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EXHIBIT <br />CITY #' <br />SANTA ANA <br />{, How many years has your organization been in business in California as a contractor under your present <br />business name and license number? 2year <br />If you 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 <br />an additional and separate questionnaire. <br />2. What is your firm's average gross revenue for the last three years? $ 2,100. 000 <br />3. Is your firm currently the debtor in a bankruptcy case?[] Yes No <br />If "yes," indicate the case number, bankruptcy court, and the date on which the petition was filed. <br />Case Number Bankruptcy Court Date Filed <br />4. Was your firm in bankruptcy any time during the last five years? (This question refers my to a <br />bankruptcy action that was not described In answer to Question 2, above., 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 Piled <br />5. Has any California State License Board license held by your firm or its responsibie�r sanaging employee <br />or responsible managing officer been suspended within the last five years?j] Yes L� No <br />S. 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 services contract with either a public or private owner? 0 Yes M No <br />7, Has your firm ever defaulted on a contraot ?C1 Yes M No <br />If "yes," explain on a separate page. <br />8, in the last five years has your firm, or any firm with which any of your company's owners, officers or <br />partners was associated, been debarred, disqualified, removed, or otherwise revented from bidding on, <br />or completing, any government agency project for any reason ?d Yes No <br />If "yes," explain on a separate page. State the name of the organization debarred, the year of the event, <br />the owner of the project, and the basis for the action. <br />9. In the past five years, has any claim against your firm concerning your firm's work on a project, been filed <br />in court or arbitration? El Yes ® No <br />If "yes," on a separate page identify the claim(s) by providing the project name, date of the claim, name of <br />the claimant, the name of the entity the claim was filed against, a brief description of the nature of the <br />claim, the court and case number, and a brief description of the status of the claim (pending or, if <br />resolved, a brief description of the resolution,) <br />City of Santa Ana — Automated Parking Citation and Processing Services <br />25A -41 <br />