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).
On Schedule B, attached, list current projects under construction by this organization, (If joint
venture, list each participant’s projects separately).
Name of Surety Company and name, address, and phone number of agent.
Arch Insurance Company; Agent: Timothy Lyons, Driscoll Agency, 141 Longwater Drive, Suite 203,
Norwell, MA 02061; t: (781) 421-2560 e: tlyons@driscollagency.com
Is your organization a member of a controlled group of corporations as defined in I-R.C. Sec.
1563?
[_]Yes [XINo
If yes, show names and addresses of affiliated companies.
Furnish on Schedule C, attached, details of the construction experience of the principal
individuals of your organization directly involved in construction operations.
Has your organization ever failed to complete any construction contract awarded to it?
C]Yes [XINo
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?
[_]Yes [XINo
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?
[]Yes [X]No
[TYes [INo
If yes, describe circumstances and provide details on attachment.
CQ-10f7
