Date: Date Format: MM slash DD slash YYYY Company Information:Company Name:Contact Name:Company Address: Company Address City State / Province / Region ZIP / Postal Code List services Bidder provides:Phone:Fax:Mobile:Email Website:Has Bidder ever worked with Lloyd Construction, Inc. before?YesNoIf yes, when?Type of company:CorporationParternshipSole ProprietorshipHave there been any significant changes to the ownership, management, or structure of Bidder's business within the last three years?YesNoIf yes, please attach an explaination:Or Explain Here:List trade membership or group membership names:List trades typically performed by Bidder’s own work forces:List trades typically performed that Bidder subcontracts to others:List states that your Company has licenses in:State:License Number:State:License Number:State:License Number:State:License Number:State:License Number:State:License Number: COMPANY EXPERIENCE & PERFORMANCEHas Bidder ever failed to complete a contract?YesNoIf yes, please attach an explanationOr Explain Here:Has Bidder ever been declared in default of a contract?YesNoIf yes, please attach an explanationOr Explain Here:Has Bidder ever been terminated?YesNoIf yes, please attach an explanationOr Explain Here:Has Bidder ever been involved in bankruptcy?YesNoIf yes, please attach an explanationOr Explain Here:Has Bidder ever been involved in re-organization?YesNoIf yes, please attach an explanationOr Explain Here:Are there or have there been any claims or suits, including arbitration or administrative proceedings by or against Bidder in relation to Bidder’s performance or compliance with applicable laws on a construction project, either pending or resolved, within the last five years?YesNoIf yes, please attach an explanation, including case name, docket number, jurisdiction, description of the claims at issues, and the final outcome if applicableAre there any pending or unpaid debts against Bidder?YesNoIf yes, please attach an explanationOr Explain Here:Are there any pending judgments against the Bidder?YesNoIf yes, please attach an explanationOr Explain Here:Has Bidder or any of its principals ever been banned from bidding any state or federal construction work or project?YesNoIf yes, please attach an explanation, including case name, docket number, jurisdiction, description of the claims at issue, and the final outcome if applicableHas Bidder or any of its principals ever been convicted of, or entered a plea of guilty, or nolo contendere, for criminal violations relating to, or arising out of, its business of the bidding or performance of a construction project?YesNo(If yes, please attach an explanation, including case name, docket number, jurisdiction, description of the claims at issue, and the final outcome if applicableHas Bidder or any of its principals ever been found civilly liable for any criminal offense or civil action involving embezzlement such as: forgery, bribery, falsification or destruction of records, receipt of stolen property, collusion, antitrust, conspiracy, or other similar offenses arising out of its business or the bidding or performance of a construction project?YesNo(If yes, please attach an explanation, including case name, docket number, jurisdiction, description of the claims at issue, and the final outcome if applicableDoes Bidder have a written safety program?YesNoIf yes, please attach a copyOr Explain Here:Does Bidder require field employees to be OSHA 10 Hour Certified?YesNoIf yes, please attach the safety training you provide Has Bidder been cited by OSHA within the last five years?YesNoIf yes, please attach an explanation including dates, violation types, description, and inspection number of each violationDoes Bidder have a written drug policy?YesNoIf yes, please attach a copyDoes Bidder employ a full-time site safety professional?YesNoIs Bidder bondable?YesNoIf yes, what are the limits: Per occurrence $Aggregate $Insurance company agent name:Phone:What are Bidder’s standard limits of insurance coverage for:General Liability: $Phone Number:Insurance Company:Umbrella: $Phone Number:Insurance Company:Design/Build: $Phone Number:Insurance Company:Workers Comp: $Phone Number:Insurance Company:Does Bidder have a line of credit from any lending institution? Yes No Please list three bank and credit references (include bank name, contact, and telephone number):1.2.3.Please list five projects that have been completed in the last five years. Be sure to include project name, contracting company, contact name and phone number, contract amount, completion date, and whether it was bonded.1.2.3.4.5.Please list any projects in progress. Be sure to include the project name, contracting company, contact name and phone number, contract amount, estimated completion date, and whether it is bonded.1.2.3.4.5.Please list any future projects. Be sure to include the project name, contracting company, contact name and phone number, contract amount, estimated completion date, and whether it will be bonded.1.2.3.4.5. What is the smallest job you would accept? $Largest? $ACKNOWLEDGEMENT & SIGNATURE The information is complete and accurate to the best of my knowledge. I understand that any falsification of the information provided may result in denial of a project award and/or immediate dismissal from job site.Signed:Printed Name:Title:Date: Date Format: MM slash DD slash YYYY