Attachment 4 - Firm and Project Information.pdf

Firm and Project Information Questionnaire

Firm Information NIT NUMBER:

NAME ADDRESS TELEPHONE/FAX

Owners, Partners and Principal Officer

NAME POSITION TELEPHONE

Legal Representatives and backups

NAME POSITION TELEPHONE

Project Director, Superintendent and key technical Personnel for this project

NAME POSITION TELEPHONE

Subcontractors for this project (if it does not apply indicate it in the chart)

NAME ACTIVITY TO PERFORM

% DEL PROJECT

TOTAL

TELEPHONE

Suppliers for this project

NAME MATERIALS TO SUPPLY

% DEL PROJECT

TOTAL

TELEPHONE

Requirements of the Offeror and Owners/partners:

DESCRIPTION YES NO NOTES

I certify that the information is accurate and verifiable

Signature of the Legal Representative Date

Name of the Legal Representative Id Number

ENGLISH COMMUNICATION

(Ability to understand, write and read)

ADDRESS AND CITY

Artículo 289 del Código Penal Colombiano: “El que falsifique documento privado que pueda servir de prueba, incurrirá, si lo usa, en prisión de uno (1) a seis (6) años .”

"FIRM AND PROJECT INFORMATION "

E-MAIL ADDRESS

ENGLISH COMMUNICATION

(Ability to understand, write and read)

Has adverse criminal record?

Has political or business affiliation which could be considered contrary to the interests of the United

States.

ADDRESS AND CITY

ENGLISH COMMUNICATION

(Ability to understand, write and read)

Has all licenses and permits required by local law to perform?(Chamber of Commerce, Merchandise

Register, Professional Licenses, etc.)

Meets local insurance requirements (Prestaciones Sociales, ICA, Sena, etc.)

Has the ability to obtain a performance and guarantee bond and payment bond, or adequate performance security, such as irrevocable letters of credit or guarantees issued by a reputable financial institution. Include Information