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CERTIFICATION OF VENDOR’S QUALIFICATIONS

All applicable questions must be answered and included with the RFP. The data given must be clear and comprehensive. A copy of the Vendor’s State of Maryland Construction Firm License or required applicable license shall be attached to this form. Information concerning this license can be obtained from Cecil County Clerk of the Court’s Office at (410) 996-5373. You can also receive information necessary for corporations to do business in the State of Maryland from the State of Maryland Sales and Use Tax Division. Ask for a Corporation Qualifying Package at (410) 225-1340. All vendors shall ensure they are qualified to do

business within Maryland must within the State (410)-767-1170.

the State of be qualified of Maryland.

Maryland. Businesses as a Foreign Business

established outside the State of to be eligible to provide service

Questions concerning Foreign Businesses may be referred to

  • 1.

    Name of Contract: Wastewater Rate Model and Report

  • 2.

    Contract No.: RFQ #10-01

  • 3.

    Name of Vendor:_______________________________________________

  • 4.

    Vendor’s Federal Employee I.D. No.:_______________________________

  • 5.

    State of Maryland Construction Firm License No.:____________________

  • 6.

    State of Maryland Control No.:___________________________________

  • 7.

    Business Address: ___________________________________________

___________________________________________

  • 8.

    When Organized:_____________________________________________

  • 9.

    Where Incorporated:___________________________________________

  • 10.

    Foreign Business No.: _________________________________________

  • 11.

    Has the Vendor paid any sales tax on the equipment to be used on the project?

Yes

_______________No

__________________

  • 12.

    If so, at what rate was the sales tax paid? __________________________ _____________Percent to State of_______________________________

  • 13.

    How many years has the bidder been engaged in this business under your present firm name?___________________________________________

  • 14.

    Have you ever refused to sign a contract at your original RFP/Bid?

Yes_____________No_______________ 15. Have you ever defaulted on a contract? Yes No ____________ ________________ Remarks: ___________________________________________________ 16. Will you, upon request, furnish any other pertinent information that Cecil

County Government may require? Yes No ____________ __________________ 17. Does your business maintain a regular place of business in the State of Maryland (Resident) _______ or would your business be considered Non-Resident ______? 18. Has the vendor or firm ever been disbarred, suspended or otherwise prohibited from

doing work with the federal government. Yes ____ No ____ ( I f y e s , e x p l a i n _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ )

With the submission of this certification, the bidder thereto certifies that the information supplied is, to the best of your knowledge, accurate and correct.

Dated this

_________

day of

_________________, 2009.

_________________________ (Name of Vendor)

B y : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Title:

______________________

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