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EXHIBIT F CITY OF SANTA ANA REQUEST FOR PROPOSALS FOR LED POST TOP RETROFIT STREETLIGHTS RESPONSIBLE PROPOSER— SUPPLEMENTAL QUESTIONNAIRE \"rcknv. acr"Q —V 1. How many years has your organization been in business in California as a coaatpaetor under your present business name and license number? \.':kCA�A If you performed same business under a different business name with same ownership and operation management and changed name due to, but not limited to, bankruptcy, loss, or license, please complete an additional and separate questionnaire. 2. What is your firm's average gross revenue for the last three years? $ 3. Is your firm currently the debtor in a bankruptcy case? ❑ Yes 'N No If "yes," indicate the case number, bankruptcy court, and the date on which the petition was filed. �- -t(A W((-\ M1 A Case Number Bankruptcy Court Date Filed Was your firm in bankruptcy any time during the last five years? (This question refers only to a bankruptcy action that was not described in answer to Question 2, above.) ❑ Yes 0 No If "yes," indicate the case number, bankruptcy court, and the date on which the petition was filed. �, uA Case Number l � or er Bankruptcy Court Date Filed 5. Has any California State License Board license held by your firm or its responsible managing employee or responsible managing officer been suspended within the last five years? ❑ Yes 9 No 6. At any time in the last five years, has your firm been assessed and paid liquidated damages after completion of a project, under a services contract with either a public or private owner? ❑ Yes Vi No 7. Has your firm ever defaulted on a contract? ❑ Yes 'Y� No If "yes," explain on a separate page. B. 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 biddin on, or completing, any government agency project for any reason? 71 Yes No If "yes," explain on a separate page. State the name of the organization debarred, the year of the event, the owner of the project, and the basis for the action. 9. In the past five years, has any claim against your firm concerning your firm's work on a project, been filed in court or arbitration? ❑ Yes X No If "yes," on a separate page identify the claim(s) by providing the project name, date of the claim, name of the claimant, the name of the entity the claim was filed against, a brief description of the nature of the claim, the court and case number, and a brief description of the status of the claim (pending or, if resolved, a brief description of the resolution.) RFP FOR LED POST TOP RETROFIT STREETLIGHTS Page 122 20B -18