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CITY OF SANTA ANA PUBLIC WORKS AGENCY <br />REQUEST FOR PROPOSALS FOR STREET SWEEPING <br />RESPONSIBLE PROPOSER - SUPPLEMENTAL QUESTIONNAIRE <br />1. How many years has your organization been in business in California as a contractor under your present <br />business name and license number? <br />Years <br />*If performed same business under a different business name with same ownership and operation <br />management and changed name due to, but not limited to, bankruptcy, loss or license, please complete an <br />additional and separate Questionnaire. <br />2. What is your firm's Average Gross Revenue for the last three years? <br />3. Is your firm currently the debtor in a bankruptcy case? <br />? Yes ? No <br />If "yes," indicate the case number, bankruptcy court, and the date on which the petition was filed. <br />Case Number <br />Bankruptcy Court Date Filed <br />4. Was your firm in bankruptcy any time during the last five years? (This question refers only to a bankruptcy <br />action that was not described in answer to question 2, above.) <br />? Yes ? No <br />If "yes," indicate the case number, bankruptcy court, and the date on which the petition was filed. <br />Case Number <br />Bankruptcy Court Date Filed <br />5. Has any California State License Board (CSLB) license held by your firm or its Responsible Managing <br />Employee (RME) or Responsible Managing Officer (RMO) been suspended within the last five years? <br />? Yes ? No <br />6. At any time in the last five years, has your firm been assessed and paid liquidated damages after <br />completion of a project, under a construction contract with either a public or private owner? <br />? Yes ? No <br />7. Has your firm ever defaulted on a contract? <br />? Yes ? No <br />If "yes," explain on a separate page. <br />TO BE INCLUDED IN PROPOSAL PACKAGE <br />EXHIBIT G <br />25H-60