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10. In the past five years, has your firm mad e. any claim against a project owner concerning work on projeact
<br />or payment for a contract, and flied that claim in court or arbitration? ❑ Yes No
<br />If "yes," on a separate page identify the elatm(s) by providing the project name, date of the olalm, name of
<br />the claimant, the name of the entity the claim was flied 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 />11. At any time during the past five years, has any surety company made any payments on your firm's behalf
<br />as a result of a default, to satisfy any claims made against a performance or payment bond Is on
<br />your firm's behalf In connection with a project, either public or private? ❑ a Yes No
<br />12. In the last five years, has any insurance carrier, for any farm of insurance, refused to renew the Ill
<br />policyfor your firm? ❑ Yes K No
<br />13. Has your firm or any of its owners, officers, or partners ever been liable In a civil suit, or found gulity in a
<br />criminal action, for making any false claim or material misrepresentation to any public agency or entity?
<br />❑ Yes No
<br />14, Has ycurfirm or any of Its owners, officers or partners ever been convicted of a federal or state critne,Of
<br />fraud, theft, or any other act of dishonesty? ❑ Yes No
<br />If "yes," Identify on a separate page, the person or parsons convicted, the court case and number, the
<br />Mmes and the year convicted.
<br />15. If your firm was required to pay a premium of mare than one percent fora performance and payment
<br />bond on any project(s) on which your firm worked at any time during the last three years, state the
<br />percentage that your firm was required to pay. You may provide an explanation for a percentage rate
<br />higher than one percent, If you wish to do so. �0
<br />'I6. During the last five years, has your firm ever been denied bond credit by a surety company, or has there
<br />ever been a period of time when your firm had no surety bond In place during a project when one was
<br />required? ❑ Yes No
<br />17, Has Cal -OSHA cited and assessed penalties against the contractor or its associates for any "serf us,"
<br />"willful" or "repeat" violations of Its safety or health regulations In the past five years? ❑ Yes X No
<br />(Nota: If you have filed an appeal of a citation, and the Occupational Safety and Health Appeals Beard
<br />has not yet rulers on your appeal, you need not include Information about It.)
<br />If "yes," on a separate page describe the citations, 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 the project, and the
<br />amount of penalty paid, If any. State the case number and the date of any OSHAIB decision,
<br />18. Has the Federal Occupational Safety and Health Administration cited and assessed penalties againet the
<br />contractor or its associates in the past five years? ❑ Yes 5l No
<br />(Note; If an appeal of the citation has been filed and the Appeals Board has riot yet ruled, or there is a
<br />court appeal pending, you need not include information about the citation.)
<br />If "yes," on a separate page 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
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<br />RFP FOR LED POST TOP RETROFIT STREETLIrhITS Pogo 123
<br />20B -19
<br />25D -37
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