Attachment 7_Financial Questionnaire.pdf

ATTACHMENT 7 – Financial Questionnaire

80KSC026R0007 – Launch Complex (LC) 39 Area Duct Bank System Replacement

Attachments and explanations provided on a separate page, as requested in the questions below, shall not be counted against Offeror’s page count limit.

Provide the following information about the Design-Build Prime for which Qualifications are being requested by the Offeror. If the Offeror is itself the General Contractor for which Qualifications are being requested, then provide all information requested as it relates to the Offeror itself.

1. Name:

2. Date of formation:

3. State of formation:

4. Number of employees?

5. If a corporation, provide information for each officer of the corporation.

Position Name Years w/ Company

Ownership

CEO

President

Administration

Treasurer/CFO

6. If an individual doing business as a sole proprietorship, please complete the following:

Name Years as Owner

7. If a joint venture, partnership, limited liability company (“LLC”), or other association, provide the following for each member of the joint venture, each partner, each member or manager of the LLC, or other association member. (Attach additional pages if necessary)

Name of Individual/Entity Principal Contact

Position Years w/ Joint Venture Partnership /

LLC / Other Association

Ownership

8. Has there been and change in ownership during the last three (3) years?

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

Yes* No

* If “yes”, please explain on a separate page.

9. Is the entity 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 your firm holds a similar position in another firm.)

Yes* No

* If “yes”, explain on a separate page.

State gross revenue for each of the last three (3) years:

2024: $

2023: $

2022: $

10. Is the entity or any of its affiliates currently the debtor in a bankruptcy case?

Yes* No

* If “yes,” indicate the case number, bankruptcy court, and the date on which the petition was filed.

Case Number: Bankruptcy Court: Date Filed:

11. Was the entity or any of its affiliates in bankruptcy at any time during the last five (5) years?

(Note: This question refers only to a bankruptcy action that was not described in answer to question A-2, above.)

Yes* No

* If “yes,” indicate the case number, bankruptcy court, and the date on which the petition was filed.

Case Number: Bankruptcy Court: Date Filed:

12. In the last five (5) years has any insurance carrier, for any form of insurance, refused to renew an insurance policy due to non-payment or contractor losses?

Yes* No

* If “yes,” on a separate page give name of the insured, name the insurance carrier, the form of insurance, and the year of the refusal.

13. Please provide the following information from most recent financial statement:

Current Assets: $

Current Liabilities: $

Total Net Worth: $

Current Ratio (Assets/Liabilities):

Working Capital (Current Assets - Current Liabilities): $

Debt to Equity Ratio:

History of Performance (Past Performance)

14. Has the entity or any of its affiliates ever been terminated for default on a construction contract?

Yes* No

* If “yes,” explain on a separate page.

15. In the last five (5) years has the entity or any of its affiliates, been debarred, disqualified, removed or otherwise prevented from bidding on, or completing, any government agency or public works project for any reason?

Yes* No

* If “yes,” explain on a separate page. State the name of the organization debarred, the year of the event, the owner of the project, and the basis for the action.

(Note: The following two (2) questions refer only to disputes between the entity and project owners. Do not include information about disputes with suppliers, other contractors, or subcontractors. Do not include information about “pass-through” disputes in which the actual dispute is between a subcontractor and a project owner.)

16. In the past five (5) years has any claim in excess of $50,000 been filed or made in court or arbitration against the entity or any of its affiliates concerning their work on a construction project?

Yes* No

* If “yes,” on a separate page identify the claim(s) by providing the project name, date of the claim, name of the claimant, the name of the entity the claim was filed against, a brief description of the nature of the claim, the court and case number, and a brief description of the status of the claim (pending or, if resolved, a brief description of the resolution).

17. In the past five (5) years has the entity or any of its affiliates made any claim in excess of $50,000 against a project owner concerning work on a project or payment for a contract and filed or made that claim in court or arbitration?

Yes* No

* If “yes,” on a separate page identify the claim by providing the name of claimant, the project name, date of the claim, name of the entity (or entities) against whom the claim was filed, a brief description of the nature of the claim, the court and case number, and a brief description of the status of the claim (pending, or if resolved, a brief description of the resolution).

18. Has the entity or any of its affiliates (or any manager of an affiliate if the affiliate is not a person) ever been found liable in a civil suit or found guilty in a criminal action for making any false claim or material misrepresentation to any public entity?

Yes* No

* If “yes,” explain on a separate page, including identifying who was found liable or guilty, the court and case number, the name of the public entity, the civil or criminal verdict, the date and the basis for the finding.

19. Has there been more than one occasion during the last five (5) years in which the entity or any of its affiliates was required to pay either back wages or penalties for failure to comply with the State’s prevailing wage laws?

Yes* No

* If “yes,” attach a separate page, describing the violator, nature of each violation, name of the project, date of its completion, the public agency for which it was constructed, the number of employees who were initially underpaid and the amount of back wages and penalties that were assessed.

20 . During the last five (5) years, has there been an occasion in which the entity or any of its affiliates have been penalized or required to pay back wages for failure to comply with the Federal Davis-Bacon prevailing wage requirements?

Yes* No

* If “yes,” attach a separate page, describing the violator, nature of each violation, name of the project, date of its completion, the public agency for which it was constructed; the number of employees who were initially underpaid and the amount of back wages and penalties that were assessed.