ATTACHMENT J-2 INFORMATION ON OFFEROR_Amendment 0001.pdf

ATTACHMENT J-2

INFORMATION ABOUT OFFEROR

1. ENGINEER OF RECORD

Name: ______________________________________

License Number: ______________________________

Years in Practice: ______________________________

a. Date of company formation or incorporation: ______________________

b. State of formation or incorporation: ______________________________

c. How many persons does the Engineer of Record or its Firm currently employ?

d. If the Engineer of Record’s Firm is a corporation, provide the following information for each officer of the corporation:

POSITION NAME YEARS WITH

COMPANY

% OWNERSHIP

CEO

President Secretary Treasurer Other (Title)

e. If the Engineer of Record is an individual doing business as a sole proprietorship, complete the following:

OWNER YEARS AS OWNER

f. If the Engineer of Record’s Firm is a joint venture, partnership, or other association (other than a corporation), provide the following information for each member of the joint venture, each partner or each other association member. (Attach additional pages if necessary)

Name of Individual or

Entity Principal Contact Position

Years with Joint Venture/Partnershi p/Other Association

Ownership

Interest

□ Yes

g. Has there been any change in ownership of the Engineer of Record’s Firm during the last three (3) years?

(NOTE: A corporation whose shares are publicly traded is not required to answer this question with regard to public trades.)

□ No

If “yes,” explain on a separate page.

h. Is the Architect of Record’s Firm a subsidiary, parent, holding company, or affiliate of another firm?

(NOTE: Include information about other firms if one firm owns 50 percent or more of another, or if an Owner, partner, or officer of the Firm holds a similar position in another firm.)

□ Yes □ No

If “yes,” explain on a separate page.

□ Yes

i. Has the Engineer of Record’s Firm changed names in the past five (5) years?

□ No

If “yes,” explain on a separate page.

2. How many years has the Engineer of Record been licensed and practicing in Alaska?

a. Years: ____________________

b. OR License:

□ Yes

□ Yes

□ Yes

□ Yes

2. MANDATORY REQUIREMENTS FOR THE OFFEROR (PASS/FAIL)

The Offeror must be answer the questions below truthfully or the Offeror may be disqualified. If an engineer’s professional license has been revolved or if liability insurance is not provided will result in a deficiency and Offeror will not be considered for Phase II.

a. Has a surety firm completed a contract or paid for completion of a contract on behalf of any Offeror Team Member because they were terminated by the Project Owner within the last ten (10) years?

□ No

b. Has any Offeror Team Member or any of their employees (Architects, Engineers) or any of their Affiliates, or any of their employees ever been convicted of a crime involving the awarding of a contract for a government project, or the bidding or performance of a government contract within the last ten (10) years?

□ No

c. Has any professional license held by any Engineers who will provide services been revoked at any time in the last ten (10) years?

□ No

d. Has any professional license held by any Engineer who will provide services been revoked at any time in the last ten (10) years?

□ No