-qualified with FDOT in all the applicable work class, in the Special Conditions Section, please fill out/provide:
1. Please complete and return the OpenGov Fillable-Final.
2. Provide your experience on Qualification Submittal Forms outlining projects of a similar size and scope.
3. A bonding letter from surety indicating the maximum amount your company can bond for.
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
Name
Address
Telephone Number and Email Address:
Project Award Amount: $
Final Project Total Amount: $
Design Professional/Engineer Estimate:
$ Change Orders $
Project 3 (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 $
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)
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:
TREASURER ADDRESS:
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:
The said company or business entity is a sole proprietorship, partnership, or joint venture and is trading and doing business as
By:
Name of Firm or Qualifying Agent
Contractor’s Registration or Certification No. issued by
| PRESIDENT ADDRESS: |
| SECRETARY ADDRESS: |
| TREASURER ADDRESS: |
| Name ADDRESS: |
| Name ADDRESS: |
| Name ADDRESS: |
| QUALIFICATION REQUIREMENTS AS SPECIFIED IN: |
| Company Name Please include below 1: |
| Company Name Please include below 2: |
| Company Name Please include below 3: |
| Project 1 of similar type Description 1: |
| Project 1 of similar type Description 2: |
| Project 1 of similar type Description 3: |
| Owner of Project Contact Information: |
| Name: |
| Address: |
| Project Manager Contact Information: |
| Name_2: |
| Address_2: |
| 1: |
| 2: |
| 3: |
| undefined: |
| Company Name Please include below 1_2: |
| Company Name Please include below 2_2: |
| Company Name Please include below 3_2: |
| Project 2 of similar type Description 1: |
| Project 2 of similar type Description 2: |
| Project 2 of similar type Description 3: |
| Owner of Project Contact Information_2: |
| Name_3: |
| Address_3: |
| Project Manager Contact Information_2: |
| Name_4: |
| Address_4: |
| 1_2: |
| 2_2: |
| 3_2: |
| undefined_2: |
| QUALIFICATION SUBMITTAL FORM continued: |
| Company Name Please include below 1_3: |
| Company Name Please include below 2_3: |
| Company Name Please include below 3_3: |
| Project 3 of similar type Description 1: |
| Project 3 of similar type Description 2: |
| Project 3 of similar type Description 3: |
| Owner of Project Contact Information_3: |
| Name_5: |
| Address_5: |
| Project ManagerContact Information: |
| Name_6: |
| Address_6: |
| 1_3: |
| 2_3: |
| 3_3: |
| undefined_3: |
| QUALIFICATION SUBMITTAL FORM continued_2: |
| Company Name Please include below 1_4: |
| Company Name Please include below 2_4: |
| Company Name Please include below 3_4: |
| Project 4 of similar type Description 1: |
| Project 4 of similar type Description 2: |
| Project 4 of similar type Description 3: |
| Owner of Project Contact Information_4: |
| Name_7: |
| Address_7: |
| Project ManagerContact Information_2: |
| Name_8: |
| Address_8: |
| 1_4: |
| 2_4: |
| 3_4: |
| undefined_4: |
| Firm Name: |
| Street Address: |
| City: |
| State: |
| ZIP: |
| Additional Info: |
| OfficerDirectorMember: |
| Title: |
| DOB: |
| Notes: |
| OfficerDirectorMember_2: |
| Title_2: |
| DOB_2: |
| Notes_2: |
| OfficerDirectorMember_3: |
| Title_3: |
| DOB_3: |
| Notes_3: |
| OfficerDirectorMember_4: |
| Title_4: |
| DOB_4: |
| Notes_4: |
| OfficerDirectorMember_5: |
| Title_5: |
| DOB_5: |
| Notes_5: |
| Additional Information On Vendor or Contract Requirements: |
| 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: |
| If Contractor is a Corporation list the names titles and business addresses of its President Secretary and Treasurer: |
| ADDRESS 1: |
| ADDRESS 2: |
| Printed Name: |
| ADDRESS 1_2: |
| ADDRESS 2_2: |
| Printed Name_2: |
| ADDRESS: |
| By: |
| Corporation Name: |
| Qualifying Agent: |
| Contractor: |
| s Registration or Certificate No: |
| Printed Name_3: |
| ADDRESS_2: |
| undefined_5: |
| Printed Name_4: |
| ADDRESS_3: |
| undefined_6: |
| Printed Name_5: |
| The said company or business entity is a sole proprietorship partnership or joint venture and: |
| Name of Firm or Qualifying Agent: |
| Contractors Registration or Certification No issued by: |
| Project Award Amount: |
| Final Project Total Amount: |
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