QUALIFICATION_SUBMITTAL_FORM_FDOT.pdf
PDF 110 KB Posted
- Attached to
- FY 2024 Pavement Preservation Package 1
- Solicitation number
- 23-0831-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
The Qualification Submittal Form is a document prepared by the Florida Department of Transportation (FDOT) for the FY 2024 Pavement Preservation Package 1 in Pinellas County, Florida. The form is designed for contractors to demonstrate their qualifications and eligibility to bid on the project, which involves milling and resurfacing approximately 25 miles of roadway, including one arterial and three local neighborhood projects. Contractors must complete either Part A (if pre-qualified with FDOT) or Part B (if not pre-qualified), providing detailed information about their company, work types, project experience, and references.
The qualification submittal requires extensive documentation, including a bonding letter or parent guarantee, the OpenGov Fillable-Final form, and details of four similar past projects. Contractors must specify their qualified work types, which include options such as bascule bridge, bridge repair, building, electrical, road/street work, and others. The form mandates submission of contact information for project owners and managers, project award and final amounts, design estimates, change orders, and scheduled/actual completion dates. Failure to meet any of the specified conditions will result in disqualification from moving forward in the bidding process.
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Text version
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 PART A and 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.
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)
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