QUALIFICATION_SUBMITTAL_FORM_8-25.pdf

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Attached to
Chesnut Park Managed Aquifer Recharge Well Drilling And Completion Of Subsurface Testing
Solicitation number
26-0046-ITB-C
Issued by
Pinellas County, Clewiston City, Florida

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Summary

This is a Qualification Submittal Form for a construction project managed by Pinellas County Utilities in Florida. The document establishes requirements for contractors bidding on the Chesnut Park Managed Aquifer Recharge (MAR) Well Drilling and Completion of Subsurface Testing project. Contractors must submit completed qualification documentation with their bids, demonstrating experience on similar projects of comparable size and scope. The project involves drilling a 24-inch diameter injection well to 1,250 feet below land surface at John Chesnut Sr. Park, with construction of a Class V injection well and potentially an optional 6-inch monitor well. The bid was issued November 3, 2025, with a mandatory site visit scheduled for November 5, 2025, at 10:00 am, questions due by November 7, 2025, and proposal submissions due November 13, 2025, at 3:00 pm. The contract will be awarded to the lowest responsive, responsible bidder for a 540-day project duration including a 12-month guarantee period.

Contractors must provide either current FDOT pre-qualification documentation with a bonding letter indicating maximum bonding capacity, or if not FDOT pre-qualified, submit bonding letters and a minimum of three reference letters from companies demonstrating similar project experience. All contractors must complete the OpenGov Fillable Form and document up to four relevant past projects with owner and project manager contact information, award amounts, final project totals, and completion dates. Non-FDOT pre-qualified contractors must provide detailed vendor information, officer and director information with dates of birth, and corporate documentation. The project includes a 5% Small Business Enterprise (SBE) participation goal, requires comprehensive insurance coverage with limits of $500,000 to $1,000,000 per occurrence, E-Verify compliance, and adherence to Florida Department of Environmental Protection (FDEP) regulations. Co-funding is provided by the Southwest Florida Water Management District (SWFWMD).

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Other files

File Type Posted
Chesnut_Park_Managed_Aquifer_Recharge_Well_Drilling_And_Completion_Of_Subsurface_Testing_(Addendum_#1_Revision).pdf PDF
QUALIFICATION_SUBMITTAL_FORM_Non_FDOT.pdf PDF
Chesnut_Park_Managed_Aquifer_Recharge_Well_Drilling_And_Completion_Of_Subsurface_Testing.pdf PDF
Pricing_Proposal26-0046(reference_only).pdf PDF
26-0046_-_Insurance_Requirements_-_Chestnut_Park_Managed_Aquifer_Recharge_Well_Drilling_and_Completion_of_Subsurface_Testing.docx DOCX document
Sample_Agreement-26-0046.pdf PDF
Chesnut_Park_Well_Technical_Specifications.pdf PDF
Bid_Form_Table_MAR_Well.xlsx XLSX spreadsheet
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OpenGov_Fillable-_Final.pdf PDF
SBE_Compliance_Form.pdf PDF
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Performance_and_Payment_Bonds.pdf PDF
Affdavit_of_Release_and_Guarantee.pdf PDF
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Non-Competitive_Oversight_Committee_Justification_Form.docx DOCX document
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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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