Resolution No. 2026-035 – A Resolution Approving the Plans, Specifications, Form of Contract and Estimate of Costs for the Village Drive and Roberts Ferry Road Traffic Signal Project — I.2 (G.2)

Statement of Bidder’s Qualifications Form The lowest responsive bidder for the listed Project shall submit a fully completed written statement on this form sworn to before an officer authorized by law to administer oaths. The Contractor shall be bound by the information set forth in the statement. Failure to submit a fully completed and accurate Statement of Bidder’s Qualifications Form by the lowest responsive bidder may result in the Proposal being deemed non-responsive and may result in the Proposal being rejected. Instructions 1. All Questions must be answered completely and correctly. 2. Do not leave blanks. 3. If a question or section is not applicable, write “Not Applicable” or “N/A”. 4. “Information Provided Upon Request” or similar responses are not acceptable. 5. If you need additional space to complete an answer, use a separate piece of paper and attach it to this form. Project Information Project Name: Roberts Ferry Road & Village Drive Traffic Signal Improvements Owner’s Name: City of Tiffin Owner’s Address: 300 Railroad Street, Tiffin, Iowa 52340 Contractor Information 1. Identification A. Name of Organization: B. Name and Title of Responsible Individual: C. Contractor’s Address: D. Telephone Number: E. Fax Number: F. Email: Statement of Bidder’s Qualifications SBQ-1 Roberts Ferry Road & Village Drive Traffic Signal Improvements