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City/Town or Other Awarding Authority Prequalification Confirmation
Apparent 3 Lowest Bidders Form
Approved Funding Program(s):
Chapter 90 Program Complete Streets Program Municipal Small Bridge Program
Utility Grants Program Mass-Works Program
Municipality Funds
Other _____________________________________________________________________________________________
City / Town or Other Awarding Authority_______________________________________________________________________
Location: ___________________________________________________________________________________________________
Description: ________________________________________________________________________________________________
Class of Work: ______________________________________________________________________________________________
Bid Opening Date: _______________________ Project Value: $__________________________________
Contractor Address City State/Zip Total Bid Rank
Signature of person completing form: _____________________________________________________________________________
Sign Date
Print name: ________________________________________________________________________________________________
Comments:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
MASSDOT PREQUAL. OFFICE USE ONLY
All Bidders Prequalified: Yes / No Reviewed by:__________ Tracking System Input:
Copied District SAE / Funding Program Manager(s) Close File: ____________ Date_____________
Comments:
_________________________________________________________________________________________
Rev. 12/2018
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