Scdot Form Ca 3 PDF Details

Scdot form CA 3 is a document used by the South Carolina Department of Transportation (SCDOT) to obtain reimbursement for costs associated with the construction or repair of state highways. This form helps ensure that all proper procedures are followed, and allows SCDOT to efficiently process reimbursable expenses. If you are involved in any type of road-related project within South Carolina that requires funding from SCDOT, it's important to be familiar with this form. In this blog post, we'll provide an overview of what Scdot form CA 3 involves, its purpose and instructions on how to fill it out correctly.

QuestionAnswer
Form NameScdot Form Ca 3
Form Length5 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 15 sec
Other namesJoint_Venture_P requalification scdot employee email login form

Form Preview Example

Direct Questions To:

Jeffrey O. Elliott

Contract Administration Engineer

Phone: 803-737-1253

Fax: 803-737-2264

E-mail: ElliottJO@scdot.org

1. JOINT VENTURE

JOINT VENTURE NAME:

OFFICE ADDRESS:

CITY:

MAILING ADDRESS:

CITY:

CONTACT PERSON:

TELEPHONE:

E-MAIL ADDRESS:

 

Return To:

 

Director of Construction

 

SCDOT Room 330

SOUTH CAROLINA DEPARTMENT OF TRANSPORTATION PO Box 191

JOINT VENTURE

Columbia, SC 29202

 

PREQUALIFICATION

 

APPLICATION

 

 

 

 

 

 

 

 

 

 

STATE:

 

ZIP:

 

 

 

 

 

 

 

 

 

 

 

 

STATE:

 

ZIP:

 

 

 

 

 

 

 

 

 

 

 

FAX:

2. COMPANIES FORMING THE JOINT VENTURE

CONTRACTOR NO. 1 :

MAILING ADDRESS:

CITY:

TELEPHONE:

E-MAIL ADDRESS:

CURRENT EMR:

CONTRACTOR NO. 2:

ADDRESS:

CITY:

TELEPHONE:

E-MAIL ADDRESS:

CURRENT EMR:

STATE:

 

ZIP:

 

 

 

FAX:

EFFECTIVE DATE:

STATE:

 

ZIP:

 

 

 

FAX:

EFFECTIVE DATE:

If there are more than 2 contractors forming the Joint Venture, attach a page with the information requested above for each of the additional Contractors.

SCDOT Form CA-3, July 1, 2014

Page 1 of 5

3.Is the joint venture or any of the companies forming the joint venture presently suspended, disqualified, debarred, or prohibited from working or bidding with SCDOT, or any Federal, State, County, Municipal or other government agency?

YES

NO

If YES, attach a page with details that include: what agency, when, for what reason, who was involved, were there any penalties or fines assessed, and what was the result.

4.Does the joint venture or any of the companies forming the joint venture owe delinquent taxes to the State of South Carolina or any County, or Municipality in South Carolina?

YES

NO

5. If the Joint Venture intends to bid on projects where Bridge Cleaning and Painting is a major portion of the work, answer questions a & b below: otherwise, skip to question 6.

a. Does any Contractor forming the Joint Venture have a current SSPC-QP1 Certificate?

YES

NO

If YES, provide a copy of the certificate with this application.

b. Does any Contractor forming the Joint Venture have a current SSPC-QP2 Certificate?

YES

NO

If YES, provide a copy of the certificate with this application.

6.In the table below, provide the names of people who are authorized to approve, sign, and execute documents on behalf of the Joint Venture. Use Document Type Codes from the list below.

Document Type Code Nos.:

1 - Organization's Statement of Experience and Equipment

2 - Bid Proposals, Contracts, and Bonds

3 - Change Orders/Supplemental Agreements

4 - Force Account Agreements

There must be AT LEAST ONE (1) individual for each Document Code.

NAME

CONTRACTOR

DOCUMENT

CODE

SCDOT Form CA-3, July 1, 2014

Page 2 of 5

AFFIDAVIT

ONE OFFICER FROM EACH OF THE CONTRACTORS FORMING THE JOINT VENTURE, BEING DULY SWORN, DEPOSES AND SAYS THAT HE/SHE IS AUTHORIZED TO EXECUTE THIS AFFIDAVIT FOR AND ON BEHALF OF, AND TO BIND THE APPLICANT JOINT VENTURE AND THEIR INDIVIDUAL COMPANY, AND THE ANSWERS TO THE FOREGOING QUESTIONS, AND FURTHER THAT ALL STATEMENTS HEREIN CONTAINED, ARE TRUE AND CORRECT TO THE BEST OF HIS/HER KNOWLEDGE.

(1)

 

 

 

 

Print Name

 

 

 

 

 

Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature

 

 

 

 

 

Company

 

 

 

 

 

 

(2)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Print Name

 

 

 

 

 

Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature

 

 

 

 

 

Company

 

 

 

 

 

 

(3)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Print Name

 

 

 

 

 

Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature

 

 

 

 

 

Company

 

 

 

 

 

 

(4)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Print Name

 

 

 

 

 

Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature

 

 

 

 

 

Company

 

 

 

 

 

 

 

 

 

Notary for Signatory (1)

 

Notary for Signatory (2)

 

 

Notary for Signatory (3)

 

 

Notary for Signatory (4)

 

 

Subscribed and sworn to before me

 

Subscribed and sworn to before me

 

Subscribed and sworn to before me

Subscribed and sworn to before me

 

 

on

day of

, 20

 

on

day of

, 20

 

on

day of

, 20

 

 

on

day of

, 20

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature of Notary Public

 

 

Signature of Notary Public

 

Signature of Notary Public

 

 

Signature of Notary Public

 

 

 

 

 

of

 

County

 

of

 

County

of

 

County

of

 

County

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State of

 

 

State of

 

 

State of

 

 

State of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

My Commission Expires:

 

 

My Commission Expires:

 

 

My Commission Expires:

 

 

 

My Commission Expires:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SCDOT Form CA-3 July 1, 2014

Page 3 of 5

ACKNOWLEDGEMENT of the

SCDOT CONTRACTOR PERFORMANCE EVALUATION

POLICIES and PROCEDURES

By signing this form as an authorized representative of the Joint Venture Contractor named below, I have read and fully understand and acknowledge the SCDOT Contractor Performance Evaluation Policies and Procedures document posted on the SCDOT Internet website; and further, that I fully understand its impact on the Joint Venture Contractor's ability to bid on SCDOT construction projects.

(Print the Name of the Joint Venture Contractor)

(Print the Name of the Joint Venture Representative)

(Print the Title and Company Name of the Authorized Representative)

(Signature of the Authorized Representative)

Subscribed and sworn to before me

NOTICE: Notary cannot be an Officer of any of the companies forming the Joint Venture.

on _________________________________ 20___

_________________________________________

Signature of Notary

Notary Public

of ________________________________ County

State of __________________________________

My Commission Expires:

on _________________________________ 20___

SCDOT FORM CA-3, July 1, 2014

Page 4 of 5

ACKNOWLEDGEMENT of the

JOINT VENTURE CONTRACTOR' S RESPONSIBILITIES

IF THERE IS ANY CHANGE TO THE INFORMATION PROVIDED IN THIS APPLICATION AFTER IT HAS BEEN SUBMITTED, IT IS THE SOLE RESPONSIBILITY OF THE JOINT VENTURE CONTRACTOR TO SUBMIT A WRITTEN DOCUMENT ADVISING THE DIRECTOR OF CONSTRUCTION'S OFFICE OF THE CHANGE WITHIN FIFTEEN (15) DAYS OF THE OCCURRENCE OF THE CHANGE.

IT IS THE SOLE RESPONSIBILITY OF THE JOINT VENTURE CONTRACTOR TO RENEW ITS PREQUALIFICATION BEFORE THE EXPIRATION DATE OF THE CURRENT CERTIFICATE.

By signing this form as an authorized representative of the Joint Venture Contractor, I acknowledge and accept the responsibilities stated above on behalf of the Joint Venture Contractor named below:

(Print the Name of the Joint Venture Contractor)

(Print the Name of the Joint Venture Representative)

(Print the Title and Company Name of the Authorized Representative)

(Signature of the Authorized Representative)

Subscribed and sworn to before me

NOTICE: Notary cannot be an Officer of any of the

Companies forming the Joint Venture.

on _________________________________ 20___

_________________________________________

Signature of Notary

Notary Public

of ________________________________ County

State of __________________________________

My Commission Expires:

on _________________________________ 20___

SCDOT FORM CA-3, July 1, 2014

Page 5 0F 5

How to Edit Scdot Form Ca 3 Online for Free

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This document requires some specific details; in order to ensure accuracy and reliability, you need to take into account the guidelines down below:

1. Before anything else, when filling out the Scdot Form Ca 3, start with the area with the following fields:

Filling in section 1 of Scdot Form Ca 3

2. Once your current task is complete, take the next step – fill out all of these fields - CONTRACTOR NO, MAILING ADDRESS, CITY, TELEPHONE, EMAIL ADDRESS, CURRENT EMR, EFFECTIVE DATE, CONTRACTOR NO, ADDRESS, CITY, TELEPHONE, EMAIL ADDRESS, STATE, ZIP, and STATE with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Filling out section 2 of Scdot Form Ca 3

3. This next portion will be about Is the joint venture or any of, YES, If YES attach a page with details, Does the joint venture or any of, YES, If the Joint Venture intends to, work answer questions a b below, a Does any Contractor forming the, YES, If YES provide a copy of the, b Does any Contractor forming the, YES, If YES provide a copy of the, In the table below provide the, and on behalf of the Joint Venture Use - type in all these blank fields.

The best way to fill out Scdot Form Ca 3 portion 3

4. Now fill out this fourth segment! Here you've got all of these NAME, CONTRACTOR, CODE, SCDOT Form CA July, and Page of blank fields to fill in.

Filling out part 4 in Scdot Form Ca 3

A lot of people often get some points incorrect when completing CONTRACTOR in this area. You need to reread everything you enter right here.

5. This very last section to complete this document is integral. You need to fill in the mandatory blanks, for example Print Name, Signature, Print Name, Signature, Print Name, Signature, Print Name, Title, Company, Title, Company, Title, Company, and Title, prior to submitting. Or else, it can end up in an unfinished and potentially unacceptable document!

How you can prepare Scdot Form Ca 3 part 5

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