Qualifications_25-0354.pdf

BID SUBMITTAL FORM

PINELLAS COUNTY PURCHASING AND RISK MANAGEMENT ITB –SIMPLIFIED CONSTRUCTION REVISED: 03-2020

Bid # 25-0354-ITB-C Bid Title: County-Wide Roofing Replacement and Repair

QUALIFICATION SUBMITTAL FORM

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. Please provide the following documentation and include with Qualification Submittal Forms due by Step 1 due date listed on page 1.

1. Provide copies of any and all Occupational Safety and Health Administration (OSHA) Inspection Reports involving your company.]

2. Bidders must be provide proof company is a licensed Certified Roofing Contractors and an insured entity, registered with the State of Florida. Individual Supervisors and Roofing Technicians must possess a valid State of Florida Roofing Contractor License. Proof of current licenses must be submitted with bid.

3. Provide a list of any subsidiaries your Company owns or is affiliated with. List name of company, full address, phone number, officers and directors of Company. Information provided must contain the first, middle and last name as well as date of birth. If verification cannot be obtained we may require a social security number.

4. Is your company owned by, or an affiliate of, a parent company? Please list the names and addresses of those officers and directors. Information provided must contain the first, middle and last name as well as date of birth. If verification cannot be obtained we may require a social security number.

5. Provide a list of all officers and directors of your company including addresses. Information provided must contain the first, middle and last name as well as date of birth. If verification cannot be obtained we may require a social security number.

6. If your company is publicly owned, provide detailed information on any occurrences or potential occurrences of a default.

7. Provide detailed information on any and all bankruptcy filings for your company. Specify the jurisdictions for all such filings.

8. Provide information on any and all lawsuits, litigation, judgments, verdicts, settlements, etc., involving your company and the owners of any projects that your company has been involved in, as follows:

a. Any and all Federal, State and/or Local lawsuits involving your company and the owners of any projects your company has been involved in, for the last three (3) years;

b. Any and all pending or recently filed litigation involving your company and the owners of any projects your company has been involved in. Specify the jurisdictions the litigation was filed in.

c. Any and all judgments involving your company and the owners of any projects your company has been involved in.

Specify the jurisdictions the judgment occurred in.

d. Any and all verdicts or settlements involving your company and the owners of any projects your company has been involved in. Specify the jurisdictions the verdicts or settlements occurred in.

QUALIFICATION SUBMITTAL FORM

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