Attachment “A”
Required Submission Documents
Macon‐Bibb County
Summary of Attachment “A” Required Documents
• Bidder Qualification Form
• List of Sub‐Contractors
• Bidder Minority Participation Goal
• Financial & Legal Stability Statement
• Insurability Statement
• Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion
• Non‐Collusion Affidavit
• Macon‐Bibb County Vendor Application
• Form W‐9
• E‐Verify Affidavit
Attachment “A”
Required Submission Documents
BIDDER QUALIFICATION FORM
Company Name: ______________________________________________________________________
Address: ____________________________________________________________________________
When Organized: ______________ Where Incorporated: __________________________________
How many years have you engaged in business under the present firm name? _____________________
Credit available for this contract? ________________________________________________________
Contracts now in hand? ________________________________________________________________
Has bidder ever refused to execute a contract at the original bid amount? _________________________
Has bidder ever been declared in default on a contract? _______________________________________
Comments: __________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Company Name: _____________________________________________________________________
Authorized By (typed name): ____________________________________________________________
Authorized Signature: _________________________________________________________________
Title: ________________________________________ Date: ________________________________
References
Following is a reference list of contracts that are similar to this project:
NAME OF PROJECT/DATE
LOCATION
CONTACT
PHONE #
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SUBSCRIBED AND SWORN
BEFORE ME ON THIS THE
______ DAY OF __________________, 202___
_____________________________________
Notary Public
My Commission Expires: _________________
[NOTARY SEAL]
Attachment “A”
Required Submission Documents
LIST OF SUB-CONTRACTORS
I do , do not , propose to sub-contract some of the work on this project. I propose to sub-contract
work to the following contractors.
NAME/ADDRESS
TYPE OF WORK
% of Contract
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Contractor Name
Attachment “A”
Required Submission Documents
BIDDER MINORITY PARTICIPATION GOAL
(Attach additional pages if required.)
I do , do not , propose to employ the minority sub-contractors as listed below on some of the work
on this project.
NAME/ADDRESS
TYPE OF WORK
% of Contract
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Contractor Name
Attachment “A”
Required Submission Documents
FINANCIAL & LEGAL STABILITY STATEMENT
Please check appropriate item(s):
__ Firm has the financial capability to undertake the work and assume the liability required if awarded this solicitation.
__ Firm has the legal capability to undertake the work and assume the responsibilities required if awarded this solicitation.
Pending litigations (if any) will not affect the firm’s ability to perform on this contract, if awarded.
Company Name: ____________________________________________________________________________
Authorized By (typed name): ___________________________________________________________________
Authorized Signature: ________________________________________________________________________
Title: ________________________________________ Date: _______________________________________
SUBSCRIBED AND SWORN
BEFORE ME ON THIS THE
_____ DAY OF _________________, 202___ My Commission Expires: _____________
____________________________________
Notary Public
[NOTARY SEAL]
This is the opportunity summary page. It provides an overview of this opportunity and a preview of the attached documentation.