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(Note: If an appeal of the citation has been filed and the Appeals Board has not yet ruled, or there is a <br />court appeal pending, y ou need not include i nfonnation about the citation.) <br />If "yes," on a separate pa ge describe the citation, the party against whom the citation was made, date of <br />citation, nature of the violation, project on which the citation was issued, owner of project, and the amount <br />of penalty paid, if any, State the case number and date of any decision. <br />19, During the last five years, has there been more than one occasion in which the General contractor or its <br />associates have been penalized or required to pay back wages for failure to comply with the federal <br />Davis -Bacon prevailing wage requirements? 0 Yes 0 No <br />If "yes," on a separate page, describe the violator, nature of each violation, name of the project, date of <br />its completion, the public agency for which it was constructed, the number of employees who were <br />initially underpaid and the am ount of back wages and penalties that were assessed. <br />THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. <br />PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE, <br />istruction Surveying Services F <br />Page 29 (ADDENDUM NO. 3) <br />