COAST SURVEYING, INC. 4 - 2014 - Laserfiche WebLink

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EXHIBIT G (REVISED) CITY OF SANTA ANA REQUEST FOR PROPOSAL FOR CONSTRUCTION SURVEYING SERVICES RESPONSIBLE PROPOSER — SUPPLEMENTAL QUESTIONNAIRE 1. How many years has your organization begg,n i bu i ass fn Californ'a s 3 ontractor under your present isiness name and license number? 2 i S 0 t A 1'SuRVEy►ut^�a u1hRP�NC�S111VI r a.w you performed same business under a different business name ith same Inership and operation management and changed name due to, but r t limited to, bankruptcy, less, or license, please complete an additional and separate questionnaire. A 2. What is your firm's average gross revenue f or the last three years? $ r ✓ �"� t% �"' 3. Is your firm currently the debtor In a bankruptcy case? ❑ Yes 5g No If °yos," indicate the case number, bankruptcy court, and the date on which the petition was filed. WA Case Number Bankruptcy Court Date Filed 4. 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 D4 No If "yes," indicate the case num bar, bankruptcy court, and the date on which the petition was filed. AIA "_"__ Case Number Bankruptcy Court Date Filed 5. Has any California State License Board license held by your firm or its responsible managing emplpyee or responsible managing officer been suspended within the last five years? ❑Yes ® 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 [S No 7, Has your firm ever defaulted on a contract? ❑ Yes CK No If "yes," explain on a separate page. S. 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 project for any reason? ❑Yes W No If'yes," explain on a separate page. Slate the name of the organization debarred, the year of the event, the owner of the project, and the basis for the action. g. In the past five years, has any claim against your firm concerning your firm's work on aproject, been filed in court or arbitration? ❑ Yes >q No City of Santa Ana - Public Works Agency Construction Surveying Services RFP Page 27 (ADDENDUM NO. 3)