Purchasing Department

Responsible Bidder Program Qualification Form

Instructions: Complete all portions of this form and submit it. A completed qualification form must be on file. You must complete all sections of this Qualification Form in order to be evaluated.

Qualification will be good for 1 year from date of approval. Contractor must maintain qualification status during any and all projects awarded by the County.

Owner: Kalamazoo County Purchasing Department,

Section 1 - General Information

Is your organization or any of its parent or subsidiary organizations currently indebted to the State of Michigan or Federal Government?   

Section 2 – Bonding and Liability Insurance

Can your firm provide both L&M and Performance Bonds, if applicable to your profession?     
Can your firm provide Commercial General Liability insurance, at a minimum, at least one million dollars per occurrence?   
For Professional Services, can your firm provide Errors and Omissions at least one million dollars per occurrence?     

(Bonding Company’s rating must be “B+” or better for firm to constitute a qualified bidder)

Has any commercial surety ever refused to furnish a performance or payment bond for your firm?   

Section 3 - Miscelaneous Questions

Has Firm ever failed to complete a contract or any work awarded to it?   
Has Firm ever been involved in bankruptcy or re-organization?   
Are there any judgments, claims, arbitration proceedings, mediations or suits pending or outstanding against the Firm or any of its officers?   
Have there been any judgments, claims, arbitration proceedings, mediations or suits filed and/or asserted against the firm or any of its officers within the last five years?   
Has the firm ever had a contract terminated by a Project Owner or Contractor for cause?   
Has the Firm filed any lawsuits or requested arbitration with regard to any construction contract within the last five years?   
Has this Firm, within the last five years, been denied qualification for any Project or by any Project Owner, or been found to be non-responsive to perform, or bid on, any project?   
Does this firm provide workers' compensation insurance benefits to its employees?   
Is Firm in compliance with all EEO requirements?   
Is Firm in compliance with Kalamazoo County's non-discrimination policy? Assurance that the bidder is an opportunity employer and does not discriminate on the basis race, color, sex, age, religion, national origin, marital status, a person’s political affiliation, sexual orientation or gender identity, height, weight, disability, genetic information, or any other legally protected status.   
Is Firm in compliance with all the requirements of the Americans with Disabilities Act?   
Is Firm in compliance with all the Rules and Regulations of the Immigration and Naturalization Service?   
Is Firm in compliance with all pertinent state laws regarding licensing and registration?   
Will the firm confirm that all sub-contractors, employees and other individuals working on the construction project will maintain current applicable licenses with the Michigan Bureau of Construction Codes and Fire Safety and as may otherwise be required by law for all licensed occupations and professions?   
Will the firm verify that no illegal non-US citizens will work on the project nor will the fraudulent use of the federal government’s H2B visa program for immigrant construction workers be allowed?   
Will the firm conduct criminal records check for each employee the bidder proposes to use on the construction site?   

Section 4 - Insurance

Experience Modification Rating for past 3 Years

Note: An applicant whose three year EMR average rating exceeds 1.0 will not be considered for qualification status. Your three year EMR average must be 1.0 or below to be considered for qualification status.

Section 5 - Safety

Does your Firm have a written Safety Program?   
Does your Firm have a Drug Testing Program?   
In the Previous 5 years has your firm ever been:
Debarred by any federal, state, or local government agency?   
Been cited by MIOSHA or OSHA for not being in compliance with MIOSHA or OSHA regulations, rules, or practices?   

SECTION 6 - DBE Status

Is your firm a certified DBE?   

Geographic Area of Firm’s Operation and Class:

Geographic Area 1
Geographic Area 1 M-DBE   
Geographic Area 1 W-DBE   
Geographic Area 1 DS-DBE   
Geographic Area 2
Geographic Area 2 M-DBE   
Geographic Area 2 W-DBE   
Geographic Area 2 DS-DBE   
Geographic Area 3
Geographic Area 3 M-DBE   
Geographic Area 3 W-DBE   
Geographic Area 3 DS-DBE   
Geographic Area 4
Geographic Area 4 M-DBE   
Geographic Area 4 W-DBE   
Geographic Area 4 DS-DBE   

SECTION 7 – Qualification Categories

Please check category/categories for which your firm is seeking Qualification:   


A statement of determination of the number of Kalamazoo County residents that each contractor/sub-contractor employs or expects to employ on the project; and (b) what percentage of their workforce can be drawn significantly from area residents because it’s a goal of the County to utilize, in its construction activities, local residents as much as is economically feasible while retaining the high quality of construction required for its construction activities. The County will consider, in evaluating which bids best serve the interest of the County, the extent to which bidders are able to achieve this goal.

A statement regarding the bidder’s staffing capabilities and labor sources including subcontractors and a verification from the bidder that construction workers will not be misclassified, nor will independent contractors be used on site in violation of state and federal law.

Documentation of an on-going MIOSHA-approved safety-training program for employees used on the proposed job site and any contractor performing work on or around electrical equipment shall implement a NFPA 7OE training program as required by OSHA, to prevent workplace injuries and fatalities due to shock, electrocution, arc flash, and arc blast.

A list of the bidder’s last three contracts, including dates, clients, approximate dollar value, and size. Documentation from these previous projects, including but not limited to all costs relating to the bidder’s timeliness, performance, quality of work, extension requests, contractual fines and penalties imposed (including proof of such fines and penalties), liens filed, history of claims for extra work and any contract defaults with an explanation of the reason for the default and how the default was resolved.

Information on any apprenticeship training programs utilized by the bidder, if apprentices are used on the job site.

Information regarding if the bidder maintains, participates in, and has a membership with/in any trade association or organization involved with training and safety classes.

Evidence of experience with construction techniques, trade standards, quality workmanship, project scheduling, cost control, management of projects of comparable size/complexity, and building codes by documenting the bidder’s ability and capacity to perform the project. The bidder must identify those portions of the project it reasonably believes will be sub-contracted in the names of the sub-contractors.

Evidence that the applicant has financial resources to start up and follow through on the project(s) and to respond to damages in case of default as shown by written verification of their bonding capacity. The written verification must be submitted by a licensed surety company rated (“B+” or better) in the current A.M. Best Guide and qualified to do business within the State of Michigan.

Ability to provide references from individuals or entities the bidder has worked for within the last five (5) years including information regarding the records of performance and job site cooperation.

Statement as to whether the bidder provides health insurance and retirement benefits to its employees and ability to provide documentation upon request.

Evidence of any quality assurance program used by the bidder and the results of any such program on the bidder’s previous projects.

A warranty statement regarding labor and material.

Assurance that all construction work for this project shall proceed economically, efficiently, continuously and without interruption.

Contractor Affidavit

I being duly sworn, deposes and says that the information provided herein is true and correct, and substantially complete so as not to be misleading. I also agree that if any incorrect or misleading information is provided herein it is grounds for disqualification, at the sole election of the Owner.

You have input errors you must correct before continuing. Please check all of the highlit fields above.