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Curb & Walk Replacement – Jefferson Middle School <br />April 25, 2022 <br />Page 5 of 8 <br /> <br /> <br />STATEMENT OF BIDDER'S QUALIFICATION/AFFIRMATIVE ACTION <br />Each bidder who submits a proposal for any portion of the work included in the Project Manual must submit with its <br />bid this form fully completed and signed by an authorized officer of the bidder and must provide the data requested by <br />the form. Unless this form is fully completed and signed by the bidder, the proposal made by that bidder will be <br />incomplete and will not be considered by the Board of School Trustees. <br /> 1. Name of Bidder . 2. Business Address . <br /> 3. Number of years engaged in contracting business under present firm's name: years. <br /> <br /> 4. *Experience in the contracting work generally similar to this project, including list of complexes, locations and <br />approximate contract cost thereof. . <br /> <br /> 5. Have you ever defaulted on a contract? Yes No. If yes, when, and whom and why? <br /> . <br /> <br /> 6. *It is a necessary requirement of this Specification that each Contractor show evidence of five (5) jobs <br />guaranteed for one (1) year (roof work two (2) years). (Masonry joint seal work ten (10) years, on <br />workmanship, unconditionally, and where Contractor has agreed to return and repair this work at no expense to <br />the Owner. <br /> <br /> <br /> 7. *Have you ever filed bankruptcy or been adjudged bankrupt? <br /> <br /> Yes No <br /> <br /> <br /> 8. Do you employ any black, Hispanic, female, or oriental minority persons? If yes, please state the number of <br />each of such minority persons you presently employ. Yes No. <br />If no, please state reasons. <br /> <br /> . <br /> <br /> Page One