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.
Unite Sterley Sivetee Compras OneBoces Stare Ch # 250 T.msnin UD 21053
: x ‘SO fo : 2453
(98:)G'ta-Gooo
Is your organization a member of a controlled group of corporations as defined in LLR.C. Sec.
1563?
Cives [ano
If yes, show names and addresses of affiliated companies.
7
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 Coo
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 _
LlyYes o
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?
LlyYes {No
(lYes Ko
If yes, describe circumstances and provide details on attachment.
CQ-1of7
