QUALIFICATION_SUBMITTAL_FORM_Non_FDOT.pdf
PDF 289 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 for a non-FDOT prequalified contractor bidding on the Palm Harbor Recreation Center Addition project with Pinellas County, Florida. The project involves the construction of a 28,000 square foot recreation center to replace an existing facility next to the Senior Centre on 16th Street in Palm Harbor. The two-step qualification and bidding process requires Step 1 submission by November 11, 2025, and Step 2 submission by November 20, 2025. A non-mandatory site visit and pre-bid conference are scheduled for October 29, 2025, with bidder questions due 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 delays. The new facility will serve dual purposes as a community recreational space and an American Red Cross-compliant hurricane shelter with capacity for up to 800 general population shelter spaces.
Contractors must meet specific qualification requirements to advance from Step One to Step Two, including submission of a bonding letter indicating maximum bonding capacity, completion of the OpenGov Fillable form, detailed experience documentation for projects of similar size and scope, and a minimum of three reference letters from previous clients. Bidders must provide vendor information including firm name and address, officer/director information with dates of birth, and detailed documentation of at least four similar past projects, including project descriptions, owner contact information, project managers, award amounts, final project totals, design professional estimates, change orders, and scheduled versus actual completion dates. The project has a 15% Small Business Enterprise (SBE) participation goal for subcontractors, and all bidders must comply with E-Verify requirements, specific insurance specifications, and local and state regulations. Failure to meet any of the mandatory qualification conditions will result in disqualification from Step Two.
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Text version
QUALIFICATION SUBMITTAL FORM
STEP 1
PART A
The invitation to bid for this Project requires that this qualification submittal be included with the proposal and completed in its entirety. There is no FDOT prequalification for this invitation to bid.
PART B
The invitation to bid for this Project requires that this qualification submittal be included with the bid and completed in its entirety.
A component of the Pre-Qualification of Bidder process is background check and review.
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 indicating the maximum amount your company can bond for.
2. Please complete and return the OpenGov Fillable-Final.
3. Provide your experience on Qualification Submittal Forms below outlining projects of a similar size and scope.
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 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 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
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:
Notes:
Officer/Director/Member: Title: DOB:
Notes:
Officer/Director/Member: Title: DOB:
Notes:
Officer/Director/Member: Title: DOB:
Notes:
Officer/Director/Member Title: DOB:
Notes:
Additional Information: (On Vendor or Contract Requirements)
QUALIFICATION FORMS – BID SUMMARY
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:
Printed Name
TREASURER ADDRESS:
Printed Name
QUALIFICATION FORMS – BID SUMMARY
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:
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
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