BIDDER EXPERIENCE STATEMENT All questions must be answered and

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BIDDER EXPERIENCE STATEMENT All questions must be answered and the date given must be clear and comprehensive. This instrument must be notarized. If necessary, questions may be answered on separate attached sheets. The Bidder may submit any additional information he desires. Attach all additional sheets to these Contract Documents. 1. Name of Bidder: 2. Permanent main office address: 3. When organized: 4. If a corporation, where incorporated: Federal I.D. Number: 5. How many years have you been engaged in the contracting business under your present firm or trade name? 6. General character of work performed by your company: 7. Have you ever failed to complete any work awarded to you? If so, where and why? 00-000/00-00 (Bidder Experience Statement) 00420-1 8. List any project of similar scope and complexity that your organization has completed or has in progress as of the date of receiving Bids: (Please include the name of project and person that can be contacted and phone number if possible). Location Contract Amount Date Complete % Complete Name & Address of Owner's Engineer Phone (Use additional pages if needed. Please attached hereto) 9. Background and experience of the principal members of your organization, including officers. (Include Company Resume if available) 10. Credit available: $ 11. Give Bank reference (Name, Address, Phone Number): 12. Will you, upon request, fill out a detailed financial statement and furnish any other information that may be required by OWNER? 00-000/00-00 (Bidder Experience Statement) 00420-2 13. The undersigned hereby authorizes and requests any person, firm, or corporation to furnish any information requested by OWNER in verification of the recitals comprising this Statement of Bidder's Qualifications. Dated this day of , 20 . Name of Bidder By Title State of County of being duly sworn deposes and says that he is of and that the answers to the foregoing questions and all statements therein contained are true and correct. Subscribed and sworn to before me this day of , 20 . Notary Public (SEAL) My Commission Expires: END OF SECTION 00-000/00-00 (Bidder Experience Statement) 00420-3

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