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EXHIBIT H <br />CITY OF SANTA ANA <br />REQUEST FOR PROPOSALS GRSC SERVICES <br />RESPONSIBLE PROPOSER — SUPPLEMENTAL QUESTIONNAIRE <br />How many years has your organization been in business in California as a contractor <br />under your present business name and license number? <br />If you performed same business under a different business name with same ownership <br />and operation management and changed name due to, but not limited to, bankruptcy, loss, <br />or license, please complete an additional and separate questionnaire. <br />2. What is your firm's average gross revenue for the last three years? <br />3. Is your firm currently the debtor in a bankruptcy case? <br />❑ Yes ❑ No <br />If "yes," indicate the case number, bankruptcy court, and the date on which the petition <br />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 only <br />to a bankruptcy action that was not described in answer to Question 2, above.) <br />❑ Yes ❑ No <br />If "yes," indicate the case number, bankruptcy court, and the date on which the petition <br />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 <br />managing employee or responsible managing officer been suspended within the last five <br />years? ❑ Yes ❑ No <br />6. At any time in the last five years, has your firm been assessed and paid liquidated <br />damages after completion of a project, under a services contract with either a public or <br />private owner? ❑ Yes ❑ No <br />7. Has your firm ever defaulted on a contract? <br />❑ Yes ❑ No <br />If "yes," explain on a separate page. <br />City of Santa Ana GRSC Services RFP Page 28 <br />