2. Has a customer terminated a contract with your firm prior to completion of the contract period at any point in the past ten (10) years? If so, please describe the circumstances:
3. Please provide the name, address and telephone of agent that will be handling your insurance for this project:
4. Has your firm been denied bonding in the past ten (10) years? If “YES” use Attachment A to explain specific circumstances, including bonding company name.
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YES
NO
5. In the past ten (10) years, has a bonding company made any payments to satisfy claims made against a bond issued on your firm’s behalf? If “YES” use Attachment A to explain the specific circumstances.
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YES
NO
6. Is your firm in preparation for, in the process of, or in negotiations toward being sold or acquired, in whole or in part, by another person, firm or entity? If “YES” use Attachment A to explain the circumstances, includi ng the name of the buyer and principal contact information:
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YES
NO
7. In the past ten (10) years, has your firm or any firm owner, partner, or officer been found to have violated or been penalized for any Federal, State, or local law in performance of a contract, including, but not limited to, laws regarding health and safety, labor and employment, wage and hours, and/or Departments of Health? If “YES” use Attachment A to explain specific circumstances surrounding each instance; include name of entity involved, specific infraction(s) or violation(s), dates of instances, and outcome with current status.
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YES
NO
8. In the past ten (10) years, has your firm been debarred or determined to be non-responsible by a government agency? If “YES” use Attachment A to explain the specific circumstances, including the name of the entity involved, the specific infraction, dates and outcome.
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YES
NO
9. If you are being considered for an award under this RFP, you may be asked to submit a statement of financial conditions including your latest regular dated financial statement, or balance sheet, which must contain current assets and liabilities. Are you willing to submit this information?
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YES
NO
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