6-Seneca Form A.pdf

LOUISVILLE PARKS AND RECREATION DEPARTMENT

SENECA PARK TENNIS COURTS REPAIR

FORM A:

FIRM BACKGROUND

(To be filled out by the Contractor and each subcontractor whose identification was requested on the Bid Form.)

FIRM NAME: __________________________________________________________________

FIRM ADDRESS: ____________________________________________________________ ____

FIRM TELEPHONE NUMBER:_____________________________FAX:__________________

AUTHORIZED OFFICIAL:_______________________TITLE:__________________________

TELEPHONE NUMBER OF AUTHORIZED OFFICIAL:_______________________________

(Authorized official must have authority to negotiate and contractually bind the company.)

Federal Identification Number_____________________________________________________

Kentucky Unemployment Insurance Number_________________________________________

Kentucky State Remittance Number ________________________________________________

How many years has your organization been in business?

Proposer intends to complete the Project with which this Evaluated Bid is concerned as a

Sole Proprietorship ___; Partnership___; Corporation ___; Joint Venture ___;

or __________________________________________________________________________

Explain_____________________________________________________________________________

If a Corporation, answer the following:

a. Date of Incorporation ___________________________

b. State of Incorporation _________________________

c. Is the Corporation authorized to do business in Kentucky? Yes ___ No ___

If Yes, as of what date? ________________________________________________

d. Furnish the following information on the principal officers of the Corporation.

Name Title Address

If a Partnership, answer the following:

a. Date of Organization _________________________

b. General Partnership ___ Limited Partnership ___

c. Has the Partnership done business in Kentucky? Yes ___ No ___

d. Name and address of each general partner:

Name Address

If a Joint Venture, answer the following:

a. Date of Organization_________________________________________________

b. Has the Joint Venture done business in Kentucky? Yes ___ No ___

c. Name and address of each Joint Venture:

Name Address

If Sole Proprietorship, furnish the following:

a. Proprietor’s Name in full_____________________________________________

b. Address___________________________________________________________

c. Company Name_____________________________________________________

d. Company Address___________________________________________________ How many years’ experience in the type of work associated with the proposed project has your organization had?

a. As a General Contractor______________________________________________

b. As a Subcontractor__________________________________________________

Has the Bidder or any officer or partner of the Bidder’s firm ever failed to complete any work or projects awarded, or been an officer or partner of some other organization that failed to complete any work or projects awarded? Yes ___ No ___

If yes, state name of individual, name of firm which defaulted and its principal owner(s) and the date and reasons, therefore.

List the name of projects, owners and scheduled completion of similar major projects currently being constructed or proposed by your organization on the date of this Bid. Estimate value of each:

Trade References:

Describe the firm’s plant and equipment, including any major equipment you own that is available for this proposed work:

List of employees by position/trade