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[null,null,"CONTRACTOR PREQUALIFICATION APPLICATION"]
[null,null,"Part I  Contractor’s General/Financial Information Sheet"]
[null,null,"(All Questions Must Be Answered)"]
[null,null,"A.  General Information."]
[]
[null,null,"Contractor’s name as it appears on license:"]
[]
[]
[null,null,"Firm Type (Select one):"]
[]
[null,null,"Contact Person: "]
[]
[null,null,"Local Address (P.O. Box is not acceptable):"]
[null,null,null,null,"Street Address 1:"]
[null,null,null,null,"Address 2:"]
[null,null,null,null,"City:"]
[null,null,null,null,"Zip:"]
[]
[null,null,null,null,"Office Telephone:"]
[null,null,null,null,"Contact Mobile:"]
[null,null,null,null,"Fax Number:"]
[]
[null,null,null,null,"E-mail address: "]
[]
[null,null,"List all California construction license numbers, classifications and expiration dates of the California contractor licenses held by your firm: "]
[null,null,"License Number",null,null,"Classification",null,null,null,null,null,"Expiration Date "]
[]
[]
[]
[]
[]
[]
[]
[null,null,"If any of your firm’s license(s) are held in the name of a corporation or partnership, list below the names of the qualifying individual(s) listed on the CSLB records who meet(s) the experience and examination requirements for each license. "]
[null,null,"License Number",null,null,"Classification",null,null,null,null,null,"Expiration Date "]
[]
[]
[]
[]
[]
[]
[null,null,"Part I  Contractor’s General/Financial Information Sheet"]
[null,null,"General contractors must maintain a liability insurance policy with a minimum limit of $3,000,000 per occurrence and $5,000,000 aggregate. Mechanical, electrical, and plumbing subcontractors must maintain a liability insurance policy with a minimum limit of $1,000,000 per occurrence and $2,000,000 aggregate. Please provide a current copy of your certificate of liability insurance as verification of compliance with these requirements."]
[]
[null,null,"B.  History and Ownership of Firm."]
[]
[null,null,"No.","Question",null,null,null,null,null,null,null,"Answer"]
[null,null,1,"How many years has your firm been in business in California as a contractor under your present business name and license number."]
[null,null,2,"Has there been any change in ownership of the firm at any time during the last three years.  If yes, please provide details on a separate signed page.",null,null,null,null,null,null,null,"?"]
[null,null,null,"NOTE: A corporation whose shares are publicly traded is not required to answer this question; please indicate “N/A – Publicly traded corporation”."]
[null,null,3,"Is the firm a subsidiary, parent, holding company or affiliate of another construction firm.  If yes, please provide details on a separate signed page.",null,null,null,null,null,null,null,"?"]
[null,null,null,"NOTE:  Include information about other firms if one firm owns 50 percent or more of another."]
[null,null,4,"Please provide the information appropriate to your firm below."]
[null,null,null,null,"For Firms That Are Corporations"]
[null,null,null,null,"For Firms That Are Partnerships"]
[null,null,null,null,"For Firms That Are Sole Proprietorships"]
[null,null,null,null,"For Firms That Intend to Make a Bid as Part of a Joint Venture"]
[null,null,"For Firms That Are Corporations:"]
[null,null,null,"Date incorporated:"]
[null,null,null,"Under the laws of what state:"]
[]
[null,null,"Provide all the following information for each person who is either (a) an officer of the corporation (president, vice president, secretary, treasurer), or (b) the owner of at least ten percent of the corporation’s stock."]
[null,null,"Name",null,null,"Position",null,null,null,"Yrs In Company",null,"% Ownership"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,"Part I  Contractor’s General/Financial Information Sheet"]
[null,null,"Identify every construction firm that any person listed above has been associated with (as owner, general partner, limited partner or officer) at any time during the last five years."]
[null,null,"NOTE: For this question, “owner” and “partner” refer to ownership of ten percent or more of the business, or 10 percent or more of its stock, if the business is a corporation. "]
[null,null,"Person’s Name",null,null,"Construction Firm",null,null,"Dates of Person’s Participation with Firm"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,"For Firms That Are Partnerships:"]
[null,null,null,"Date established:"]
[null,null,null,"Under the laws of what state:"]
[]
[null,null,"Provide all the following information for each partner who owns 10 percent or more of the firm."]
[null,null,"Name",null,null,"Position",null,null,null,"Yrs In Company",null,"% Ownership"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,"Identify every construction company that any partner has been associated with (as owner, general partner, limited partner or officer) at any time during the last five years. Use additional sheets as needed."]
[]
[null,null,"NOTE: For this question, “owner” and “partner” refer to ownership of ten percent or more of the business, or ten percent or more of its stock, if the business is a corporation. "]
[]
[null,null,"Part I  Contractor’s General/Financial Information Sheet"]
[null,null,"Person’s Name",null,null,"Construction Company",null,null,"Dates of Person’s Participation with Company"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,"For Firms That Are Sole Proprietorships:"]
[]
[null,null,"Date of commencement of business:  "]
[]
[null,null,"Identify every construction firm that the business owner has been associated with (as owner, general partner, limited partner or officer) at any time during the last five years. "]
[]
[null,null,"NOTE:  For this question, “owner” and “partner” refer to ownership of ten percent or more of the business, or ten percent or more of its stock, if the business is a corporation. "]
[null,null,"Person’s Name",null,null,"Construction Company",null,null,"Dates of Person’s Participation With Company"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,"For Firms That Intend to Make a Bid as Part of a Joint Venture:"]
[]
[null,null,"Date of commencement of joint venture:"]
[]
[null,null,"NOTE: Provide all of the following information for each firm that is a member of the joint venture that expects to bid on one or more projects:"]
[null,null,"Name of firm",null,null,null,null,null,null,null,null,"% Ownership"]
[]
[]
[]
[]
[]
[null,null,"NOTE: On a separate sheet provide all other pertinent information required in the sections above, for each corporation, partnership or sole-proprietorship that is a part of the joint venture."]
[null,null,"Part I  Contractor’s General/Financial Information Sheet"]
[null,null,5,"State your firm’s gross revenues for each of the last three fiscal years:"]
[null,null,null,"Current year ($): "]
[null,null,null,"Previous year ($):  "]
[null,null,null,"Year prior to previous year ($): "]
[null,null,6,"State the number of projects your firm has completed in each of the last three fiscal years:"]
[null,null,null,"Current year: "]
[null,null,null,"Previous year:  "]
[null,null,null,"Year prior to previous year: "]
[null,null,7,"Has your firm changed names or license number in the past five years",null,null,null,null,null,null,null,"?"]
[null,null,null,"NOTE: If yes, explain on a separate signed page, including the reason for the change."]
[]
[null,null,"C.  Bonding."]
[]
[null,null,8,"Please attach a   notarized statement from an admitted surety insurer (approved by the California\nDepartment of Insurance and authorized to issue bonds in the State of California) which states your current bonding capacity. Any statement submitted in response to this section must be issued by the surety insurer within six months of the submission of this application. "]
[null,null,null,"Name of bonding company/surety:"]
[null,null,null,"Name of surety agent:"]
[null,null,null,"Address:"]
[null,null,null,"Telephone number:"]
[]
[null,null,9,"List all other sureties (name and full address) that have written bonds for your firm during the last five years, including the dates during which each wrote the bonds:"]
[null,null,"Name",null,null,null,"Address",null,null,null,null,"Date"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,"Part I  Contractor’s General/Financial Information Sheet"]
[null,null,"D.  Financial Information."]
[]
[null,null,10,"Please attach your most current reviewed or audited year-end financial statement, which must have been prepared by a certified public accountant, within twelve (12) months of submission of this prequalification package.  Also, please provide your most current financial statement, which must have been prepared within three (3) months of submission of this prequalification package."]
[null,null,11,"Name of accounting firm and primary contact:"]
[null,null,null,"Address:"]
[null,null,null,"Telephone:"]
[null,null,null,"How many years has this accounting firm prepared financial statements for you?"]
[null,null,12,"Banking information:"]
[]
[null,null,null,"Name of Bank:"]
[null,null,null,"Account Manager:"]
[null,null,null,"Address:"]
[null,null,null,"Address Cont'"]
[null,null,null,"Telephone:"]
[null,null,null,"Account No.:"]
[null,null,null,"Line of Credit:"]
[null,null,null,"Amount in Use:"]
[null,null,null,"How Secured:"]
[null,null,null,"Expiration Date:"]
[null,null,null,"NOTE: Attach extra sheets for additional banks/accounts"]
[]
[null,null,"Part I  Contractor’s General/Financial Information Sheet"]
[null,null,"E.  Recent Construction Projects Completed."]
[]
[null,null,"Please provide the information requested below about all current public works projects, all public works projects completed in the last 24 months, and all K-12 public projects completed in the last three years.  Names and references must be current and verifiable.  "]
[]
[null,null,"For general contractor applicants:  Only list projects your firm performed as the general contractor in charge of all trades for the construction of a building.  "]
[]
[null,null,"For subcontractor applicants:  Only list projects your firm performed as the prime contractor if a single trade job or as a subcontractor on a multiple trade contract.  For multiple trade contracts, indicate the general contractor’s name and contact information."]
[]
[null,null,"Use separate sheets of paper that contain all of the following information:"]
[]
[null,null,"Project Name:"]
[]
[null,null,"Location:"]
[]
[null,null,"Owner:"]
[]
[null,null,"Owner Contact (name and current phone number): "]
[]
[null,null,"Architect or Engineering firm: "]
[]
[null,null,"Architect or Engineer Contact (name and current phone number):"]
[]
[null,null,"Construction Manager (name and current phone number):"]
[]
[null,null,"Inspector of Record (name and current phone #):"]
[]
[null,null,"Description of Project, Scope of Work Performed: "]
[]
[]
[]
[null,null,"Total Value of Construction (including change orders): "]
[]
[null,null,"Date Construction Commenced:"]
[]
[null,null,"Original Contractual Completion Deadline:  "]
[]
[null,null,"Adjusted Completion Deadline Based on Time Extensions Granted by Owner: "]
[]
[null,null,"Actual Date of Completion: "]
[]
[null,null,"General Contractor’s Project Manager (lead contact in office) "]
[]
[null,null,"General Contractor’s Superintendent (lead contact on project site) "]
[]
[null,null,"Part I  Contractor’s General/Financial Information Sheet"]
[null,null,"F.  Apprenticeship Program Information"]
[]
[null,null,13,"Provide the name, address and telephone number of the apprenticeship program sponsor(s) (approved by the California Apprenticeship Council) from whom you intend to request the dispatch of apprentices to your company for use on any public work project for which you are awarded a contract the District."]
[null,null,null,"Name",null,null,"Address",null,null,null,null,"Phone"]
[]
[]
[]
[]
[]
[]
[null,null,14,"If your firm operates its own State-approved apprenticeship program:"]
[null,null,null,"(a)","Identify the craft or crafts in which your firm provided apprenticeship training in the past year. "]
[null,null,null,"(b)","State the year in which each such apprenticeship program was approved, and attach evidence of the most recent California Apprenticeship Council approval(s) of your apprenticeship program(s).  "]
[null,null,null,"(c)","State the number of individuals who were employed by your firm as apprentices at any time during the past three years in each apprenticeship and the number of persons who, during the past three years, completed apprenticeships in each craft while employed by your firm."]
[]
[null,null,"(a) Craft",null,null,null,null,"(b) Year",null,"(c ) No. Apprentices",null,"(c ) No. Completed"]

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[]
[null,"PART II: Essential Requirements for Prequalification"]
[null,"(All Questions Must Be Answered)"]
[null,"No.","Question",null,"Answer"]
[null,1,"Do you possess a valid and current California contractor's license for the Project?",null,"?"]
[null,2,"If you are a general contractor, do you have a liability insurance policy with the policy limit of at least $3,000,000 per occurrence and $5,000,000 aggregate?  If you are a mechanical, electrical, or plumbing subcontractor, do you have a liability insurance policy with a policy limit of at least $1,000,000 per occurrence and $2,000,000 aggregate?",null,"?"]
[null,"3","Do you have any employees?",null,"?"]
[null,null,"If yes, do you have current workers’ compensation insurance policy as required by the Labor Code or are you legally self-insured pursuant to Labor Code section 3700 et seq.?",null,"?"]
[null,4,"Has your firm completed at least two California public school K-12 construction projects, subject to DSA approval?",null,"?"]
[null,"5","Has your contractor’s license been revoked or suspended at any time in the last five years, even if later reinstated retroactively? ",null,"?"]
[null,"6","At the time of submitting this prequalification form, is your firm ineligible to bid on or be awarded a public works contract, or perform as a subcontractor on a public works contract, pursuant to either Labor Code section 1777.1 or Labor Code section 1777.7?",null,"?"]
[null,null,"If yes, state the beginning and ending dates of the period of debarment:","Began","Ends"]
[]
[null,"7","At any time during the last five years, has your firm or any of its owners or officers been convicted of a crime involving the awarding of a contract of a government construction project, or the bidding or performance of a government contract?",null,"?"]
[null,"8","Is your firm currently the debtor in a bankruptcy or receivership case?",null,"?"]
[null,null,"If yes, please attach a copy of the bankruptcy petition, showing the case number, and the date on which the petition was filed. "]
[null,"9","Has a surety firm completed a contract on your behalf, or paid for completion because your firm was default terminated by the project owner within the last five (5) years? ",null,"?"]
[null,"10","Has your firm, or any of its owners, officers, or partners 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 agency or entity?  ",null,"?"]
[null,null,"If yes, explain on a separate signed page, including identifying who was involved, the name of the public agency, the date of the investigation and the grounds for the finding."]
[null,"11","Has your firm, or any of its owners, officers or partners ever been convicted of a crime involving any federal, state, or local law related to construction?",null,"?"]
[null,"12","Has your firm or any of its owners, officers or partners ever been convicted of a federal or state crime of fraud, theft, or any act of dishonesty? ",null,"?"]
[null,null,"If yes, identify on a separate signed  page the person or persons convicted, the court (the county if a state court, the district or location of the federal court), the year and the criminal conduct."]

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[]
[null,"PART III: Scored Questions"]
[null,"(All Questions Must Be Answered)"]
[null,"No.","Question","Answer"]
[null,"A","Financial History & Licensing"]
[null,"1","Was your firm in bankruptcy or receivership any time during the last five years?","?"]
[null,null,"If yes, please attach a copy of the bankruptcy petition, showing the case number and the date on which the petition was filed, and a copy of the Bankruptcy Court’s discharge order, or of any other document that ended the case, if no discharge order was issued. "]
[null,"2","Has any CSLB license held by your firm or its Responsible Managing Employee (RME) or Responsible Managing Officer (RMO) been suspended within the last five years? ","?"]
[null,"B","Disputes"]
[null,"3","At any time in the last five years, have liquidated damages been assessed or levied against your firm under a construction contract with either a public or private owner?","?"]
[null," ","If yes, explain on a separate signed page, identifying all such projects by owner, owner’s address, the date of completion of the project, amount of liquidated damages assessed or levied by the owner, amount of liquidated damages paid or credited by you to the owner, and all other information necessary to fully explain the assessment or levy of liquidated damages."]
[null,"4","In the last five years has your firm, or any firm with which any of your company’s owners, officers or partners was associated, been debarred, disqualified, removed or otherwise prevented from bidding on, or completing, any government agency or public works project for any reason?","?"]
[null,null,"NOTE:  “Associated” refers to another construction firm in which an owner, partner or officer of your firm held a similar position, and which is listed in response to question 1c or 1d on this form."]
[null," ","If yes, explain on a separate signed page.  State whether the firm involved was the firm applying for prequalification here or another firm.  Identify by name of the company, the name of the person within your firm who was associated with that company, the year of the event, the owner of the project, the project and the basis for the action."]
[null,"5","In the last five years, has your firm been denied an award of a public works contract based on a finding by a public agency that your company was not a responsible bidder?","?"]
[null," ","If yes, explain on a separate page.  Identify the year of the event, the owner, the project and the basis for the finding by the public agency."]
[null,null,"NOTE: The following two questions refer only to disputes between your firm and the owner of a project. You need not include information about disputes between your firm and a supplier, another contractor, or subcontractor.  You need not include information about “pass-through” disputes in which the actual dispute is between a sub-contractor and a project owner.              Also, you may omit reference to all disputes about amounts of less than $50,000."]
[null,"6","In the past five years, has any claim by a project owner (including a complaint) against your firm concerning your firm’s work on a construction project, been filed in court or been the subject of arbitration?","?"]
[null," ","If yes, on separate signed sheets of paper identify the claim(s) by providing the project name, date of the claim, name of the claimant, a brief description of the nature and amount of the claim (including a breakdown of the major elements of the claim), the court in which the case was filed, and a brief description of the status of the claim (pending or, if resolved, a brief description of the resolution)."]
[null,"7","In the past five years, has your firm filed any claim (including a complaint) in court or arbitration against a project owner concerning work on a project or payment for a contract?","?"]
[null,null,"If yes, on separate signed sheets of paper identify the claim by providing 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 and amount of the claim (including a breakdown of the major elements of the claim), the court in which the case was filed and a brief description of the status of the claim (pending, or if resolved, a brief description of the resolution)."]
[null,"8","Has your firm had a contract for a public work of improvement in the last five years that was terminated for cause by a public entity, or terminated in whole or in part with your consent?","?"]
[null,null,"Note: you need not answer “yes” if the public entity terminated the contract for convenience."]
[null,null,"If the answer is “Yes,” for each such contract attach a separate sheet identifying the owner, your bonding company, the original contract value, the value of the work terminated and a brief explanation of the circumstances leading to the termination."]
[null,"9","At any time during the past five years, has any surety company made any payments on your firm’s behalf as a result of a default, to satisfy any claims made against a performance or payment bond issued on your firm’s behalf, in connection with a construction project, either public or private?","?"]
[null,null,"If “yes,” explain on a separate signed page the amount of each such claim, the name and telephone number of the claimant, the date of the claim, the grounds for the claim, the present status of the claim, the date of resolution of such claim if resolved, the method by which such was resolved if resolved, the nature of the resolution and the amount, if any, at which the claim was resolved."]
[null,"10","In the last three years has your firm held a public works contract on which more than three (3) stop payment notices were served against your firm.","?"]
[null,null,"If “yes,” explain on a separate signed page."]
[null,"11","In the last 3 years have you had any Stop Payment Notice result in a claim against your Payment Bond?  ","?"]
[null,null,"If “yes,” explain on a separate signed page."]
[null,"C","Insurance and Bonding"]
[null,"12","In the last five years, has any insurance carrier, for any form of insurance, refused to renew the insurance policy for your firm?","?"]
[null,null,"If yes, how many instances?  "]
[null,"13","Was your firm was required to pay a premium of more than one percent for a performance and payment bond on any project(s) on which your firm worked at any time during the last five  years?","?"]
[null,null," If \"yes\", state the percentage in column to right that your firm was required to pay. ",0]
[null,null," On a separate signed sheet identify the project, identify the owner, and identify the dates of the project.  You may provide an explanation for a percentage rate higher than one percent, if you wish to do so. "]
[null,"14","During the last five years, has your firm ever been denied bond coverage by a surety company, or has there ever been a period of time when your firm had no surety bond in place during a public construction project when one was required?","?"]
[null,null,"If yes, provide details on a separate signed sheet indicating the date when your firm was denied coverage and the name of the company or companies which denied coverage; and the period during which you had no surety bond in place. "]
[null,"D","Compliance With Law"]
[null,"15","Has CAL OSHA cited and assessed penalties against your firm for any “serious,” “willful” or “repeat” violations of its safety or health regulations in the past five years?  ","?"]
[null,null,"Note: If you have filed an appeal of a citation and the Occupational Safety and Health Appeals Board has not yet ruled on your appeal, you need not include information about it."]
[null,null,"If yes, attach a separate signed page describing each citation."]
[null,"16","Has the federal Occupational Safety and Health Administration cited and assessed penalties against your firm in the past five years?  "]
[null,null,"Note: If you have filed an appeal of a citation and the appropriate appeals Board has not yet ruled on your appeal, you need not include information about it.","?"]
[null,null,"If yes, attach a separate signed page describing each citation."]
[null,"17","Has the EPA or any Air Quality Management District or any Regional Water Quality Control Board cited and assessed penalties against either your firm or the owner of a project on which your firm was the contractor, in the past five years?  "]
[null,null,"NOTE: If you have filed an appeal of a citation and the Appeals Board has not yet ruled on your appeal, or if there is a court appeal pending, you need not include information about the citation.","?"]
[null,null,"If yes, attach a separate signed page describing each citation."]
[null,"18","How often do you require documented safety meetings to be held for construction employees and field supervisors during the course of a project? ","?"]
[null,"19","List your firm’s Experience Modification Rate (EMR) (California workers’ compensation insurance) for each of the past three premium years:"]
[null,null,"NOTE: An Experience Modification Rate is issued to your firm annually by your workers’ compensation insurance carrier."]
[null,null,"Current Year:"]
[null,null,"Previous Year:"]
[null,null,"Year Prior To Previous:"]
[null,"20","Within the last five years, has there ever been a period when your firm had employees but was without workers’ compensation insurance or state-approved self-insurance?","?"]
[null,"E","Prevailing Wage and Apprenticeship Compliance Record"]
[null,"21","Has there been any occasion during the last five years on which your firm was required to pay either back wages or penalties for your own firm’s failure to comply with the state’s prevailing wage laws? ","?"]
[null,null,"NOTE:  This question refers only to your own firm’s violation of prevailing wage laws, not to violations of the prevailing wage laws by a subcontractor.  "]
[null,null,"If yes, attach a separate signed page or pages, describing the nature of each violation, identifying the name of the project, the 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 you were required to pay."]
[null,"22","During the last five years, has there been any occasion on which your own firm has been penalized or required to pay back wages for failure to comply with the federal Davis-Bacon prevailing wage requirements? ","?"]
[null,null,"If yes, attach a separate signed page or pages describing the nature of the violation, identifying the name of the project, the date of its completion, the public agency for which it was constructed; the number of employees who were initially underpaid, the amount of back wages you were required to pay along with the amount of any penalty paid."]
[null,"23","Other than as already described in response to any question above, have any other labor or environmental charges or penalties been assessed or levied against, or paid by, your firm or the owner of a project on which your firm was the contractor in the past five years?","?"]
[null,"24","At any time during the last five years, has your firm been found to have violated any provision of California apprenticeship laws or regulations, or the laws pertaining to use of apprentices on public works?","?"]
[null,null,"If “yes,” provide the date(s) of such findings, and attach copies of the Department’s final decision(s)."]
[null,null,"If yes, attach a separate signed page or pages describing the nature of the violation, identifying the name of the project, the date of its completion, and the public agency for which it was constructed."]
[null,null," "]

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[]
[null,"PART IV:  CERTIFICATION"]
[]
[null,"Questionnaires submitted by corporations must be signed with the legal name of the corporation, followed by the name of the state of incorporation and by the signature and designation of the chairman of the board, president or any vice president, and then followed by a second signature by the secretary, assistant secretary, the chief financial officer or assistant treasurer.  All persons signing must be authorized to bind the corporation in the matter.  The name of each person signing shall also be typed or printed below the signature.  Satisfactory evidence of the authority of each officer signing on behalf of a corporation shall be furnished."]
[]
[null,"Questionnaires submitted by partnerships must furnish the full name of all partners and must be signed in the partnership name by a general partner with authority to bind the partnership in such matters, followed by the signature and designation of the person signing.  The name of the person signing shall also be typed or printed below the signature.  "]
[null,"Each person signing below makes the following representations under penalty of perjury:"]
[]
[null,"The submitter of the foregoing answers to the questionnaire has read the same and the matters stated therein are true of his or her own personal knowledge.  This information is provided for the purpose of qualifying to bid on the Project, and any individual, company or other agency named herein is hereby authorized to supply the District with any information necessary to verify the prospective bidder’s statements.  By signing below, the submitter and the named contractor hereby grant permission to the District to contact any or all of the above listed persons or entities to confirm facts or otherwise investigate the above facts and issues."]
[null,"The submitter understands that any statement which is proven to be false shall be grounds for immediate disqualification from bidding on the Project.  The submitter whose signature appears below represents and warrants that he or she has authority to bind the named contractor."]
[null,"I, the undersigned, certify and declare that I have read all the foregoing answers to this prequalification questionnaire and know their contents.  The matters stated in the questionnaire answers are true of my own knowledge and belief, except as to those matters stated on information and belief, and as to those matters I believe them to be true.  I declare under penalty of perjury under the laws of the State of California, that the foregoing is correct."]
[]
[null,"Executed on this:",null,"day of",null,"at"]
[]
[null,"Signature Celebratory:"]
[]
[null,"Typed Name:"]
[]
[null,"Contractor:"]
[]
[null,"(Add additional signature pages as necessary to comply with the directions above.)"]