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In the last five years has your firm, or any firm with which any of your company's owners,
<br />officers or partners was associated, been debarred, disqualified, removed, or otherwise
<br />prevented from bidding on, or completing, any government agency project for any reason?
<br />❑ Yes ❑ No
<br />If "yes," explain on a separate page. State the name of the organization debarred, the
<br />year of the event, the owner of the project, and the basis for the action.
<br />In the past five years, has any claim against your firm concerning your firm's work on a
<br />project, been filed in court or arbitration?
<br />❑ Yes ❑ No
<br />If "yes," on a separate page identify the claim(s) by providing the project name, date of the
<br />claim, name of the claimant, the name of the entity the claim was filed against, a brief
<br />description of the nature of the claim, the court and case number, and a brief description of
<br />the status of the claim (pending or, if resolved, a brief description of the resolution.)
<br />10. In the past five years, has your firm made any claim against a project owner concerning
<br />work on a project or payment for a contract, and filed that claim in court or arbitration?
<br />❑ Yes ❑ No
<br />If "yes," on a separate page identify the claim(s) by providing the project name, date of the
<br />claim, name of the claimant, the name of the entity the claim was filed against, a brief
<br />description of the nature of the claim, the court and case number, and a brief description of
<br />the status of the claim (pending or, if 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
<br />your firm's behalf as a result of a default, to satisfy any claims made against a
<br />performance or payment bond issued on your firm's behalf in connection with a project,
<br />either public or private? ❑ Yes ❑ No
<br />12. In the last five years, has any insurance carrier, for any form of insurance, refused to
<br />renew the insurance policy for your firm?
<br />❑ Yes ❑ No
<br />13. Has your firm or any of its owners, officers, or partners ever been liable in a civil suit, or
<br />found guilty in a criminal action, for making any false claim or material misrepresentation
<br />to any public agency or entity?
<br />❑ Yes ❑ No
<br />14. Has your firm or any of its owners, officers or partners ever been convicted of a federal or
<br />state crime of fraud, theft, or any other act of dishonesty?
<br />❑ Yes ❑ No
<br />If "yes," identify on a separate page, the person or persons convicted, the court case and
<br />number, the crimes and the year convicted.
<br />15. If your firm was required to pay a premium of more than one percent for a performance
<br />and payment bond on any project(s) on which your firm worked at any time during the last
<br />City of Santa Ana GRSC Services RFP Page 29
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