BONUS PROJECT
JOROBALEM COSAM
STATEMENT OF BIDDER QUALIFICATION
All questions must be answered and data given must be clear and comprehensive. This statement
must be notarized. If necessary, questions may be answered on separate attached sheets. The
bidder may submit any additional information s/he desires.
1. Name of the bidder_______________________________________________________
2. Permanent main office address______________________________________________
3. Permanent e-mail address and contact phone number
_______________________________________________________________________
4. When organized__________________________________________________________
5. How many years engaged in the business related to this project under present
name___________________________________________________________________
6. General type of work performed by your company
_______________________________________________________________________
7. Have you ever failed to complete any work awarded to you? If so, where and why? Give
name of the owner
________________________________________________________________________
________________________________________________________________________
8. Have you ever defaulted on a contract? If so, where and why? Give name of the owner?
________________________________________________________________________
________________________________________________________________________
9. Have you ever sued an owner of a project? If so, where and why? Give name of the
owner. __________________________________________________________________
10. Have you ever sued a consultant or subcontractor representing the owner of a project? If
so, where and why? Give name of the owner
________________________________________________________________________
11. Have you ever been terminated by the owner of a project? If so, where and why? Give the
name of the owner ________________________________________________________
12. List of equipment that would be available for use on this project
________________________________________________________________________
________________________________________________________________________
13. Background and experience of the principal members of your organization
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
14. Give bank references
________________________________________________________________________
______________________________________________________________
15. Will you, upon request, fill out a detailed financial statement and furnish any other
pertinent information that may be required by JOROBALEM COSAM? _____________
16. The undersigned hereby authorizes and requests any persons, firms, or corporation to
furnish any information requested by JOROBALEM COSAM in verification of the
recitals comprising this Statement of Bidder’s Qualifications.
Dated at _________________________________, this_______ day of_______ 20_____
_____________________________________________by: ______________________
(Contractor)
Title_________________________
State of ________________________
County of ______________________
________________________________, being duly sworn deposes and says s/he is
______________ of ________________________________ and that the answers to the
foregoing questions and all statements therein contained are true and correct.
SBSCIBED AND SWORN to before me this ___________ day of _________, 20_____
___________________________________
Notary Signature
____________________________________
Notary Printed Name
NOTARY PUBLIC , STATE OF_________
My commission expires:
______________________, 20___________