J.P-10 A3 GSA Form 527 Contractor Qualification and Financial Information.pdf

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Alliant 3 Unrestricted GWAC Solicitation No.: 47QTCB24R0009

J.P-10 A3 GSA Form 527 Contractor Qualifications and Financial Information

ATTACHMENT J.P-10

A3 GSA FORM 527 CONTRACTOR’S QUALIFICATIONS AND FINANCIAL INFORMATION

Purpose: The GSA Form 527, Contractor’s Qualifications and Financial Information, is provided to prospective offerors as a crucial component of the procurement process, particularly in reference to Section L.5.5 regarding responsibility determinations. The GSA Form 527 is a vital tool in the procurement process, as outlined in Section L.5.5 for responsibility determinations. It ensures that prospective offerors are financially responsible, capable of fulfilling contractual obligations, and aligned with the goals of risk mitigation and transparency. Through the standardized collection and evaluation of financial information, GSA can make informed decisions.

CONTRACTOR'S QUALIFICATIONS AND FINANCIAL INFORMATION OMB Control Number: 3090-0007 Expiration Date: 10/31/2024

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 USC § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for this collection is 3090-0007. We estimate that it will take 1.5 hours to read the instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate, including suggestions for reducing this burden, or any other aspects of this collection of information to: U.S. General Services Administration, Regulatory Secretariat Division (M1V1CB), 1800 F Street, NW, Washington, DC 20405.

SECTION I - GENERAL INFORMATION

1A. NAME

1B. STREET ADDRESS

1C. CITY 1D. STATE 1E. ZIP CODE

2. TYPE OF ORGANIZATION (Check one)

A. SOLE PROPRIETORSHIP

B. GENERAL PARTNERSHIP

C. LIMITED PARTNERSHIP

D. CORPORATION

E. SUBCHAPTER S CORPORATION

I. OTHER (Specify below)

3. TAXPAYER ID NUMBER 4. DATE ORGANIZATION ESTABLISHED 5. STATE OF INCORPORATION

6. TRADE STYLE NAME (Provide a copy of filing) 7. KIND OF PRODUCT OR SERVICE PROVIDED

8. FORMER BUSINESS NAME

D. RETAILER

E. OTHER (Specify) B. FIFO

A. LIFO C. AVERAGE COST

D. OTHER (Specify)

11. OWNERSHIP INFORMATION-PARTNERS-PRINCIPAL STOCKHOLDERS-OTHERS

NAME

10. INVENTORY VALUATION METHOD

9. KIND OF BUSINESS

A. MANUFACTURER

B. CONTRACTOR

C. WHOLESALER

TITLE

(If partner, state G(General) or L(Limited) in column)

ACTUAL TITLE G OR L

PERCENT

BUSINESS OWNED

12. PARENT COMPANY (If applicable)

13. IF "YES" TO ANY QUESTION BELOW, PROVIDE DETAILED

INFORMATION IN SECTION VIII, REMARKS YES NO

A. NAME

B. CITY C. STATE

A. HAVE YOU, OR ANY OF YOUR AFFILIATES EVER FILED FOR BANKRUPTCY?

B. DO YOU HAVE ANY JUDGMENTS, LIENS, OR PENDING SUITS?

C. DO YOU HAVE ANY CONTINGENT LIABILITIES?

D. HAVE YOU OR ANY OF YOUR AFFILIATES DISCONTINUED BUSINESS

OPERATIONS WITH OUTSTANDING DEBTS?

SECTION II - GOVERNMENT FINANCIAL AID AND INDEBTEDNESS

14A. ARE YOU DELINQUENT ON ANY FEDERAL DEBT (OMB CIRCULAR A-129)

(If "Yes", provide detailed information, Section VIII, Remarks)

14B. DO YOU OWE THE

GOVERNMENT

FOR ANY

CONTRACT OR

OTHER CLAIMS?

YES NO

IF "YES", COMPLETE THE ITEMS BELOW

AGENCY CLAIM AMOUNT PAYMENT MATURITY BALANCE

15A. AGENCY INVOLVED WITH DELINQUENCY 15B. AMOUNT OF DELINQUENCY ($)

16. ARE YOU

CURRENTLY

RECEIVING

GOVERNMENT

FINANCING?

YES

NO (Go to Section III )

17. COMPLETE ITEMS BELOW IF APPLICABLE

A. INDUSTRIAL REVENUE BONDS

B. GUARANTEED LOANS

C. ADVANCED PAYMENTS

D. PROGRESS PAYMENTS

AUTHORIZED ($) IN USE ($) GOVERNMENT AGENCY INVOLVED

E. OTHER (Specify)

GENERAL SERVICES ADMINISTRATION GSA 527 (REV. 10/2021)

F. LIMITED LIABILITY COMPANY

G. JOINT VENTURE

H. TRUST

TYPE OF FINANCING

GSA 527 (REV. 10/2021) PAGE 2

SECTION III - FINANCIAL STATEMENTS

Prepared Financial Statements with notes may be provided in lieu of completing Section III

When financial statements are prepared or certified by independent accountants and transcribed to this form, please furnish the name and address of accountant of accounting firm.

18. ARE YOU THE INCUMBENT CONTRACTOR FOR THIS SOLICITATION?

NO

19A. NAME

19B. STREET ADDRESS

19C. CITY 19D. STATE 19E. ZIP CODE

20. IF TRANSCRIBED STATEMENTS DIFFER FROM INDEPENDENT ACCOUNTANT'S,

PLEASE DESCRIBE ADJUSTMENT IN SECTION VII, REMARKS. ALL OF THE

LISTED FIGURES ARE:

ACTUAL

IN THOUSANDS

IN MILLIONS

U.S. DOLLARS

FOREIGN CURRENCY (Specify)

21. BALANCE SHEET AS OF (Month, Day, Year) 22. FISCAL YEAR ENDS (Month, Day, Year) 23. PREPARED STATEMENTS

YES

ARE ATTACHED

24. ASSETS 25. LIABILITIES AND NET WORTH

A. Current Assets A. Current Liabilities

Cash Short Term cash investments Accounts receivable, less allowance for doubtful accounts of $ Inventories Other current assets (Itemize below)

Total Current Assets

B. Property, Plant and Equipment

Accounts payable Notes payable (current) Current portion of long term debt Accrued expenses Accrued taxes on income/excess profits Other current liabilities (Itemize below)

Total Current Liabilities

B. Other Liabilities

Land Buildings and equipment Leasehold improvements Less accumulated depreciation and amortization

Total Property, Plant and Equipment C. Other Assets

Investments in and advance to affiliated company Goodwill, less amortization Due from officer, employee Other (Itemize below)

Total Other Assets

D. TOTAL ASSETS

Mortgages Bonds Deferred income taxes Other long term debt

Total Other Liabilities

Total Liabilities

C. Minority Interest in Subsidiary D. Net Worth

Preferred stock Common stock Additional paid-in capital Retained earnings/owner's equity Less, Treasury stock

Total Net Worth

E. TOTAL LIABILITIES AND NET WORTH

SECTION IV - INCOME STATEMENT

26. FROM (Month, Day, Year) 27. TO (Month, Day, Year)

A. Net Sales

28. INCOME

Cost and Expenses Cost of Goods Sold Depreciation and Amortization

Selling, General, and Admin. Expenses Interest Expense Other Expenses (Itemize below)

Minority Interest in Earnings of Subsidiaries

Total Costs and Expenses

Earnings Before Taxes Taxes on Income Income Before Extraordinary Items Extraordinary Gains (Losses) Net of Taxes

NET INCOME (LOSS)

ZIP CODE

Yes No

A.

B.

C.

CITY STATE ZIP CODE

AREA CODE NUMBER

AREA CODE NUMBER EXTENSION

STREET ADDRESS

37. Maximum Amount Authorized ($)

38. Amount Outstanding ($)

39. Loans Secured by Company's Assets - Real and Personal Property

BANK 1 BANK 2

SECTION V - BANKING AND FINANCE COMPANY INFORMATION

(Please attach a separate sheet using this format for any additional banks.)

ITEM

29. Name of Bank

30. Contact Person

31. Phone Number

32. Fax Number

33. Address

34. Amount Owing ($)

35. Term Loans

36. Line of Credit

D.

SECURED PARTY NAME CONTACT NAME

STREET ADDRESS CITY STATE ZIP CODE

SECURING ASSETS MATURITY DATE MONTHLY PAYMENT ($)

40. ARE ANY OF THE ASSETS SHOWN ON THE BALANCE SHEET

PLEDGED OR MORTGAGED, EXCEPT AS STATED ABOVE?

41B. TOTAL

LIABILITY ($)

41A. IF CONTRACTOR IS A PARTNERSHIP OR SOLE PROPIERTORSHIP,

ARE THE INDIVIDUAL LIABILITIES OF THE PROPIETOR(S) FOR

FEDERAL AND STATE INCOME AND/OR EXCESS PROFIT TAXES

INCLUDED ON THE BALANCE SHEET?

42. ARE YOU NOW IN OR PENDING DEFAULT ON ANY OBLIGATIONS, I.E., BANKS, FINANCIAL INSTITUTIONS, SUPPLIERS, OTHER?

NO YES (Explain in Section VII, Remarks)

NO YES (Provide detailed information in Section VII, Remarks)

GSA 527 (REV. 10/2021) PAGE 3

CITY STATE

SECTION VI - PRINCIPAL MERCHANDISE OR RAW MATERIAL SUPPLIER INFORMATION

(Please attach separate sheet(s) using this format for additional suppliers.)

43. PAST DUE ACCOUNTS PAYABLE ($)

ITEM 44. SUPPLIER 1 45. SUPPLIER 2

STATECITY ZIP CODE

ITEM 46. SUPPLIER 3 47. SUPPLIER 4

A. Name of Supplier B. Contact Person

C. Telephone

D. Fax

E. Address

F. Amount Now Owing ($) G. High Credit ($)

A. Name of Supplier B. Contact Person

F. Amount Now Owing ($) G. High Credit ($)

SECTION VII - CONSTRUCTION/SERVICE CONTRACTS INFORMATION (Public Buildings Service Contracts Only)

CONTRACTS IN FORCE

GSA 527 (REV. 10/2021) PAGE 4

ITEM 48. CONTRACT 1 49. CONTRACT 2

A. Location B. Owner's Name

C. Address

D. Type of Work E. Contract Amount ($) F. Percent Completed G. Estimated Completion Date

F. Percent Completed

50. CONTRACT 3 51. CONTRACT 4

CITY STATE ZIP CODECITY STATE ZIP CODE

GSA 527 (REV. 10/2021) PAGE 5

D. Telephone

E. Type of Work F. Contract Amount ($) G. Amount Sublet ($)

ITEM 58. JOB 3 59. JOB 4

B. Contact's Name

ITEM 60. JOB 5 61. JOB 6

ITEM 52. CONTRACT 5 53. CONTRACT 6

F. Percent Completed

F. Percent Completed

54. CONTRACT 7 55. CONTRACT 8

LARGEST JOBS YOU HAVE COMPLETED IN THE LAST FIVE YEARS

ITEM 56. JOB 1 57. JOB 2

CERTIFICATION

For the purpose of establishing financial responsibility with, or procuring credit from the U.S. General Services Administration, we furnish the above as a true and correct statement of our financial condition and further certify that all other statements are true and correct. There has been no material change in the applicant's financial condition since the date of the above statement. We agree to notify you immediately in writing of any materially unfavorable change in our financial condition. In the absence of such notice or of a new and full financial statement, this is to be considered as a continuing statement.

NAME OF BUSINESS BY (Signature of Authorized Official)

NAME OF AUTHORIZED OFFICIAL (Type or print)

TITLE OF AUTHORIZED OFFICIAL (Type or print)

DATE

GSA 527 (REV. 10/2021) PAGE 6

NUMBER

64. PRESENT AMOUNT OF BONDING

COVERAGE ($)

65. HAS YOUR APPLICATION FOR SURETY

BOND EVER BEEN DECLINED? (If Yes, please provide detailed information in

Remarks)

66. DURING THE PAST 2 YEARS, HAVE YOU BEEN CHARGED WITH A

FAILURE TO MEET THE CLAIMS OF YOUR SUBCONTRACTORS OR

SUPPLIERS? (If Yes, please provide detailed information in Remarks)

YES NO YES NO

SECTION VIII - REMARKS

REMARKS (Cite those sections of the form relating to your remarks. If additional space is required, attach additional sheet(s).)

LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS

ITEM 62. SURETY COMPANY 1 63. SURETY COMPANY 2

A. Company Name

AREA CODE

Barbara Williams

GSA 527 - Contractor's Qualifications and Financial Information

CONTRACTOR'S QUALIFICATIONS AND FINANCIAL INFORMATION

OMB Control Number: 3090-0007 Expiration Date: 10/31/2024

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 USC § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for this collection is 3090-0007. We estimate that it will take 1.5 hours to read the instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate, including suggestions for reducing this burden, or any other aspects of this collection of information to: U.S. General Services Administration, Regulatory Secretariat Division (M1V1CB), 1800 F Street, NW, Washington, DC 20405.

SECTION I - GENERAL INFORMATION

1A. NAME

1B. STREET ADDRESS

1C. CITY

1D. STATE

1E. ZIP CODE

2. TYPE OF ORGANIZATION (Check one)

A. SOLE PROPRIETORSHIP

B. GENERAL PARTNERSHIP

C. LIMITED PARTNERSHIP

D. CORPORATION

E. SUBCHAPTER S CORPORATION

I. OTHER (Specify below)

3. TAXPAYER ID NUMBER

4. DATE ORGANIZATION ESTABLISHED

5. STATE OF INCORPORATION

6. TRADE STYLE NAME (Provide a copy of filing)

7. KIND OF PRODUCT OR SERVICE PROVIDED

8. FORMER BUSINESS NAME

D. RETAILER

E. OTHER (Specify)

B. FIFO

A. LIFO

C. AVERAGE COST

D. OTHER (Specify)

11. OWNERSHIP INFORMATION-PARTNERS-PRINCIPAL STOCKHOLDERS-OTHERS

NAME

10. INVENTORY VALUATION METHOD

9. KIND OF BUSINESS

A. MANUFACTURER

B. CONTRACTOR

C. WHOLESALER

TITLE

(If partner, state G(General) or L(Limited) in column)

ACTUAL TITLE

G OR L

PERCENT

BUSINESS OWNED

12. PARENT COMPANY (If applicable)

13. IF "YES" TO ANY QUESTION BELOW, PROVIDE DETAILED

INFORMATION IN SECTION VIII, REMARKS

YES

NO

A. NAME

B. CITY

C. STATE

A. HAVE YOU, OR ANY OF YOUR AFFILIATES EVER FILED FOR BANKRUPTCY?

B. DO YOU HAVE ANY JUDGMENTS, LIENS, OR PENDING SUITS?

C. DO YOU HAVE ANY CONTINGENT LIABILITIES?

D. HAVE YOU OR ANY OF YOUR AFFILIATES DISCONTINUED BUSINESS OPERATIONS WITH OUTSTANDING DEBTS?

SECTION II - GOVERNMENT FINANCIAL AID AND INDEBTEDNESS

14A. ARE YOU DELINQUENT ON ANY FEDERAL DEBT (OMB CIRCULAR A-129)(If "Yes", provide detailed information, Section VIII, Remarks)

14B. DO YOU OWE THE

GOVERNMENT

FOR ANY CONTRACT OR OTHER CLAIMS?

YES

NO

IF "YES", COMPLETE THE ITEMS BELOW

AGENCY

CLAIM AMOUNT

PAYMENT

MATURITY

BALANCE

15A. AGENCY INVOLVED WITH DELINQUENCY

15B. AMOUNT OF DELINQUENCY ($)

16. ARE YOU CURRENTLY

RECEIVING

GOVERNMENT

FINANCING?

YES

NO

YES

NO (Go to Section III )

17. COMPLETE ITEMS BELOW IF APPLICABLE

A. INDUSTRIAL REVENUE BONDS

B. GUARANTEED LOANS

C. ADVANCED PAYMENTS

D. PROGRESS PAYMENTS

AUTHORIZED ($)

IN USE ($)

GOVERNMENT AGENCY INVOLVED

E. OTHER (Specify)

GENERAL SERVICES ADMINISTRATION

GSA 527 (REV. 10/2021)

F. LIMITED LIABILITY COMPANY

G. JOINT VENTURE

H. TRUST

TYPE OF FINANCING

GSA 527 (REV. 10/2021) PAGE 2

SECTION III - FINANCIAL STATEMENTS

Prepared Financial Statements with notes may be provided in lieu of completing Section III

When financial statements are prepared or certified by independent accountants and transcribed to this form, please furnish the name and address of accountant of accounting firm.

18. ARE YOU THE INCUMBENT CONTRACTOR FOR THIS SOLICITATION?

NO

19A. NAME

19B. STREET ADDRESS

19C. CITY

19D. STATE

19E. ZIP CODE

20. IF TRANSCRIBED STATEMENTS DIFFER FROM INDEPENDENT ACCOUNTANT'S, PLEASE DESCRIBE ADJUSTMENT IN SECTION VII, REMARKS. ALL OF THE

LISTED FIGURES ARE:

ACTUAL

IN THOUSANDS

IN MILLIONS

U.S. DOLLARS

FOREIGN CURRENCY (Specify)

21. BALANCE SHEET AS OF (Month, Day, Year)

22. FISCAL YEAR ENDS (Month, Day, Year)

23. PREPARED STATEMENTS

YES

ARE ATTACHED

24. ASSETS

25. LIABILITIES AND NET WORTH

A. Current Assets

A. Current Liabilities

Cash

Short Term cash investments

Accounts receivable, less allowance for doubtful accounts of $

Inventories

Other current assets (Itemize below)

Total Current Assets

B. Property, Plant and Equipment

Accounts payable

Notes payable (current)

Current portion of long term debt

Accrued expenses

Accrued taxes on income/excess profits

Other current liabilities (Itemize below)

Total Current Liabilities

B. Other Liabilities

Land

Buildings and equipment

Leasehold improvements

Less accumulated depreciation and amortization

Total Property, Plant and Equipment

C. Other Assets

Investments in and advance to affiliated company

Goodwill, less amortization

Due from officer, employee

Other (Itemize below)

Total Other Assets

D. TOTAL ASSETS

Mortgages

Bonds

Deferred income taxes

Other long term debt

Total Other Liabilities

Total Liabilities

C. Minority Interest in Subsidiary

D. Net Worth

Preferred stock

Common stock

Additional paid-in capital

Retained earnings/owner's equity

Less, Treasury stock

Total Net Worth

E. TOTAL LIABILITIES AND NET WORTH

SECTION IV - INCOME STATEMENT

26. FROM (Month, Day, Year)

27. TO (Month, Day, Year)

A. Net Sales

28. INCOME

Cost and Expenses

Cost of Goods Sold

Depreciation and Amortization

Selling, General, and Admin. Expenses

Interest Expense

Other Expenses (Itemize below)

Minority Interest in Earnings of Subsidiaries

Total Costs and Expenses

Earnings Before Taxes

Taxes on Income

Income Before Extraordinary Items

Extraordinary Gains (Losses) Net of Taxes

NET INCOME (LOSS)

\\iaimain\apps1\Pam_Ward\Logos\Pointer.jpg

Image of a triangle pointing to field 41B: Total Liability.

ZIP CODE

Yes

No

Yes

No

A.

B.

C.

CITY

STATE

ZIP CODE

Yes

No

Yes

No

AREA CODE

NUMBER

AREA CODE

NUMBER

EXTENSION

AREA CODE

NUMBER

STREET ADDRESS

37. Maximum Amount

Authorized ($)

38. Amount

Outstanding ($)

39. Loans Secured by Company's Assets - Real and Personal Property

BANK 1

BANK 2

SECTION V - BANKING AND FINANCE COMPANY INFORMATION

(Please attach a separate sheet using this format for any additional banks.)

ITEM

29. Name of Bank

30. Contact Person

31. Phone Number

32. Fax Number

33. Address

34. Amount Owing ($)

35. Term Loans

36. Line of Credit

D.

SECURED PARTY NAME

CONTACT NAME

STREET ADDRESS

CITY

STATE

ZIP CODE

SECURING ASSETS

MATURITY DATE

MONTHLY PAYMENT ($)

SECURED PARTY NAME

CONTACT NAME

STREET ADDRESS

CITY

STATE

ZIP CODE

SECURING ASSETS

MATURITY DATE

MONTHLY PAYMENT ($)

SECURED PARTY NAME

CONTACT NAME

STREET ADDRESS

CITY

STATE

ZIP CODE

SECURING ASSETS

MATURITY DATE

MONTHLY PAYMENT ($)

SECURED PARTY NAME

CONTACT NAME

STREET ADDRESS

CITY

STATE

ZIP CODE

SECURING ASSETS

MATURITY DATE

MONTHLY PAYMENT ($)

40. ARE ANY OF THE ASSETS SHOWN ON THE BALANCE SHEET

PLEDGED OR MORTGAGED, EXCEPT AS STATED ABOVE?

41B. TOTAL

LIABILITY ($)

41A. IF CONTRACTOR IS A PARTNERSHIP OR SOLE PROPIERTORSHIP,

ARE THE INDIVIDUAL LIABILITIES OF THE PROPIETOR(S) FOR

FEDERAL AND STATE INCOME AND/OR EXCESS PROFIT TAXES

INCLUDED ON THE BALANCE SHEET?

YES

NO

42. ARE YOU NOW IN OR PENDING DEFAULT ON ANY OBLIGATIONS, I.E., BANKS, FINANCIAL INSTITUTIONS, SUPPLIERS, OTHER?

NO

YES (Explain in Section VII, Remarks)

NO

YES (Provide detailed information in Section VII, Remarks)

GSA 527 (REV. 10/2021) PAGE 3

AREA CODE

NUMBER

EXTENSION

STREET ADDRESS

CITY

STATE

SECTION VI - PRINCIPAL MERCHANDISE OR RAW MATERIAL SUPPLIER INFORMATION

(Please attach separate sheet(s) using this format for additional suppliers.)

43. PAST DUE ACCOUNTS PAYABLE ($)

ITEM

44. SUPPLIER 1

45. SUPPLIER 2

AREA CODE

NUMBER

EXTENSION

AREA CODE

NUMBER

STREET ADDRESS

STATE

CITY

ZIP CODE

ITEM

46. SUPPLIER 3

47. SUPPLIER 4

A. Name of Supplier

B. Contact Person

C. Telephone

D. Fax

E. Address

F. Amount Now

Owing ($)

G. High Credit ($)

A. Name of Supplier

B. Contact Person

C. Telephone

D. Fax

E. Address

F. Amount Now

Owing ($)

G. High Credit ($)

AREA CODE

NUMBER

EXTENSION

AREA CODE

NUMBER

STREET ADDRESS

CITY

STATE

ZIP CODE

AREA CODE

NUMBER

EXTENSION

AREA CODE

NUMBER

AREA CODE

NUMBER

EXTENSION

AREA CODE

NUMBER

STREET ADDRESS

CITY

STATE

ZIP CODE

SECTION VII - CONSTRUCTION/SERVICE CONTRACTS INFORMATION (Public Buildings Service Contracts Only)

CONTRACTS IN FORCE

STREET ADDRESS

CITY

STATE

ZIP CODE

GSA 527 (REV. 10/2021) PAGE 4

ITEM

48. CONTRACT 1

49. CONTRACT 2

A. Location

B. Owner's Name

C. Address

D. Type of Work

E. Contract Amount ($)

F. Percent Completed

G. Estimated Completion Date

STREET ADDRESS

CITY

STATE

ZIP CODE

STREET ADDRESS

CITY

STATE

ZIP CODE

ITEM

A. Location

B. Owner's Name

C. Address

D. Type of Work

E. Contract Amount ($)

F. Percent Completed

G. Estimated Completion Date

50. CONTRACT 3

51. CONTRACT 4

STREET ADDRESS

CITY

STATE

ZIP CODE

CITY

STATE

ZIP CODE

STREET ADDRESS

GSA 527 (REV. 10/2021) PAGE 5

C. Address

D. Telephone

E. Type of Work

F. Contract Amount ($)

G. Amount Sublet ($)

STREET ADDRESS

CITY

STATE

ZIP CODE

AREA CODE

NUMBER

EXTENSION

STREET ADDRESS

CITY

STATE

ZIP CODE

AREA CODE

NUMBER

EXTENSION

ITEM

58. JOB 3

59. JOB 4

A. Location

B. Contact's Name

C. Address

D. Telephone

E. Type of Work

F. Contract Amount ($)

G. Amount Sublet ($)

STREET ADDRESS

CITY

STATE

ZIP CODE

AREA CODE

NUMBER

EXTENSION

STREET ADDRESS

CITY

STATE

ZIP CODE

AREA CODE

NUMBER

EXTENSION

ITEM

60. JOB 5

61. JOB 6

A. Location

B. Contact's Name

C. Address

D. Telephone

E. Type of Work

F. Contract Amount ($)

G. Amount Sublet ($)

STREET ADDRESS

CITY

STATE

ZIP CODE

AREA CODE

NUMBER

EXTENSION

STREET ADDRESS

CITY

STATE

ZIP CODE

AREA CODE

NUMBER

EXTENSION

ITEM

52. CONTRACT 5

53. CONTRACT 6

A. Location

B. Owner's Name

C. Address

D. Type of Work

E. Contract Amount ($)

F. Percent Completed

G. Estimated Completion Date

STREET ADDRESS

CITY

STATE

ZIP CODE

STREET ADDRESS

CITY

STATE

ZIP CODE

ITEM

A. Location

B. Owner's Name

C. Address

D. Type of Work

E. Contract Amount ($)

F. Percent Completed

G. Estimated

Completion Date

54. CONTRACT 7

55. CONTRACT 8

STREET ADDRESS

CITY

STATE

ZIP CODE

STREET ADDRESS

CITY

STATE

ZIP CODE

LARGEST JOBS YOU HAVE COMPLETED IN THE LAST FIVE YEARS

ITEM

56. JOB 1

57. JOB 2

A. Location

B. Contact's Name

CERTIFICATION

For the purpose of establishing financial responsibility with, or procuring credit from the U.S. General Services Administration, we furnish the above as a true and correct statement of our financial condition and further certify that all other statements are true and correct. There has been no material change in the applicant's financial condition since the date of the above statement. We agree to notify you immediately in writing of any materially unfavorable change in our financial condition. In the absence of such notice or of a new and full financial statement, this is to be considered as a continuing statement.

NAME OF BUSINESS

BY (Signature of Authorized Official)

NAME OF AUTHORIZED OFFICIAL (Type or print)

TITLE OF AUTHORIZED OFFICIAL (Type or print)

DATE

GSA 527 (REV. 10/2021) PAGE 6

NUMBER

STREET ADDRESS

CITY

STATE

ZIP CODE

AREA CODE

NUMBER

EXTENSION

AREA CODE

NUMBER

STREET ADDRESS

CITY

STATE

ZIP CODE

64. PRESENT AMOUNT OF BONDING

COVERAGE ($)

65. HAS YOUR APPLICATION FOR SURETY

BOND EVER BEEN DECLINED? (If Yes, please provide detailed information in Remarks)

66. DURING THE PAST 2 YEARS, HAVE YOU BEEN CHARGED WITH A

FAILURE TO MEET THE CLAIMS OF YOUR SUBCONTRACTORS OR

SUPPLIERS? (If Yes, please provide detailed information in Remarks)

YES

NO

YES

NO

SECTION VIII - REMARKS

REMARKS (Cite those sections of the form relating to your remarks. If additional space is required, attach additional sheet(s).)

LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS

ITEM

62. SURETY COMPANY 1

63. SURETY COMPANY 2

A. Company Name

B. Contact's Name

C. Telephone

D. Fax

E. Address

AREA CODE

NUMBER

EXTENSION

AREA CODE

1A. NAME:

LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS. ITEM. E. Address. 62. SURETY COMPANY 1. STREET ADDRESS.:

LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS. ITEM. E. Address. 62. SURETY COMPANY 1. CITY.:

3. TAXPAYER ID NUMBER:

6. TRADE STYLE NAME (Provide a copy of filing):

8. FORMER BUSINESS NAME:

11. OWNERSHIP INFORMATION-PARTNERS-PRINCIPAL STOCKHOLDERS-OTHERS. NAME. LINE 1 of 5.:

11. OWNERSHIP INFORMATION-PARTNERS-PRINCIPAL STOCKHOLDERS-OTHERS. TITLE (If partner, state G (General) or L(Limited) in column). ACTUAL TITLE.:

11. OWNERSHIP INFORMATION-PARTNERS-PRINCIPAL STOCKHOLDERS-OTHERS. TITLE (If partner, state G (General) or L(Limited) in column). G OR L.:

11. OWNERSHIP INFORMATION-PARTNERS-PRINCIPAL STOCKHOLDERS-OTHERS. PERCENT BUSINESS OWNED.:

11. OWNERSHIP INFORMATION-PARTNERS-PRINCIPAL STOCKHOLDERS-OTHERS. NAME. LINE 2 of 5.:

11. OWNERSHIP INFORMATION-PARTNERS-PRINCIPAL STOCKHOLDERS-OTHERS. NAME. LINE 3 of 5.:

11. OWNERSHIP INFORMATION-PARTNERS-PRINCIPAL STOCKHOLDERS-OTHERS. NAME. LINE 4 of 5.:

11. OWNERSHIP INFORMATION-PARTNERS-PRINCIPAL STOCKHOLDERS-OTHERS. NAME. LINE 5 of 5.:

12. PARENT COMPANY (If applicable). A. NAME.:

12. PARENT COMPANY (If applicable). B. CITY.:

14B. IF "YES", COMPLETE THE ITEMS BELOW. AGENCY.:

15A. AGENCY INVOLVED WITH DELINQUENCY:

9. KIND OF BUSINESS. E. OTHER (Specify).:

12. PARENT COMPANY (If applicable). C. STATE.:

5. STATE OF INCORPORATION:

2. TYPE OF ORGANIZATION (Check one). I. OTHER (Specify below).:

10. INVENTORY VALUATION METHOD. D. OTHER (Specify).:

7. KIND OF PRODUCT OR SERVICE PROVIDED:

LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS. ITEM. E. Address. 62. SURETY COMPANY 1. STATE.:

LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS. ITEM. E. Address. 62. SURETY COMPANY 1. ZIP CODE.:

9. KIND OF BUSINESS. A. MANUFACTURER.: 0

9. KIND OF BUSINESS. B. CONTRACTOR.: 0

9. KIND OF BUSINESS. C. WHOLESALER.: 0

9. KIND OF BUSINESS. D. RETAILER.: 0

9. KIND OF BUSINESS. E. OTHER (Specify).: 0

2. TYPE OF ORGANIZATION (Check one). A. SOLE PROPRIETORSHIP. : 0

2. TYPE OF ORGANIZATION (Check one). B. GENERAL PARTNERSHIP.: 0

2. TYPE OF ORGANIZATION (Check one). C. LIMITED PARTNERSHIP.: 0

2. TYPE OF ORGANIZATION (Check one). D. CORPORATION.: 0

2. TYPE OF ORGANIZATION (Check one). E. SUBCHAPTER S CORPORATION.: 0

10. INVENTORY VALUATION METHOD. A. LIFO.: 0

10. INVENTORY VALUATION METHOD. B. FIFO.: 0

10. INVENTORY VALUATION METHOD. C. AVERAGE COST.: 0

10. INVENTORY VALUATION METHOD. D. OTHER (Specify).: 0

13. IF "YES" TO ANY QUESTION BELOW, PROVIDE DETAILED INFORMATION IN SECTION 8, REMARKS. A. HAVE YOU, OR ANY OF YOUR AFFILIATES EVER FILED FOR BANKRUPTCY? YES.: 0

13. IF "YES" TO ANY QUESTION BELOW, PROVIDE DETAILED INFORMATION IN SECTION 8, REMARKS. A. HAVE YOU, OR ANY OF YOUR AFFILIATES EVER FILED FOR BANKRUPTCY? NO.: 0

13. IF "YES" TO ANY QUESTION BELOW, PROVIDE DETAILED INFORMATION IN SECTION 8, REMARKS. B. DO YOU HAVE ANY JUDGMENTS, LIENS, OR PENDING SUITS? YES.: 0

13. IF "YES" TO ANY QUESTION BELOW, PROVIDE DETAILED INFORMATION IN SECTION 8, REMARKS. B. DO YOU HAVE ANY JUDGMENTS, LIENS, OR PENDING SUITS? NO.: 0

13. IF "YES" TO ANY QUESTION BELOW, PROVIDE DETAILED INFORMATION IN SECTION 8, REMARKS. C. DO YOU HAVE ANY CONTINGENT LIABILITIES? YES.: 0

13. IF "YES" TO ANY QUESTION BELOW, PROVIDE DETAILED INFORMATION IN SECTION 8, REMARKS. C. DO YOU HAVE ANY CONTINGENT LIABILITIES? NO.: 0

13. IF "YES" TO ANY QUESTION BELOW, PROVIDE DETAILED INFORMATION IN SECTION 8, REMARKS. D. HAVE YOU OR ANY OF YOUR AFFILIATES DISCONTINUED BUSINESS OPERATIONS WITH OUTSTANDING DEBTS? YES.: 0

13. IF "YES" TO ANY QUESTION BELOW, PROVIDE DETAILED INFORMATION IN SECTION 8, REMARKS. D. HAVE YOU OR ANY OF YOUR AFFILIATES DISCONTINUED BUSINESS OPERATIONS WITH OUTSTANDING DEBTS? NO: 0

65. HAS YOUR APPLICATION FOR SURETY BOND EVER BEEN DECLINED? (If Yes, please provide detailed information in Remarks). YES.: 0

65. HAS YOUR APPLICATION FOR SURETY BOND EVER BEEN DECLINED? (If Yes, please provide detailed information in Remarks). YES.: 0

65. HAS YOUR APPLICATION FOR SURETY BOND EVER BEEN DECLINED? (If Yes, please provide detailed information in Remarks). YES.: 0

65. HAS YOUR APPLICATION FOR SURETY BOND EVER BEEN DECLINED? (If Yes, please provide detailed information in Remarks). NO.: 0

65. HAS YOUR APPLICATION FOR SURETY BOND EVER BEEN DECLINED? (If Yes, please provide detailed information in Remarks). NO.: 0

65. HAS YOUR APPLICATION FOR SURETY BOND EVER BEEN DECLINED? (If Yes, please provide detailed information in Remarks). NO.: 0

66. DURING THE PAST 2 YEARS, HAVE YOU BEEN CHARGED WITH A FAILURE TO MEET THE CLAIMS OF YOUR SUBCONTRACTORS OR SUPPLIERS? (If Yes, please provide detailed information in Remarks). YES.: 0

66. DURING THE PAST 2 YEARS, HAVE YOU BEEN CHARGED WITH A FAILURE TO MEET THE CLAIMS OF YOUR SUBCONTRACTORS OR SUPPLIERS? (If Yes, please provide detailed information in Remarks). YES.: 0

66. DURING THE PAST 2 YEARS, HAVE YOU BEEN CHARGED WITH A FAILURE TO MEET THE CLAIMS OF YOUR SUBCONTRACTORS OR SUPPLIERS? (If Yes, please provide detailed information in Remarks). NO.: 0

66. DURING THE PAST 2 YEARS, HAVE YOU BEEN CHARGED WITH A FAILURE TO MEET THE CLAIMS OF YOUR SUBCONTRACTORS OR SUPPLIERS? (If Yes, please provide detailed information in Remarks). NO.: 0

16. ARE YOU CURRENTLY RECEIVING GOVERNMENT FINANCING? YES.: 0

16. ARE YOU CURRENTLY RECEIVING GOVERNMENT FINANCING? NO (Go to Section 3).: 0

2. TYPE OF ORGANIZATION (Check one). F. LIMITED LIABILITY COMPANY.: 0

2. TYPE OF ORGANIZATION (Check one). G. JOINT VENTURE.: 0

2. TYPE OF ORGANIZATION (Check one). H. TRUST.: 0

2. TYPE OF ORGANIZATION (Check one). I. OTHER (Specify below).: 0

4. DATE ORGANIZATION ESTABLISHED. Enter 2 digit month, 2 digit day and 4 digit year.:

14B. IF "YES", COMPLETE THE ITEMS BELOW. CLAIM AMOUNT.:

17. COMPLETE ITEMS BELOW IF APPLICABLE. TYPE OF FINANCING. A. INDUSTRIAL REVENUE BONDS. AUTHORIZED ($).:

17. COMPLETE ITEMS BELOW IF APPLICABLE. TYPE OF FINANCING. E. OTHER (Specify). IN USE ($).:

17. COMPLETE ITEMS BELOW IF APPLICABLE. TYPE OF FINANCING. E. OTHER (Specify). GOVERNMENT AGENCY INVOLVED.:

17. COMPLETE ITEMS BELOW IF APPLICABLE. TYPE OF FINANCING. D. PROGRESS PAYMENTS. IN USE ($).:

17. COMPLETE ITEMS BELOW IF APPLICABLE. TYPE OF FINANCING. C. ADVANCED PAYMENTS. IN USE ($).:

17. COMPLETE ITEMS BELOW IF APPLICABLE. TYPE OF FINANCING. B. GUARANTEED LOANS. IN USE ($).:

17. COMPLETE ITEMS BELOW IF APPLICABLE. TYPE OF FINANCING. A. INDUSTRIAL REVENUE BONDS. IN USE ($).:

17. COMPLETE ITEMS BELOW IF APPLICABLE. TYPE OF FINANCING. B. GUARANTEED LOANS. AUTHORIZED ($).:

17. COMPLETE ITEMS BELOW IF APPLICABLE. TYPE OF FINANCING. C. ADVANCED PAYMENTS. AUTHORIZED ($).:

17. COMPLETE ITEMS BELOW IF APPLICABLE. TYPE OF FINANCING. D. PROGRESS PAYMENTS. AUTHORIZED ($).:

17. COMPLETE ITEMS BELOW IF APPLICABLE. TYPE OF FINANCING. E. OTHER (Specify). AUTHORIZED ($).:

14B. IF "YES", COMPLETE THE ITEMS BELOW. PAYMENT.:

14B. IF "YES", COMPLETE THE ITEMS BELOW. MATURITY.:

15B. AMOUNT OF DELINQUENCY ($):

14B. IF "YES", COMPLETE THE ITEMS BELOW. BALANCE.:

20. IF TRANSCRIBED STATEMENTS DIFFER FROM INDEPENDENT ACCOUNTANT'S, PLEASE DESCRIBE ADJUSTMENT IN SECTION VII, REMARKS. ALL OF THE LISTED FIGURES ARE ACTUAL.: 0

20. IF TRANSCRIBED STATEMENTS DIFFER FROM INDEPENDENT ACCOUNTANT'S, PLEASE DESCRIBE ADJUSTMENT IN SECTION VII, REMARKS. ALL OF THE LISTED FIGURES ARE IN THOUSANDS.: 0

20. IF TRANSCRIBED STATEMENTS DIFFER FROM INDEPENDENT ACCOUNTANT'S, PLEASE DESCRIBE ADJUSTMENT IN SECTION VII, REMARKS. ALL OF THE LISTED FIGURES ARE IN MILLIONS.: 0

20. IF TRANSCRIBED STATEMENTS DIFFER FROM INDEPENDENT ACCOUNTANT'S, PLEASE DESCRIBE ADJUSTMENT IN SECTION VII, REMARKS. ALL OF THE LISTED FIGURES ARE IN U.S. DOLLARS.: 0

20. IF TRANSCRIBED STATEMENTS DIFFER FROM INDEPENDENT ACCOUNTANT'S, PLEASE DESCRIBE ADJUSTMENT IN SECTION VII, REMARKS. ALL OF THE LISTED FIGURES ARE IN FOREIGN CURRENCY (Specify).: 0

19A. NAME:

19B. STREET ADDRESS:

19C. CITY:

24. ASSETS. C. Other Assets. Other (Itemize). Line 3 of 3.:

28. INCOME. A. Net Sales. Other Expenses (Itemize). Line 2 of 2.:

19D. STATE:

19E. ZIP CODE:

20. IF TRANSCRIBED STATEMENTS DIFFER FROM INDEPENDENT ACCOUNTANT'S, PLEASE DESCRIBE ADJUSTMENT IN SECTION VII, REMARKS. ALL OF THE LISTED FIGURES ARE IN FOREIGN CURRENCY (Specify).:

23. PREPARED STATEMENTS ARE ATTACHED.: 0

22. FISCAL YEAR ENDS (Month, Day, Year). Enter 2 digit month, 2 digit day and 4 digit year.:

21. BALANCE SHEET AS OF (Month, Day, Year). Enter 2 digit month, 2 digit day and 4 digit year.:

26. FROM (Month, Day, Year). Enter 2 digit month, 2 digit day and 4 digit year.:

27. TO (Month, Day, Year). Enter 2 digit month, 2 digit day and 4 digit year.:

24. ASSETS. A. Current Assets. Cash.:

25. LIABILITIES AND NET WORTH. A. Current Liabilities. Other current liabilities (Itemize). Line 1 of 2.:

25. LIABILITIES AND NET WORTH. A. Current Liabilities. Total Current Liabilities.:

25. LIABILITIES AND NET WORTH. B. Other Liabilities. Mortgages.:

25. LIABILITIES AND NET WORTH. B. Other Liabilities. Bonds.:

25. LIABILITIES AND NET WORTH. B. Other Liabilities. Deferred income taxes.:

25. LIABILITIES AND NET WORTH. B. Other Liabilities. Other long term debt.:

25. LIABILITIES AND NET WORTH. B. Other Liabilities. Total Other Liabilities.:

25. LIABILITIES AND NET WORTH. Total Liabilities.:

25. LIABILITIES AND NET WORTH. C. Minority Interest in Subsidiary.:

25. LIABILITIES AND NET WORTH. D. Net Worth. Preferred Stock.:

25. LIABILITIES AND NET WORTH. D. Net Worth. Common Stock.:

25. LIABILITIES AND NET WORTH. D. Net Worth. Additional paid-in capital.:

25. LIABILITIES AND NET WORTH. D. Net Worth. Retained earnings/owner's equity.:

25. LIABILITIES AND NET WORTH. D. Net Worth. Less, Treasury stock.:

25. LIABILITIES AND NET WORTH. D. Net Worth. Total Net Worth.:

25. LIABILITIES AND NET WORTH. E. TOTAL LIABILITIES AND NET WORTH.:

25. LIABILITIES AND NET WORTH. A. Current Liabilities. Other current liabilities.:

25. LIABILITIES AND NET WORTH. A. Current Liabilities. Other current liabilities.:

25. LIABILITIES AND NET WORTH. A. Current Liabilities. Accrued taxes on income/excess profits.:

25. LIABILITIES AND NET WORTH. A. Current Liabilities. Accrued expenses.:

25. LIABILITIES AND NET WORTH. A. Current Liabilities. Notes payable (current).:

25. LIABILITIES AND NET WORTH. A. Current Liabilities. Current portion of long term debt.:

25. LIABILITIES AND NET WORTH. A. Current Liabilities. Accounts payable.:

24. ASSETS. A. Current Assets. Short Term cash investments.:

24. ASSETS. A. Current Assets. Accounts receivable, less allowance for doubtful accounts of $:

24. ASSETS. A. Current Assets. Inventories.:

24. ASSETS. A. Current Assets. Other current assets.:

24. ASSETS. A. Current Assets. Other current assets.:

24. ASSETS. A. Current Assets. Total Current Assets.:

24. ASSETS. B. Property, Plant and Equipment. Land.:

24. ASSETS. B. Property, Plant and Equipment. Buildings and Equipment.:

24. ASSETS. B. Property, Plant and Equipment. Leasehold improvements.:

24. ASSETS. B. Property, Plant and Equipment. Less accumulated depreciation and amortization.:

24. ASSETS. C. Other Assets. Investments in and advance to affiliated company.:

24. ASSETS. C. Other Assets. Goodwill, less amortization.:

24. ASSETS. C. Other Assets. Due from officer, employee.:

24. ASSETS. C. Other Assets. Other.:

24. ASSETS. C. Other Assets. Other.:

24. ASSETS. C. Other Assets. Other.:

24. ASSETS. C. Other Assets. Total Other Assets.:

28. INCOME. A. Net Sales. Cost and Expenses. Cost of Goods Sold.:

28. INCOME. A. Net Sales. Minority Interest in Earnings of Subsidiaries.:

28. INCOME. Earnings Before Taxes.:

28. INCOME. Taxes on Income.:

28. INCOME. Income Before Extraordinary Items.:

28. INCOME. Extraordinary Gains (Losses) Net of Taxes.:

28. INCOME. NET INCOME (LOSS).:

28. INCOME. A. Net Sales. Total Cost and Expenses.:

28. INCOME. A. Net Sales. Cost and Expenses. Depreciation and Amortization.:

28. INCOME. A. Net Sales. Selling, General, and Admin. Expenses.:

28. INCOME. A. Net Sales. Interest Expense.:

28. INCOME. A. Net Sales. Other Expenses. :

28. INCOME. A. Net Sales. Other Expenses. :

24. ASSETS. D. TOTAL ASSETS.:

24. ASSETS. B. Property, Plant and Equipment. Total Property, Plant and Equipment.:

28. INCOME. A. Net Sales. :

29. Name of Bank. Bank 2.:

ITEM. B. Contact Person. 44. SUPPLIER 1.:

LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS. ITEM. C. Telephone. 62. SURETY COMPANY 1. AREA CODE:

LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS. ITEM. C. Telephone. 62. SURETY COMPANY 1. NUMBER.:

LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS. ITEM. C. Telephone. 63. SURETY COMPANY 2. EXTENSION.:

39. Loans Secured by Company's Assets - Real and Personal Property. D. SECURED PARTY NAME.:

39. Loans Secured by Company's Assets - Real and Personal Property. D. CONTACT NAME.:

39. Loans Secured by Company's Assets - Real and Personal Property. C. SECURING ASSETS.:

39. Loans Secured by Company's Assets - Real and Personal Property. A. MONTHLY PAYMENT ($).:

39. Loans Secured by Company's Assets - Real and Personal Property. A. MATURITY DATE. Enter 2 digit month, 2 digit day and 4 digit year.:

41B. TOTAL LIABILITY ($):

34. Amount Owing ($). Bank 2.:

37. Maximum Amount Authorized ($). Bank 2.:

38. Amount Outstanding ($). Bank 2.:

35. Term Loans. Bank 1. Yes.: 0

36. Line of Credit. Bank 2. No.: 0

36. Line of Credit. Bank 2. Yes.: 0

35. Term Loans. Bank 2. No.: 0

35. Term Loans. Bank 2. Yes.: 0

35. Term Loans. Bank 1. No.: 0

36. Line of Credit. Bank 1. Yes.: 0

36. Line of Credit. Bank 1. No.: 0

40. ARE ANY OF THE ASSETS SHOWN ON THE BALANCE SHEET PLEDGED OR MORTGAGED, EXCEPT AS STATED ABOVE? NO.: 0

41A. IF CONTRACTOR IS A PARTNERSHIP OR SOLE PROPIERTORSHIP, ARE THE INDIVIDUAL LIABILITIES OF THE PROPIETOR(S) FOR FEDERAL AND STATE INCOME AND/OR EXCESS PROFIT TAXES INCLUDED ON THE BALANCE SHEET? YES.: 0

41A. IF CONTRACTOR IS A PARTNERSHIP OR SOLE PROPIERTORSHIP, ARE THE INDIVIDUAL LIABILITIES OF THE PROPIETOR(S) FOR FEDERAL AND STATE INCOME AND/OR EXCESS PROFIT TAXES INCLUDED ON THE BALANCE SHEET? NO.: 0

40. ARE ANY OF THE ASSETS SHOWN ON THE BALANCE SHEET PLEDGED OR MORTGAGED, EXCEPT AS STATED ABOVE? YES (Explain in Section 8, Remarks).: 0

42. ARE YOU NOW IN OR PENDING DEFAULT ON ANY OBLIGATIONS, I.E., BANKS, FINANCIAL INSTITUTIONS, SUPPLIERS, OTHER? NO.: 0

42. ARE YOU NOW IN OR PENDING DEFAULT ON ANY OBLIGATIONS, I.E., BANKS, FINANCIAL INSTITUTIONS, SUPPLIERS, OTHER? YES (Provide detailed information in Section 8, Remarks).: 0

ITEM. A. Name of Supplier. 45. SUPPLIER 2.:

LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS. ITEM. D. Fax. 62. SURETY COMPANY 1. NUMBER.:

LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS. ITEM. D. Fax. 62. SURETY COMPANY 1. AREA CODE.:

ITEM. F. Amount Now Owing ($). 44. SUPPLIER 1.:

ITEM. G. High Credit ($). 44. SUPPLIER 1.:

CONTRACTS IN FORCE. ITEM. E. Contract Amount ($). 53. CONTRACT 6. :

CONTRACTS IN FORCE. ITEM. A. Location. 55. CONTRACT 8.:

CONTRACTS IN FORCE. ITEM. B. Owner's Name. 53. CONTRACT 6.:

CONTRACTS IN FORCE. ITEM. D. Type of Work. 53. CONTRACT 6. :

CONTRACTS IN FORCE. ITEM. F. Percent Completed. 53. CONTRACT 6.:

CONTRACTS IN FORCE. ITEM. G. Estimated Completion Date. 52. CONTRACT 5. Enter 2 digit month, 2 digit day and 4 digit year.:

43. PAST DUE ACCOUNTS PAYABLE ($):

LARGEST JOBS YOU HAVE COMPLETED IN THE LAST FIVE YEARS. ITEM. G. Amount Sublet ($). 60. JOB 5.:

LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS. ITEM. B. Contact's Name. 62. SURETY COMPANY 1.:

LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS. ITEM. A. Company Name. 63. SURETY COMPANY 2.:

NAME OF BUSINESS:

NAME OF AUTHORIZED OFFICIAL (Type or print):

TITLE OF AUTHORIZED OFFICIAL (Type or print):

REMARKS (Cite those sections of the form relating to your remarks. If additional space is required, attach additional sheet(s).):

64. PRESENT AMOUNT OF BONDING COVERAGE ($):

Date of Signature. Enter 2 digit month, 2 digit day and 4 digit year.:

BY (Signature of Authorized Official):