Qualifications of General Contractor

Instructions: Qualification forms must be completed and electronically submitted by an authorized officer of the appropriate development team's organization. Submit this completed qualification form to mhfa.app@state.mn.us through the Partner Login on Minnesota Housing’s website.

General Contractor Information	
Full Legal Name of General Contractor (Firm)	     	
Address	     	
City, State, Zip	     ,      ,      	
Website 	     	
Telephone Number	     	
Fax Number (if available)	     	
Contact Person	     	
Contact Person Email Address	     	

1.	Legal status of firm:
		Individual		Corporation
		Partnership		Other (Specify):      

2.	If not an individual, the firm was organized on       [month and year] and under the laws of the state of      .

3.	If an out-of-state corporation, is the corporation authorized to do business in Minnesota:	 Yes  No

4.	Is the organization at least 51% led or owned by a woman or women? 	 Yes  No

5.	Is the organization at least 51% owned by a person or people who are Black, Indigenous, or people of color*? 
* Includes Native and Indigenous North and South American, Black and African-descent, Hispanic or Latinx, Asian and Pacific Islander, and other non-white communities.	 
 Yes   No

If other, state:      

6.	In the table that follows, list principals of the firm, names and addresses of partners, officers, directors and those who hold or control 10% or more of any class of stock, directly or indirectly: 

Principal Name	Residence Address	Title	% Interest	
     	     	     	     	
     	     	     	     	
     	     	     	     	
     	     	     	     	
Total Percentage			100%	

7.	List which construction trades are generally performed directly by the firm's own employees. If none, state.
     

8.	With respect to any profit or fee to be earned by the firm for construction of the housing development, the undersigned hereby certifies that neither the firm, nor any partner, director, stockholder, officer, employee, or agent associated with the firm, nor any person, firm, or corporation having a financial interest in the affairs of the firm, has agreed, directly or indirectly, or with the firm’s knowledge and consent, will agree, directly or indirectly, to give to any other party any part of said profit or fee as a rebate, refund or commission of any kind or nature, except as disclosed in this form. If none, state.
     

9.	Has the firm or any of its principals, ever started a construction job that was completed by another general contractor?	 Yes  No
If yes, provide details:
     

10.	Has the firm, or any of the principals, ever been convicted of any crime or offense except traffic violations? 
	 Yes  No
If yes, provide details (offender, nature of crime or offense, date and location): 
     

11.	Has the firm previously been debarred? 	 Yes  No
If yes, provide details: 
     

12.	In answering the following questions, the term principal also includes any other firm in which such person participated as principal.
a.	Have any of the principals ever filed a petition of involuntary bankruptcy? 	 Yes  No
b.	Has there ever been a petition of involuntary bankruptcy filed against the firm 
and/or any of the principals? 	 Yes  No
c.	Has the firm and/or any of the principals ever made an assignment for the benefit of creditors? 
 Yes  No
d.	Are there any unsatisfied judgments against the firm and/or any of the principals? 	 Yes  No
e.	Has the firm or any of the principals been a party to any litigation within the last five years? 	
 Yes  No
f.	If yes to any of the questions in #12, provide details: 
     

13.	Is the general contractor (firm) able to obtain 100% Payment and Performance Bonds for constructing? 
	 Yes  No
If yes, name of bonding company to be used: 
     

14.	Does the firm have experience implementing and incorporating Section 3 and federal labor standards/federal cross-cutting requirements?	 Yes  No
     

I,      , hereby certify that the information set forth, and in any supporting attachments, is true, correct, and complete to the best of my knowledge and belief.

     		     	
Name of General Contractor		Signature 	
			
     	     	     	
Printed Authorized Signatory	Title of Authorized Signatory	Date 	

	Multifamily General Construction Experience	

Instructions: Complete the following, describing current and completed developments constructed by the firm and/or its principals. If you have the information requested below is available in a separate document, you may submit your existing document instead of using the form that follows. 

Name and Address of Development	Name and Address of Developer	# of Units	Construction Cost	Date Completed or % of Construction Complete 
To-Date	List Various Building Types and Number of Stories	Type of Financing (Conventional, Federal or State Agency)	Role of Firm and/or Principal