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' CITY OF EVERETT PUBLIC WORKS DOCUMENT 00 45 13 <br /> SPECIAL PROVISIONS BIDDER QUALIFICATION STATEMENT <br /> DOCUMENT 004513—BIDDER QUALIFICATION STATEMENT <br /> 1.1 GENERAL <br /> ' A. Fill out the following information: <br /> ' PROJECT NAME: PSO6 REROUTE(WO#UP3583) <br /> DATE: <br /> 1 <br /> BIDDER NAME: <br /> ADDRESS: <br /> 1 <br /> TELEPHONE: <br /> EMAIL: <br /> ' B. IF BIDDER IS USING A TIEBACK SUBCONTRACTOR,LIST THAT <br /> SUBCONTRACTOR'S NAME AND ADDRESS: <br /> ' C. The Bidder must document that the Bidder meets the Supplemental Responsibility Criteria in <br /> the Supplementary Instructions to Bidders (DOCUMENT 002213). The Bidder should provide <br /> additional sheets to fully describe referenced projects and experience. <br /> 1 <br /> 1. The Supplementary Instructions to Bidders (DOCUMENT 002213) states that the Bidder <br /> must have successfully completed at least 5 Similar Projects with 10 years prior to bid <br /> opening. The Bidder may count Similar Projects successfully completed by its Tieback <br /> ' Subcontractor to fulfill this requirement. List the Similar Project's that show this <br /> experience. <br /> PROJECT NAME YEAR OWNER LOCATION <br /> 1) <br /> 1 2) <br /> 3) <br /> ' 4) <br /> ' 5) <br /> 2. A brief description of each project and a reference from the Owner shall be included for <br /> each project listed. As a minimum, the reference shall include an individual's name and <br /> current phone number. <br /> 3. Furnish references for information concerning all work listed above. <br /> 4. If the project listed is a project successfully completed by the Tieback Subcontractor and <br /> ' not Bidder,identify it as such and state the dollar amount of the subcontract. <br /> PSO6 REROUTE 004513 - 1 <br /> WO NO.—UP3583 MAY 2016 <br />