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EXHIBIT 0 (REVISED) <br />CITY OF SANTA ANA <br />REQUEST FOR PROPOSAL. FOR <br />CONSTRUCTION SURVEYING SERVICES <br />RESPONSIBLE PROPOSER — SUPPLEMENTAL QUESTIONNAIRE <br />1. How many years has your organization been I bu in ass in Calif 'a s a ontractor under your present <br />%�siness name and license number? A <br />LeauVF.�%i13�StAPPIP4f <br />511 [vi iF 1 j°2 f <br />U you performed same business under a different business name Stith same wnership and operation <br />management and changed name due to, but of limited to, bankruptcy, loss; or license, please cam plate <br />an additional and separate questionnaire, ja <br />2. What is your firm's average gross revenue for the last three years? $ J ✓ r ✓ <br />3, Is your firm currently the debtor In a bankruptcy case? <br />: M'1 <br />If "yes," indicate the case num bar, 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 onl to a <br />bankruptcy action that was not described in answer to Question 2, above.) Yes [9 No <br />If "yes," indicate the case num bar, bankruptcy court, and the date on which the petition was filed. <br />Case Number Bankruptcy Court Date Filed <br />5. Has any California State License Board license held by your firm or its responsible managing employee <br />or responsible managing officer been suspended within the last five years? ❑ Yes 9 No <br />6, At any time in the last five years, has your firm been assessed and paid liquidated dame es after <br />completion of a project, under a services contract with either a public or private owner? Yes 9 No <br />7, Flas your firm ever defaulted atr a contract? EJ Yes DA 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 prevented from biddin on, <br />or completing, any government agency project for any reason? D Yes DJ 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? �j Yes M No <br />City of Santa Ana, Public Works Agency <br />Construction Surveying Services RFP <br />Page 27 (ADDENDUM N0. 3) <br />25E -78 <br />