QUALIFICATION_SUBMITTAL_FORM.pdf

QUALIFICATION SUBMITTAL FORM

STEP 1

Part A

If you are currently a pre-qualified construction contractor with FDOT in the applicable work type, please check box and fill out OpenGov Fillable-Final and return with signed Part A pages below.

I am Pre-qualified with FDOT in one or more of the work class(s) as referenced in the Special Conditions Section.

Signature by Contractor for Part A Only: ___________________________________________________

If you are not pre-qualified with FDOT, please complete PART B and include all Qualification Forms.

Part B

Applicable only for contractors who are not pre-qualified with FDOT in in one or more of the work class(s) as referenced in the Special Conditions Section.

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

A component of the Pre-Qualification of Bidder process is background check and review. If you are not currently pre-qualified with FDOT 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 or a letter of parent guarantee indicating at a minimum the maximum amount of the budget estimate referenced in the Notice Section.

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

3. Confirm Project Work Type(s) (outlined below – check appropriate box(es)

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

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

Work Types your company is qualified to perform - *Check all boxes that apply

Project Work Types

Bascule Bridge Fixed Bridge Roofing

Bridge Repair Marine Well Drilling

Building Mechanical Water and Sanitary Sewer

Electrical Road, Street, Storm Sewer

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

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.

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

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)

Project 2 (of similar type) Description

Project Manager - Contact Information

Address

Telephone Number and Email Address:

Project Award Amount: $

Final Project Total Amount: $

Design Professional/Engineer

Project 3 (of similar type) Description

Project Manager- Contact Information

Address

Telephone Number and Email Address:

Project Award Amount: $

Final Project Total Amount: $

Design Professional/Engineer

Project 4 (of similar type) Description

Project Manager- Contact Information

Address

Telephone Number and Email Address:

Project Award Amount: $

Final Project Total Amount: $

Design Professional/Engineer

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:

SSN:

Notes:

Officer/Director/Member

Additional Information: (On Vendor or Contract Requirements)