CONSTRUCTION CONTRACTOR’S
QUALIFICATION STATEMENT
On Schedule A, attached, list major engineered construction projects completed by this
organization in the past five (5) years. (If joint venture, list each participant’s projects separately).
See attached References .
On Schedule B, attached, list current projects under construction by this organization, (If joint
venture, list each participant’s projects separately).
See attached References.
Name of Surety Company and name, address, and phone number of agent.
North American Specialty Insurance Company
160 Gould Street, Sulte 118, Needham, MA 02494
Richard Leveron! 860-268-2179
Is your organization a member of a controlled group of corporations as defined. in I.R.C. Sec.
1563?
X]Yes []No
If yes, show names and addresses of affiliated companies.
Newport Materials LLC, 145 Temple Street, Nashua, NH 03060
Furnish on Schedule C, attached, details of the construction experience of the principal
individuals of your organization directly involved in construction operations.
See attached Personnel List.
Has your organization ever failed to complete any construction contract awarded to it?
C]Yes KIJNo
If yes, describe circumstances and provide details on attachment.
Has any Corporate officer, partner, joint venture participant or proprietor ever failed to complete
a construction contract awarded to him or her in their own name or when acting as a principal of
another organization?
ClYes [KINo
If yes, describe circumstances and provide details on attachment.
In the last five years, has your organization ever failed to substantially complete a project in a
timely manner?
[lYes [XINo
ClYes [No
If yes, describe circumstances and provide details on attachment.
CQ-1of7
