AIA Document A305 1986

Contractor's Qualification Statement

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The Undersigned certifies under oath that the information provided herein is true and sufficiently complete so as not to be misleading. SUBMITTED TO: Westmere Fire District ADDRESS: 1741 Western Avenue Albany !e" #or$ 1%%&' SUBMITTED BY: NAME: ADDRESS: PRINCIPAL OFFICE: [ [ [ [ [ ] (orporation ] )artnership ] *ndividual ] +oint ,enture ] -ther
ADDITIONS AND DELETIONS: The author of this document has added information needed for its completion. The author may also have revised the text of the original AIA standard form. An Additions and Deletions Report that notes added information as well as revisions to the standard form text is available from the author and should be reviewed. This document has important legal consequences. Consultation with an attorney is encouraged with respect to its completion or modification. This form is approved and recommended by the American Institute of Architects (AIA) and The Associated General Contractors of America (AGC) for use in evaluating the qualifications of contractors. No endorsement of the submitting party or verification of the information is made by AIA or AGC.

NAME OF PROJECT (if applicable): Westmere Fire District -verhead Door .eplacement TYPE OF WORK /file separate form for each (lassification of Wor$01 [ X ] 2eneral (onstruction [ [ [ [ ] 3,A( ] 4lectrical ] )lumbing ] -ther /please specify0

1. ORGANIZATION 1.1 3o" many years has your organi5ation been in business as a (ontractor6 1.2 3o" many years has your organi5ation been in business under its present business name6 1.2.1 Under "hat other or former names has your organi5ation operated6
ELECTRONIC COPYING of any portion of this AIA Document to another electronic file is prohibited and constitutes a violation of copyright laws as set forth in the footer of this document.

1.3 *f your organi5ation is a corporation ans"er the follo"ing1 1.3.1 Date of incorporation1 1.3.2 7tate of incorporation1 1.3.3 )resident8s name1

AIA Document A305 1986. Copyright 1964, 1969, 1979 and 1986 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. This draft was produced by AIA software at 14:49:19 on 02/13/2007 under Order No.1000238089_1 which expires on 8/31/2007, and is not for resale. User Notes: (394545467)

 1.3.4 ,ice9president8s name/s0

1.3. 7ecretary8s name1 1.3.! Treasurer8s name1 1.4 *f your organi5ation is a partnership ans"er the follo"ing1 1.4.1 Date of organi5ation1 1.4.2 Type of partnership /if applicable01 1.4.3 !ame/s0 of general partner/s0

1. *f your organi5ation is individually o"ned ans"er the follo"ing1 1. .1 Date of organi5ation1 1. .2 !ame of o"ner1

1.! *f the form of your organi5ation is other than those listed above describe it and name the principals1

2. LICENSING 2.1 :ist ;urisdictions and trade categories in "hich your organi5ation is legally <ualified to do business and indicate registration or license numbers if applicable.

2.2 :ist ;urisdictions in "hich your organi5ation8s partnership or trade name is filed.

3. EXPERIENCE 3.1 :ist the categories of "or$ that your organi5ation normally performs "ith its o"n forces.

3.2 (laims and 7uits. /*f the ans"er to any of the <uestions belo" is yes please attach details.0 3.2.1 3as your organi5ation ever failed to complete any "or$ a"arded to it6

3.2.2 Are there any ;udgments claims arbitration proceedings or suits pending or outstanding against your organi5ation or its officers6

3.2.3 3as your organi5ation filed any la" suits or re<uested arbitration "ith regard to construction contracts "ithin the last five years6

3.3 Within the last five years has any officer or principal of your organi5ation ever been an officer or principal of another organi5ation "hen it failed to complete a construction contract6 /*f the ans"er is yes please attach details.0

AIA Document A305 1986. Copyright 1964, 1969, 1979 and 1986 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. This draft was produced by AIA software at 14:49:19 on 02/13/2007 under Order No.1000238089_1 which expires on 8/31/2007, and is not for resale. User Notes: (394545467)

 3.4 -n a separate sheet list ma;or construction pro;ects your organi5ation has in progress giving the name of pro;ect o"ner architect contract amount percent complete and scheduled completion date.

3.4.1 7tate total "orth of "or$ in progress and under contract1

3. -n a separate sheet list the ma;or pro;ects your organi5ation has completed in the past five years giving the name of pro;ect o"ner architect contract amount date of completion and percentage of the cost of the "or$ performed "ith your o"n forces.

3. .1 7tate average annual amount of construction "or$ performed during the past five years1

3.! -n a separate sheet list the construction e=perience and present commitments of the $ey individuals of your organi5ation.

4. REFERENCES 4.1 Trade .eferences1

4.2 >an$ .eferences1

4.3 7urety1 4.3.1 !ame of bonding company1

4.3.2 !ame and address of agent1

. FINANCING .1 Financial 7tatement. .1.1 Attach a financial statement preferably audited including your organi5ation8s latest balance sheet and income statement sho"ing the follo"ing items1 (urrent Assets /e.g. cash ;oint venture accounts accounts receivable notes receivable accrued income deposits materials inventory and prepaid e=penses0? !et Fi=ed Assets? -ther Assets? (urrent :iabilities /e.g. accounts payable notes payable accrued e=penses provision for income ta=es advances accrued salaries and accrued payroll ta=es0?
AIA Document A305 1986. Copyright 1964, 1969, 1979 and 1986 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. This draft was produced by AIA software at 14:49:19 on 02/13/2007 under Order No.1000238089_1 which expires on 8/31/2007, and is not for resale. User Notes: (394545467)

-ther :iabilities /e.g. capital capital stoc$ authori5ed and outstanding shares par values earned surplus and retained earnings0. .1.2 !ame and address of firm preparing attached financial statement and date thereof1

.1.3 *s the attached financial statement for the identical organi5ation named on page one6

.1.4 *f not e=plain the relationship and financial responsibility of the organi5ation "hose financial statement is provided /e.g. parent9subsidiary0.

.2 Will the organi5ation "hose financial statement is attached act as guarantor of the contract for construction6

!. SIGNATURE !.1 Dated at this

day of

!ame of -rgani5ation1 >y1 Title1 !.2

@ being duly s"orn deposes and says that the information provided herein is true and sufficiently complete so as not to be misleading. 7ubscribed and s"orn before me this !otary )ublic1 @y (ommission 4=pires1 day of %&

AIA Document A305 1986. Copyright 1964, 1969, 1979 and 1986 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. This draft was produced by AIA software at 14:49:19 on 02/13/2007 under Order No.1000238089_1 which expires on 8/31/2007, and is not for resale. User Notes: (394545467)