9-Contractors Qualification Statement.pdf

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4. CONTRACTOR’S QUALIFICATION STATEMENT

This statement is to be submitted as requested by the Owner. (Note: Attach separate sheets as required.)

The undersigned certified the truth and correctness of all statements and of all answers to questions made hereinafter.

TO: Northampton Township 55 Township Road Richboro, PA 18954

Submitted by: Corporation

Name: Partnership

Address: Individual

Principal Office: Joint Venture

Other

How many years has your organization been in business as a Contractor?

How many years has your organization been in business under its present business name?

If a corporation, answer the following:

1) Date of incorporation:

2) State of incorporation:

3) President’s name:

4) Vice President’s name(s):

5) Secretary or Clerk’s name:

6) Treasurer’s name:

7) List name and address of all parties holding greater than ten percent (10%) interest in the corporation:

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If individual or partnership, answer the following:

1) Date of origination:

2) Name and address of all partners (State whether general or limited partnership):

If other than corporation or partnership, describe organization and name principals:

We normally perform ____% of the Work with our own forces. List trades below:

Have you ever failed to complete any Work awarded to you? If so, note when, where and why:

Has any officer or partner of your organization ever been an officer or partner of another organization that failed to complete a construction Contract? If so, state circumstances:

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List name of project, Owner, architect, Contract amount, percent complete and scheduled Completion of the comparable construction projects your organization has in progress on this date:

List name of project, Owner, architect, Contract amount, date of Completion, percent or Work with own forces of the projects your organization has completed in the past two (2) years which equal at least fifty percent (50%) of the total amount of the Bid for the project under consideration:

List the construction experience of the principal individuals of your organization:

List the categories in which your organization is legally qualified to do business in Pennsylvania:

Trade References:

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Bank References:

Name of Bonding Company and name and address of agent:

Dated at this day of , 20 .

Name of Organization:

By:

Title:

M , being duly sworn, deposes and says that he/she is the of Contractor(s), and that answers to the foregoing questions and all statements therein contained are true and correct.

Subscribed and sworn before me this day of , 20 .

Notary Public:

My Commission Expires: