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Home My WebLink AboutBid/Contract Excel Excavating .' . -'" . .. . .. . . . '.' . . '.. ,'. ~, FDrm ND. 96 (Revised 1987) r BID OF t e: X ( c::L- e::-- XC~ ~-rr tJ l7r (Contractor) , r-. _"P ~ . gv\c t;4ts (Address) ~-1"SC1~ILCE W 4/!3D . I FOR PUBLIC WORKS PROJECTS OF Filed , 19 Action taken B-102 ..' - .... . ....... . - ..' " . Pfeaa:it*ll bf SWllIoard 01 AQCOIlNIi A.E. ea,ce CD.. AnC:. ....... IN '240-1. Farm NO Ii IRftIMG t.7I CONTRACTORS BID FOR PUBLIC WORKS PART I (To be cDmpleted fDr all bids) (Please type or print) 1. Governmental Unit: Pit~U~ t.00 e...lc S ~ '5 ~~11 Glt-<-I C P- ,~f'f.e"P,)() gJ~ Date: gO{l..-fL 7? (\ C ~ LM IL-- c- .x ~ i::-L P. I) . f2-,'O 't.- ~+ B City/State: ::st:; ~1Z<;;oN \~ ~ I 4. Telephone Number: f1 r 2-- ')..4 ~ - 0 fDC::;7 5. Agent of Bidder (if applicable): \iVI , IL~ f;-J ~ p ~ Pursuant tD notices given, the undersigned offers to furnish labor and/Dr material necessary to cDmplete the public works project of ~ ':;j -(') F ~5o ~Je~<m~ ~nW in accordance with plans f:\F'I"(' ~\V... 'f'-to S4.. Q E.t&"'T 1ol,,"'ClQ.1!O 'S,..~ F.",e .y~. ~ LA- and specifications df said unit for the sum of ~~. The under- signed further agrees to furnish a bond or certified check with this bid for an amDunt specified in the nDtice of the letting. If alternative bids apply, submit a proposal for each in accDrdance with the notice. If additional units of material included in the contract are needed, the cost Df units must be the same as that shown in the original contract. If the bid is to be awarded on a unit basis, the itemization of units shall be shown on a separate attachment. The Contractor and his subcontractDrs, if any, shall not discriminate against or intimidate any emplDyee, or applicant for employment, to be employed in the performance of this contract, with respect to any matter direclly or indireclly related to employment because of race, religion, color, sex, national origin or ancestry. Breach of this covenant may be regarded as a material breach of the contract. 2. County: a. Bidder (Firm): Address: ~ t~ W iLL-:"1 we- r;~ .';:61,-;0 ~:.. ,.r--\:j ..l CERTiFiCATION OF USE OF U~ITED STATES STEEL PRODUCTS (II applicable) I, the undersigned bidder or agent as a contractor on a public works project, understand my statutory obliga- tion to use steel products made in the United States. I.C. 6-16-8-2. I hereby certify that I and all subcontractors emplDyed by me for this project will use U.S. steel products on this project if awarded. I understand that violations hereunder may result in forfeiture of contractual payments. r- t , NON-COLLUSION AFFIDAVIT The undersigned bidder or agent, being duly sworn on oath, says that he has not, nor has any other member, representative. or agent of the firm, company, corporation or partnership represented by him. entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to induce anyone to refrain from bidding, and that this bid is made without reference to any other bid and without "any agreement, understanding or combination with any other person in reference to such bidding. He further says that no persDn or persons. firms. or corporation has, have or will receive directly or indirect- ly, any rebate, fee. gift, commission or thing of value on account of such sale. OATH AND AFFiRMATION f l I affirm under the penalties of perjury that the foregoing facts and information are true and correct to the best of my knowledge and belief. Dated at ~"Cl) 0,."", <S. P.n,)~b 0.9 this t~~ day of F~Il. e1c.e.. ~'.""''n'''l:. \..,c. (Name 01 Organizalion) By ~ L -:l::::>- ~\ ""'l.A. "'Z(::I()f?> ,+9_. (Title 01 Person Signing) ACKNOVVLEDGEMENT STATE OF \NO,__~'" COUNTY OF t\.4G!U- M-\"'E C:W~...., being duly sworn. deposes and says that he is ?(Z6) "\:loll. of the above e....C.E'" e:~~,.,,.:J1:l l t.)c, and that the (TIlle) (Name of Organization) statements contained In the foregoing bid. certification and affidavit are true and correct. 'Z-b09 Subscribed and sworn to before me this l~ "1' Cl day 01 , '"€C!... , . 1-90_ . _~-.ih. ~~ Notary ublic ss: . My Comission Expires: County 01 Residence: 4-9 - I~ C\nrH . . B-103 L , ~.. .-~ ". ) i\ >::-~~, .- .- , r- .- k-,~,.. ,.-r- " t. .J :i ..( "I: The above bid is accepted this following conditions: ACCEPTANCE "0'" ~ ...-" z.ot>S P day of ~~ ,t!_. subject to the - rJON~ -.- ~~ ~ ~M (Complete sections 1,11,11I, and IV for all state and local public works projects as required by statutes.) Governmental Unit: Bidder (Firm): Date: ~ i'lll . () +- ~Dl0It/LE cJ Ct~ et\ ~ >hi ,.,....,1-J 6., jJ-. l3 0 15 . These statements to be submitted under oath by each bidder with and as a part of his bid. Attach additional pages lor each section as needed. SECTION I EXPERIENCE QUESTIONNAIRE 1. What public works projects has your organization completed? Contract Amount Class of Work When Completed Name and Address ot Owner L~~ Lf It- A 2. What public works projects has your organization now in process of construction? Contracl Amount Class of Work When 10 be Completed Pt:1'rt <-~T Name and Address 01 Owner erg I--'e:W kLBk1-J 3. Have you ever failed to complete any work awarded to you? N e If so, where and why? 4. List references from private firms for which you have performed work. ~LO }0 P fZ.o r ~-tt c::S tJ Ie. tL- <fu ~-<; RLD~1<;' e f?-ok1-""S tevW(~ <!1) PSI. B-I04 :,...,' . f"" t t...", ;.. 1; 2. r" ! 3. 4. SECTION II PLAN AND EQUIPMENT QUESTIONNAIRE Explain your plan or layout for performing proposed work. feLLOCU P.> I D P be u J~ctS i PLvt-N S If you intend 10 sublet any portion 01 the work, slate the name and address' of each subcontractor, equip- ment to be used by the subcontractor, and whether you expect to require a bond. tJ I A What equipment do you intend 10 use for the proposed project? e Ae-.K t-to-es; Le I4fJ t4l S, / -roz.. t4 Ct::' .S t:~ Have you made contracts or received offers for all materials wilhin prices used in preparing your proposal? .... LJES SECTION 111 CONTRACTOR'S FINANCIAL STATEMENT Attachment of bidder's financial statement is mandatory. Any bid submitted without said financial state- ment as required by statule shall thereby be rendered invalid. The financial statement provided hereunder to the governing body awarding the contract must be specific enough in detail so that said governing body can make - a proper determination of the bidder's capability for completing the project if awarded. SECTION IV OATH AND AFFIRMATION I hereby affirm under Ihe penalliesof perjury Ihat the facts and information contained in the foregoing bid for public works are true and correcl to the besl of my knowledge and belief. 0$""0 UTIcA C;.~ CZQ Dated at By ,~ T~ day of t=e6 E"k.e\. E'y.cA"Q."f'<....t.. l....c.. (Name of Organization) MU",e.~...J. l-t~ -;:;>120) "",we (Tille of Person Signing) ~ ,1'9-_ this r-~ :\ .r ';;" ACKNOWLEDGEMENT STATE OF ~D I ~ COUNTY OF t. l ~ v\-12....t:-- "^\~ h..wN ?acn N\l...2.. (Title) ss: being duly sworn, deposes and says Ihat he is of the above €'-Ic.61. E""C.Av~TI"'t.. \Nt,. andthatthe (Name Dl QrganlzatiDn) answers to the questions in the foregoing queslionnaires and all statements therein contained are lrue and correct. Subscribed and sworn 10 before me this ~'?1 'f'1:!: . day of t:"e t3 . , 1'9': 20U~ o . . ..S- , .'\<' ^ . t-t:.... , )... ) ,-<t -~ - . Notary Public ~ My Commission Expires: Counly of Residence: Y -q-IY C \ C\ I \l B-I05 ..:, J. ,.,-i r- r ~ l r- r- , , , .--" ~- EIGHTH STREET SIDEWALK INSTALLATION, JOB NO. 0710 ITEM NO. ";,:;-,:;,?,;?j~c APPROXIMATE QUANTITY DESCRIPTION WITH UNIT PRICE WRITTEN IN UNIT PRICE IN TOTAL AMOUNT WORDS NUMBERS FOR BID ITEM ...- iJ D \ 4-~~--- , 1 Clearing and Grubbing 1 L5 ~\\U:~~..:::t!ln.J>.~~.... $ \ 1 48>S.# $ G1""~ ...kwI.uC;t.Dollars per Lump Sum Linear Grading 1 L5 9""" ~&....~~.... $ '1, '1 e1, q9 $ ~..o \~ ...............Dollars Per Lump /- /- Sum jJ-lt .'1 Jb/, ~ .:rl 2 3 Type '0' compacted Aggregate Base, Size No. 10 $ 3l'1', . 136 TONS 53 ~ I . for.............~..~.~':J... '/(9/ l\)o D II P T ............... 0 ars er on A;1 $ --4.Mf~ 51'1.-1.'2-0 I 4 4" Thick Concrete Sidewalk 575 SYS "'It.. I~~~.~n!......f..\.~.~. 1 ................. Dollars Per Square Yard $ dt' ~I ~~ "2h~I2..' $ 4b,1J;; 5 40 SYS 6" Thick Concrete Sidewalk for..~.'.&h\.....tr.l.~....... $ ltPI ~ ~4.1~Q............. Dollars Per Square Yard Sodding for......::Q::t!?:~~............ $ '3, ~ .~.~l.t.'?gDollars Per 00 ;) I "1"1 ')- ;--- ~ :zl\~.oc $ $ -?)+~ 6 700 SYS ~ {05.00 C;nll::lrp V::Irrl ~~ 7 1500 SYS ~~~~~~~:.?:..A~.~.............. ................. Dollars Per Square Yard Thermoplastic White pavement Markings, Crosswalks Stopbars, "Stop", etc. for.::tM:~.....#~. ()t0e:....~k't.:?...Dollars Per Lump sum Concrete Curb Ramp, Red fo~!]tfr.....3:-L~.~.P..~!? I:Slb--.~.!........./..!.I:'{)ollars Per Square Yard J $ . $[ $ feO $ 3J..1 ' :- $ ~o 3dl. ~ 8 1 LS ~\1'1'-~ jf 31 :3 \ $ \1-&. ~9- $ lr3 2 ~.;,,--- ~ r;;> t ' 9 29 SYS ~'L~"(\.( 10 Detectable Warning Strip 17 SYS for..~~~.~~~~>...." p\lC \cz-f (uJ ~~-r'-t _ ......... .......... Dollars Per Square Yard $ ~(IJ:. $ --;, ~. ~ ?~~ / A-2DS S:\5vdnev\WPDOCS\07\0710\SecA Grid.xls ,...., > , , EIGHTH STREET SIDEWALK INSTALLATION, JOB NO. 0710 11 171 LFT 6" Stand-Up Crub, Concrete for...~~:..~.~~...... "2.;~.~~..... Dollars Per Linear Foot 2tO zS""" $ 0, - $ JN1I -4 I ~ . 9;!::::.. 4f'S~D~ 7S 12 1 LS (21 Pf-eI Maintenance of Traffic, Signs, Barricades, Complete ~,::n::r ~~'t1'- For ..~~J;:.':':7..:7.'.... ..l.V.\~:..... ..M. J2-lv8'" ..:~!U'f:.d. Dollars Per Lump Sum $ 3. e~.~ . I -;-"2- ~.DS"S/- , ~ Qf-c--&9- ---$->.:::::.. iD'" '--'>. - Dollars I SUMMATIONS OF ITEMS 1 THROUGH 12 = TOTAL BID PR.ICE= ,...... A"'IV"'L- 1:>lb G s5'7, 3 J>>n. ,...... [ r S:\Sydney\WPDOCS\o7\0710\SecA Grid.xls A-20G , , r t r I L, r- ~\. , ) '~v"."..;~._,.? SECTION A-3 _ METHOD OF MEASUREMENT AND PAYMENT FOR BID ITEMS 1.0 UNITS 1.1 The unit shown for each item on the bid form shall be used for payment purposes. These prices shall be installed unit prices. 1.2 Where no quantity is shown for a particular bid item, a unit price shall be supplied, but will only be used where unanticipated extra or deleted work is called for by job conditions and authorized by change order. These unit prices and items shall not be included in the total price shown on the bid form. 1.3 A bid not containing unit prices on all items will be rejected by the OWNER as improper. 2.0 MEASUREMENT FOR PAYMENT 2.1 The lump sum price for clearing and grubbing shall include removal of all trees, bushes, relocation of signs, mailboxes, and any other item that may interfere with the construction of the sidewalk. 2.2 The lump sum price for linear grading shall include all cut, fill, ditch regrading, removal of existing bituminous and/or concrete driveway pavement, compaction, proof-rolling, and any other items necessary to complete this work. 2.3 The amount of concrete sidewalk, seeding, and sodding, will be paid for on a square yard basis and measured for payment in the field. 2.4 The lump sum price for Thermoplastic pavement markings shall include all crosswalks, stop bars, and any other marking shown on the plans. 2.5 The lump sum price for Traffic Control shall include all signs, drums, barricades, flagmen, and any other items necessary to safely maintain traffic around the construction operations. 3.0 INCIDENT AL CONSTRUCTION EXPENSES 3.1 All incidental construction expenses and items not mentioned or shown necessary for the project shall be distributed in the appropriate unit prices. S:ISYDNEy\WPDOCS\07\0710\SECA3.DOCX A-30 1 r- r .r r- I'"'""" DIVISION B - CONTRACT FORMS SECtION B-t . CONTRACT DOCUMENTS 1.0 GENERAL 1.1 It is understood that the signature and seal of the CONTRACTOR on a properly completed and executed State Board of Accounts Form 96 (pages B-I02 through B-lOS) indicates the CONTRACTOR's acceptance of all terms as set out in these specifications and documents and his willingness to complete the project as stated herein and shown on the drawings. 1.2 It is further understood that by the acceptance of, and the proper affixing of the signatures of the OWNER to the Form 96, that a binding contract exists between the OWNER and the CONTRACTOR. 1.3 After the OWNER signs the Form 96, and notifies the CONTRACTOR of his acceptance, the CONTRACTOR shall proceed to complete the project with the best workmanship possible conforming to all specifications set out herein and to all details, drawings and notes shown on the plans for this project. C,\Sydney\wp.loc.\miscellaneous\mastor\divB.wpd B-10l " ~\ TO THE BIDDER. The following Form 96a is not required by the State Board of Accounts. However, the bidder must either use this form or one similar to it prepared by their accountant. JACOBI, TOOMBS AND LANZ, INC. C:\Sydney\wpdcos\miscellaneous\masker\divB.wpd B-106 General Form No. 96-. prescribed by the State Board of Accounts of Indian.. Revised 1949 , STANDARD QUESTIONNAIRES AND FINANCIAL STATEMENT FOR BIDDERS Prescribed by THE STATE BOARD OF ACCOUNTS OF INDIANA For use in investigating and determining the qualifications of bidders on public construction when the aggregate cost of any such work or improvement will be Five Thousand Dollars or more. These statements to be submitted under oath by each bidder with and as a part of his bid, as provided by Chapter 305, page 1248, Acts of 1947. Submitted ' B C ~"''''''''''''=::'.''''''''''''''''''''''''''''''''''';'~':'''''''~._''-~.....~ n. :~=-orpora:~ y ........d...._.................t:.................&:1J..4\!...h....................................... ~ p~ ^ . di '0: al .L-.LfL 111 vI 11 Address .........~:.~.:....~.~.~........:€~~.................................................................................................. .........n:...er~?g.~.!..L~.~....t;.....t...~.........::.::..~..?...g................................... Date submitted ..............;?;.J...!.~.)....................................................................... 20 .....~..~..... Filed ..................................................................................................................................u. .......................................u....................................................................................... ............................................................................................................................. ............................................................................................................................... A:E. BOYCE, MUNCIE, IN!) C,\Sydney\wpdocs\misc.naneous\m..ler\divB,wpd B-107 ~ . emitted by ...........................:l;2S.G.!!.:h..........t;::~0.:Y.4.:t'.~\:J......................_..................................................{ ~ ~j~p [~pal Office at ........5.:I.LQ...........v.:i.:!.C&.:.._....~"'-!?."T!5.J5..fi.ff'-7..........U2........................................................................................... j:. '::,.. ........................... ...... ....D.tt1(..,.~?.f?.k1...(..: .(1...........1....'B?........ .......:::F...:.l.!..:?...k........ ........ ...................... ...... .............................. ............... r EXPERIENCE QUESTIONNAIRE t'he signatory of this questionnaire guarantees the truth and accuracy of all statements and of all answers to tmterrogatories hereinafter made. How many years has your organization been in business as a general contractor under your present business name? r. H~;..;;;-;;;;:iy~;-~~;;;;;:;;;..;;:;...~;;;;:;-;cti~~.;~~f.e.i~;;.~~i~~..kd""(~f;;.;..~..g;;;;:~;:;:i"";;;;;;tr;;;~~;-~f(bi t..; as, a subcontractor? ..................... ..................... ...... ........ ......... .l.Q....f:4..~s...... ............................ .................... ................ ........................ .............. 3. . What projects has your organization completed?.........................s~........B.~:9.~::~......................................................................... r- ! CONTRACT AMOUNT CLASS OF WORK WHEN COMPLETED NAME AND ADDRESS OF OWNER 31;'0 DOO .. ............. ..C2.J. rs:... ....... .................... ....... ........~.f..~ .'?............................... .....0.J.!;:z.t!~..~......lli.~~;€. .. ...... . ..... ....... ....,. . ..... ...................... ........ .............kk..~.J2.~'..Q................... ...............?...!..!:C........................... ................. ~..r.'?.J........................... Jet) f-J . ....................................................................... , . r7-~ ,What projects does your organization now have in process of construction? , [ ~8"// WHEN COMPLETED NAME AND ADDRESS OF OWNER ..........h..~.~..~.{2.Q................... ...............?..J.~.......................... .............~..I....9...~........................... ..!::.~......~~.~(.....R~~ CONTRACT AMOUNT CLASS OF WORK .......................................................................... ..................................a.............................. ................a.....................a....a............a......... ......a....a.................................a..................... 4. ,Have you ever failed to complete any work awarded to you? If so, where and why. ........ .............. ......... .t!5?... ................ ............. ............... ............................. ................................. ...... ... ... ...... ..... ............. ... ....... .... .............. ..... -. .. ..................... ................................a..............................a..............a......a..................................................................a.a............................................................................................................................a.......... 5. .......................................................................................................................................................................a.......................................................................................................................................a............................. Has any officer or partner of your organization ever been an officer or partner of some other organization that failed to complete a construction contract? If so, state name of individual, other organization and reason therefor. . .. ...... ........ ........... ..... ~ ..2........... ............. . ............... . .................. .......... .................................. ........................ ....... ....... ............. .... .......... ............. .................. ................................................................................................................................................................................................................................................................................................................... ~ f: 6. t, Has any officer or partner of your organization ever failed to complete a construction contract handled in his/her own name? If so, state name of individual, name of owner and reason therefor. ....................................~.Q...................................................................................................................................................................................................... ....................a............................a....a................. ...a....................... ..........~.......;..a.'a....~.................................................................................................................................a....................a........... In what other lines of business are you financially interested? ............................................JJ../..8........................................................................................................................................................................................... ................................................................................................................................................................................................................................................... C:\Sy<!ney\"'I'doca\D1iscdlaneous\masbo:\divB. "'I'd B-108 r' L-. ,.For what corporations or individuals have you performed work, and to whom do you refer? ............. :...... .............................. t?!.~f::........~.~?....... ............................ ....................... ................................ ...... ..... ................................................ ::r:c_~ ~ f e, P .................... ..................................;g..~(~;;..............r:{fj.:.:.:;.:r........ ..... .m......... ................. ................ ...... ........................................................... ....................................................................................................................................................................................................................................................................... ..................................................................................................................................................................................................................................................................... ~.,../ r9 . F~~..;h~t..~iti~;.h~;~.y~~.p~rl;;;~~~i":;~~k.~~ft~.;h~;.d~..y~~..;~f~~?........................................................................................... L, ................................t..J..t.~1............~..€:......~............:::::......f?..~.:t?............~.!.~~.!of.-~............................................................................... ................................~.~.~......~.~.....$.g~~$.&.~!:.;~........!':::".............~r.12...~.........1Jd.~tLt.!............................................................ ...i..............................t!....l.ttj-.....:...fJ.f::.........~.::.b...................=........B..Il?::!..f~...........Q.1..6':;~.~................................................................. ............................................................................................................................................................................................................................................................................................................................. r ...,................................................................................................................................................................................................................................................ l 10. For what counties have you performed work and to whom do you refer? t: .... ....... ................... ..... .............................!bf.}. !.1. ............................. ...... ........ ....... .......... ........... ............................ ..... ~........ ........ ........... .... ................ ......... ..... ................................................................................................................................................................................................................................................................................................................................ ....................................................................................................................................................................................................................................................................... .......................................................................................................................................................................................................................................................................................................... r, .......................... .... ........ ...... ..... ........ ..... ......... ......... ................................ ........................ .......................... ............ ...................... ....... .............. ........... ............... t. 11. For what State burea1.ls or departments have you performed work and to whom do you refer? .. m." .......... ........ .... ........ ....... .... ...... ..:..t:!. }.. fr..... ... .. ................................... .......... .. .............. .. ............ .............. ..... .... ........... .... ...................... .............. ........ .................................................................................................................................................................................................................................................................................. .......................................................................................................................................................................................................................................................................................................................... ................................................................................................................................................................................................................................................................................................................... r i L 12. H~~~.y;;~..~;~~.p~rl;~~~d..;;y..;~.;k.f~;..t.h~.U~.S~..G;~~~~~~t?ff.;;;.;:h~~.;:d.t;;.:;h;~..d~.y~~.~~f~;?................... 'j ........................... .. ....... ............. ,.. .... ......l::!..1 A. .... ...............................................................................,............ ......... ......... .......,....... .... ....... ............;.... .......... ................................................................................................................................................................................................................................................................................................................ ................................................................................................................................................................................................................................................................................................... .......................................................................................................................................................................................................................................................................................................... .................................................................................................................................................................~................................................................................................................................... 13 What is the construction experience of the principal individuals of your organization? PRESENT YEARS OF INDIVIDUALS POSITION OR CONSTRUCTION MAGNITUDE AND IN WHAT NAME OFFICE EXPERIENCE TYPE OF WORK CAPACITY .....e:Mrs.....~~~. ...............~..e.~2.............. ..................~.~....................... ...~.i.~...L.l:5.!J..~:.~T!:/... .........J?!::..~~1!::................. ....~.~...........~.~~. ...............v....~....................... ....................~..~...................... ..........t...................J............... .........~.~~..~-:1~............. ......~!.fu...~~:.?.. ...._........:P..~................ ...................::':.~.................. .........V...............#............. ..................?.~\>.~-'-............. ......J1?..~.......~~~ ..................~.~..~............. ..................k..'?..................... ................................................. .............?..~..p...~................... .....n....................................~................. ......00.................................................... ........................................................ ....................................................... ............................................................ - .............................."............................ ....................................................... ................................................... ......................................................... ........................................................... .....00..................................................... ............................................................ ........................................................ .................................................... ........................................................ [ ;::;. ;........... ............... ............... .... ........ .............. ............. .......... ....... ................. .......... ............... .... ............ ............. ............... ..... .................................. ................ J ..................................................... ........................................................... ....................................................... ........................................................ .......................................................... r,..i t. C,\Sy<!ney\wpdocs\misccllaneous\maslcr\divB.wpd B-I09 PLAN AND EQUIPMENT QUESTIONNAIRE The signatory of this questionnaire guarantees the truth and accuracy of all statements and of all answers to rlterrogatories hereinafter made. f'~ i r t 'm what manner have you inspected this proposed work? Explain in detail. :::::::::::::::::::::::::::: :::::::::::::::::::::::: ::::::::::::::::::::::f.(~:$:/:::::::?i2T!~::f}/:.:::::::::::::::::: ::::::::::~::irr.:::::0.j::~::~~r:::::::::::::::::::::::::::::::::::::::::: ....................................................................................................................................................................................................................................................................u.................... ,. ..................................................u......................................................................................................................................................u................................................................. ........................................................................................................................................................................................................................................................................... (. l ' Explain your plan or layout for performing the proposed work. ...........................................................................................................................................................-....................................................................................................... ::::J::::::::::::~:::::..:::::::::::::::::::::~::::::::::::::::::::::~:~~:~~:::::::~:::::C;~i:::i.?::::::::::::~::::::P:~::~~~~~::;;;::~:~1:S::::::::::::~::::::::::::::::::::::::::::::::::::::::::::::::: ... .1.. ........ .... ..... ..... .... ............. ....... .. ....... ................ .......... .........,.......... ....... ................... ..... ... ....... ..... .... ......... .. ....... ... ......... ............ ...................... ............. ......... ............................................................................................................................................................................................................................................................................................... .....~......................................................................................................................................................................................................................................................................................................... ........................................................................................................................................................................................................................,......................................................................... ...........................................................................................................................................................................................................................'................................................................................. .....................................................................~......................................................................................................................................,;~.....~..........................................................~.................. ...............................................................................................................................................................;..~..............................~............................................................................................................. ....... t l- ................................................................................................................................................................................................................................................................................................................... .............................................................................................................................................................................................................................'..................................................................................... ............................................................................................................................................................................................................................................................................................................................ ..................................................................................................................................................................................................................................................................-...................................................... The work, if awarded to you, will have the personal supervision of whom? ... ............................... ................. .....................~. .~~.~...........~.Q~...... ............................ .................................. ................................................. r t 4. .............................................................................................................................................~................................................................................................................................................... * Do you intend to do the hauling on the proposed work with you own forces? If so, give amount and type of equipment to be used. .............. ......... ........ ............... ..... ................. ...Lf..i;;:~........=...............~..:tE:.):;. ...S....................................... .......... ........................................................ I .....................................................................................................................................'......................................................................................................................................................................... * If you intend to sublet the hauling or perform it through an agent, state amount of subcontract or agent contract and, if known, the name and address of subcontractor or agent, amount and type of his equipment, and financial responsibility . C~::~::::~:::::::::::::::::~:::::::::~t=~:~::::::~~:=-L::::::::~:.~::::=:~:::::~:::::~:~::.::::~::::::::::::~~~:::~::~::::~~::::::==::::~~:::::~::::::~ ...................................................................................~.n......................~.......................................................................................................................................................................................... 5. 6. .;;...D;.y~~.~t.~~~ft;..d~.~h~..g~~di~.g.~~.~h~.p~;p;-~.~d"';~.;k.;i~h.y~~;.;;~.f~.;~~~?................................................................. .......................................................................................................................................~.......~................................................................................................................................................................ ..........,....,....,.......,..................t4..~....................................................................................................................................................................................... .................-........;............................................................................................................................................................................................................................................................................................. ............................................................................................................................................................................................................................................................................................... ;;.... i~;~; '4;.5;'(;~d7. ;;~y.~~~.b~.;ppii~~bi;~.illbciidi;;g.~~~;;:~~~;:.If~~;:~;ci~:....................... ...................................... ............. .......... ..................................................... C:\Sy<!ney\wpIoos\uUscel!anoous\ma,ter\divB.wpd B-ll 0 . ..* If you intend to sublet the grading or perform it through an agent, state amount of subcontract or agent's contract and, if known, the name and address of subcontractor or agent, amount and type of his equipment and financial responsibility. r;~ ....L......................................-............................~.................................l:-!..!_~...................................................................,................................................... I::t~ 'I.......................................................................................................................................................................................................................................................................... ..."...............................................................................................................................................................................................................................................u......................... r I ~,u8. ...j.....~......................................................................................................................................................................................................................................... Do you intend to sublet any other portions of the work? If so, state amount of subcontract and, if known, the name and address of the subcontractor, amount and type of his equipment and financial responsibility. . ..'............... ............;............. ...... ............ . ...........................................N. Q........................... ................. ................. ...... ........ .. ~ ....... ......... ...;...;.. ................. ........ ...................................................................................................................................................................................................................................................................................................... ......................................................................................................................................................................................................................................................................................... 9. From which subcontractors or agents do you expect to require a bond? .........................."'................................................................................................................................................................................................................................ I. ' .' ......................................................................................................................................................................................................................................................................... .w... ........ ......... ............... no......... ....... ........ ........ .... no..... .............. ......w ......... ...... ...... .. ......... ........>>.0...... ................ ........ .......................;... .................... ......... ............................................................................................................................................................................................................................................................................................. t L 10 Wh~t..~q~ip.~~~t.d~.~~~.;;~.a;:;~..i~..;~JGbi~.f~;.th~..~.;.;~~~~;r;~~k~............................................................................................ DESCRIPTION, SIZE, CAPACITY, CONDITION ETC. .........L....~................... ...................................... ..........12 ::.~~@:............... .....~.~.~~~-C.. ................~..................... .......~!;}!:;:!!?.':!.~.~1. cx~~v. . ~ r I QUANTITY ITEM YEARS OF SERVICE PRESENT LOCA nON I , t , ",,-. r- . I ~ .......................................................................................................................................... ............................................... ......................................... ................................................ ................................................ .......................................... ................................................ ........................................... .................................................... ............................................... ............................................... ................................................. ..................................................... ....................................................... .....................................:.............. ....................................................... ................................................................................................... ........................................................... ................................................... .......................................................... ...................................................... ................................................. .............................................. ............................................................ .................................................... .................................................. ........................................................ ....................................................... ................................................. .......................................................... ....................................................... ................................................... ...................................................... ...................................................... ............................................. ....................................................... ....................................................... ................................................... ...................................................... .................................................. ............................................... ........................................................ ................................................. ....................................................... .......................................................... C,ISydn"l'\wpdocslmi.ceIlanoous\maso.:\divB.wpd B-ll1 ou intend to urchase for use on the ro osed work, should the contract be awardea to OUf APPROXIMATE COST ...L.~~... ........ ...... ..... ...~~. ~~.... ......... ... ......... ............. ......................~...k................ ..... ...... ........................ ............ ...... .......... ....~~.A:........ ........ ITEM DESCRIPTION, SIZE CAPACITY, ETC. r i . ......... ............ .......... ........... ................... ........... ............... ......... ....................... ................. ....... ...... .................. .................... .......... ....................... .................. . . . . . ".,.... ........... ..... ................... ........ .... ............. .................................. ............ ............ .... ............... ...... ..................................... ........ .......... ... ........... ......... ........ ............. r ...... .......... ............. .......... ... ........................................... .......... ......................................... ..... ............ ........................ ............. ........ ....... ......................................... i L, ..... ........................ ......... ... ............... .......................... .................................... ............................................................... .................. ........ ........... .............................. roo ..........J............... ............ ...... ................ ..... .............. ................................... ....... ............. ................ ..... .................................................. ......................................... L I . .. .................. .... .. ............... ............................... ...... .... ........ .......................... . ...... ...... ... . ...... .... ..... .... ............... . ..... ... .. .......... .. ................. ... ............... ........... ............ r-. t 12. I I How and when will you pay for the equipment purchased? ........ . ......... . ............ ............... ........... ...... ................. ....... . .... .............. ........ .......... . ........ ..t.A..... . ............ .......... ....... ............... ................ ... ...... ....... ....... .~.. ..... r , ........ ........... ........ ............ .................. ................ ....... ...... ................ ............ .. .. ...... .. ............. ............... ...... ........................... .... ........ .... ....................... ...... ........... L 13. Do you propose to rent any equipment for this work? If so, state type, quantity and reasons for renting. ................................................................................................................................................................................................................................................... .l.... ................................................ ...... .........;... ............... ...........~..~.JS.~~...h2.......... ........... ..... ....... ............................................................... .................. ............ ............. ...... .... ... .. ...... ................................. ..................................... ........... ........ ." ....... .............. ........ . ........... ........... ..... ....... ..... ...... ............. ...... ........... ................... ............ ... ................. ......... .................. ........... ..... .... ....... .................. ........ .. ........... ... ............ ........ ......................... ....... ........... ........ .................... ..... 14. Have you made contracts or received firm offers for all materials within prices used in preparing your proposal? Do not give names of dealers or manufactUrers. ~ ........................... ................ ......... .. ....................... .. .................................~.. 6....... ....... ............... ............................ ............ .......... ........... ............... ......... .......... ........ .......... ..... ....................... ................... ....... no.. .......... ....... .......... ......... ............. ...................... .................................... .... ........................ ......... ............ Datid at ...~~~._gq..rPL....this .................l}.:':L.:......_.......day of ................t!;.~.................................. 20....Q....~... ..............;.~!:-~~..g.~.~e!.~~~.~~.~.............................................................. (Name of Organization) By........~.~~~....~~.!::"...........~:f~............................................................ ?fZo~ Wl..~ .......................... ......................'{fi~i~.;;ri;;;;;,~.si~~....... ......................................... ST ATE OF .....~?..~...~~..............) . ) 55: COUNTY OF 1\ I ~- . ) .........._.~...u.............................................. .........Ch...;.\.c~.......E.L~;O.f.:\..................................._....................being duly sworn, deposes and says that he is a member of ..................~XS:~~.......-c~.~~V;:~....................................and that the answers to the questions in the foregoing (Name of Organiza.tion) auestionnaire and all statements therein contained are true and correct. '. ..cribed and sworn to me this .....................'}~........................day of .............!:~~:.m.........................................20 ..Q~.......................... commission expires .....Y...::i..:..!.~.......................................... C,\Sy<!ncy\wpdoca\miscellanoous\master\divB.wpd B-112 CONTRACTO~SFrnANC~STATEMffiNT Submitted bY..............................):;:f...~.~............\2iS.~~................................................................ {~ A:-n IndiviJuaf ..principal office at ........~1..!.Q........~:lT1r~...:=.?~3::~;..~..~.:1~S......@..............5..t;;.!:l;.~.!?..~'!.€..t;:..."J.....;r.~ I .'0 ...... .............................. ............ ......................................... ..... ;?.~...::::...A:::~:.~............................... ....... ... ........... ........... ......................... !. :onditions at close of business ~ r r~ l ? 6 7 8 -9 10 r./""\ ic ' L ' 12 13 1 2 ASSETS Cash: (a) on hand l...........................Jb) in bank t.......................................Jc) elsewhere ~.......................... Notes receivable (a) due within 90 days .........._..................................................................-........................... (b) due after 90 days ........................................................................................................... (c) past due ............. ........... .......... ...................... ......... ........... ............... ............ ........ .............. Accounts receivable from completed contracts, exclusive of claims not approved for payment.............. Sums earned on uncompleted contracts as shown by engineer's or architect's estimate (a) Amount receivable after deducting retainage .................................................... (b) Retainage to date, due upon completion of contracts ............................................... Accounts receivable from sources other than construction contracts Deposits for bids or other guarantees (a) Recoverable within 90.d~;...::::::::::::::::::::::::::::::::::::: (b) Recoverable after 90 days ..................................... Interest accrued on loans, securities, etc. .......................................................................................................... Real Estate: (a) Used for business purposes................................................................................................ (b) Not used for business purposes ..................................................................................... Stocks and bonds: (a) Listed. present market value ......................................................................... (b) Unlisted - present value ......................................................................... Materials in stock not included in Item 4 (a) for uncompleted contracts (present value) .............. (b) other materials (present value) ........................... Equipment, book value............. ...................................... .................. ......... ..................... ..... .................................... Furniture and fixtures , book value ................. .............. .......... ..................................... ....................... .......... ...... Other assets .....~...............n........................._.................................................................................................................................................... Total Assets LIABILITIES 3 4 5 6 Notes payable (a) to banks regular ........................................................................................................... (b) to banks for certified checks ..................................................................................... (c) to others for equipment obligations ......................................................................... (d) to others exclusive of equipment obligations............................................................... Accounts payable (a) Not past due ............................................................................................................... (b) Past due ................ ..... ............................ ........................ ............................ ................ Real estate encumb rances ..................... ............. ..... ......... ......... ........... ........................ ............... ......................... Other liab iliti es ....... ........ ........ ......... ..... .......... ........................ ......... ...................................... ................ ., ............ I Reserves ........ .......... ................................................................. ... .... ........... .......... ....................... ........ ..................... Capital stock paid up (a) Common ........................................................................................................... (b) Co mmo n ... .......... ....... ............. ........................... ......... ................ ........ ..... ......... (c) Preferred ..... ........ ...... ............ .................. ...... ........... ........................ ................. (d) Preferred ..................... ............................ ........ .......... ... ............... ..... ...... ........... Surplus (net worth).. .......... ............... .............. ...... ......... ...... .......... ...... ...... ........ ........ ........ ........................... ..... ........ Total Liabilities CONTINGENT LIABiliTIES Liability on notes receivable, discounted or sold................................................................................................ Liability on accounts receivable, pledged, assigned or sold ......................................................................m Liab ility as bo ndsman ............ ................. ............. ..... ......... ............ .............. ....... ................ ...m............... .......... ..... Liability as guarantor on contracts or on accounts of others ......................................................................... Other co n tingent liabilities ...m........ ........ .... ..... ... ...... .................. ..... ......... ..... ....... .......... ................ ............. ..... ..... Total Contin!!:ent Liabilities 7 1 2 3 C,\Syclney\wpdocs\mi&cena.""",\maste>:\divB.wpd B-1l3 Dollars Cts. t: DETAILS RELATIVE TO ASSETS 1 ! NAME OF BANK LOCATION DEPOSITINNAME AMOUNT [. ...........L..... ................. . ........................ ........ ... ..................... ........... .................. . ........ ..................... ................. ..... .......... .. ............................... .............. ...... ......... Cash (a) on hand ... ..................... ............................................. .............. ................ ...................... .... $ ..... .................... ......... ................. (b) deposited in banks named below........................................................................ $ ................................................... (c) elsewhere - (state where) ......................................................................................... $ ................................................... ......................................................................... ......................................................................... .n.......................................u.................................. ..................................................................... ~ l : ........-..... ......-....................... ...........-.. ...-.....-............ ............ ~... .....-_........... ...-..... ..-..................... ..........---........... -..-. .....-. ........-.---..........-...... ............ (a) due within 90 ays ................................................................................... $ .........,......................................... 2 ::. Notes receivable (b)" due after 90 days ......................................................................................... $ ................................................... (c) past due ............ ........................... .................. ......... ........................................... $ ...... .................................... ......... FOR DATE OF MATURITY WHAT HOW SECURED RECEIVABLES FROM: NAME AND ADDRESS ! AMOUNT ........................................................................................................................................... ............................. ...........................".........."................"....... .............................."..................."..". r- ~" ....... ... ............. ........ .................. ....................... .......... ..... .m....... ............ .... . ..... .... ..... .. .......... .... ..... ........ ......................................... .......... ......... ....... .. .............. ....... ~ ... .......................................""........................................................................................... ............................. ........................................................................ .......................................................... rHave any of the above discounted or sold? If so, state amount, to whom, and reason. t ......................................"..........................................................................................................................................................".............................................................................. '3~~ Accounts receivable from completed contracts exclusive of claims not approved for payment.............................. , ME AND ADDRESS OF OWNER NATURE OF CONTRACT AMOUNT OF CONTRACT AMOUNT RECEIVABLE ................................................................................................... ........................................................ ...................................................... ..................".............................................................. ..............................................-.......................................................... ..................................................... .................................................... ................................................................................ , .................................................................................................................. ........................................................... ..................................................... ............................................................................ .............................................................................................................................. ............................................................" ........................................................ ...................................................................................... Have any of the above discounted or sold? If so, state amount, to whom, and reason. ................................................................................................................................................."..............................................................................................................................................".......................".................... , I Sums earned uncompleted contracts, shown by engineer's architect's estimate on as or 4 " (a) Amount receivable after deducting $ ." retalnage...................... ..... ................................... ............................................................. (b) Retainage to date due upon completion of contract $ ............................................................... , ................................................................ , DESIGNATION OF AMOUNT OF AMOUNT AMOUNT RETAINAGE AMOUNT CONTRACT AND NAME CONTRACT EARNED RECEIVED EXCLUSIVE OF AND ADDRESS OF OWNER WHEN DUE AMOUNT RETAINAGE .................................................................................... .....~................................... ....................................... ................................................ ........................................ ............................... ...................................... ........................".............................................. .......................................... ...................................... .n............................................ ........................................ ....................................... ................................................ ............'..............................!"................................... ............................................. ...................................... .................................... .............".................... ................................. ............................................ ........................................................................ ............................................ ................................... ............................................ .................................. ............................. ....................................... I . Haye any of the above been sold, assigned or pledged? If so, amount, to whom and reason. i ...................................................................................'"...........................................:..~................................~......................................................................................................................................... separately each item amounting to 10 percent or more of the total at:ld combine the remainder. C:\Sy<\ney\wpdocs\miscellaneouslmast",,\divB ."'I'd B-114 5.... , .. Accounts receivable not from constructlOn contracts $ ," .............................................................. .............................................................. RECEN ABLES FROM: NAME AND FOR WHAT WHEN DUE AMOUNT I, ADDRESS , " .~ i .......................................................................................................... .................................................... ...................................................... ................................................. .... . . ........................................................ .................................................... .................................................. ............................................................................................................................ 1..1,'.'" ............... ~...~.......~ .....~.....~....~.... ................................~..........~........ .........~................~.~.....~.. ...... ~................... ,..~..~..~......~...~...............................................................~............~..............~.....~...... M . r- t r .~ l rWhat amount, if any, is past due ...................................................................................................................... $ ......................................................... , .. t<,.,,,,,,,'j 6.~ .. i ! Deposits with bids or otherwise as guarantees .................................................................. $ ........................................................ r DEPOSITED WITH: NAME AND ADDRESS FOR WHAT WHEN RECEIVABLE AMOUNT , f ... ~.~.................... ..................................~...... ..................... .....~....... .....~. ... ....~......... ....................~.........................~. .n... ............ ................. .,. .... .......... ~....~.............~~..... ...~.......~............. ........~.........~............. ~...~..~. ..........~.... ............~....~.. ..... ~..,~................................... .~....~..... .~...~.... ............. ......~.~................ .......... ............. ......~.... .........~ ..........~............~. ...~........... ..................................."............ ............ ~ r- .. t ,"...... .....;..................; .. ........ . ........ ......... ..... . ....... .......... ..... ........ ..... .. ....... .... ..... ........ .......... ............. ...... .................. ....... ...... ... .... ........ ...... ............ ......... ... ..... ............ t ..., ........ , .. ....... ............ .......... ..... ...... ............. ....... .................. .. . .............. .......... .................. ....... .......... . .-...... ........ ........ . ...... ... . ......... .. ........ .... ........ ............. .............. 7 Interest accrued on loans securities etc. $ , ,... ... ......... .......... ....... ............... ..... .......... ......... ..... ....... .............. .. ............. .................... ON WHAT ACCRUED TOBEPAIDWHEN AMOUNT ~: !.... ...... L .. ...................,............... ......,.... ...... . ....... . ...... . .... .... ... . .. ...... ........ .....~. ... ............ .......... ., .......... .................. ......... ........... ..... ..... .... ...... ........... ..................... ..... ...................................~..~..................................................................~...~.......................~..........~......~.................~......................~~~......~~.............~....~.....~.........~~..........~.....~.................~~~............~.~.....n.n............~............~ r 'i"'~" ~.... .................................. ........ ..... ...... ........ ........... ..... .... .... ..... .................. .............. ......... .............. ..... ........ ....... ........ ............. ... ........ ..... ......... ............. ..... .. ..... [" ~' ,,'; .l..... :~....~'..~~'. ~ '.....'~ ...;~...'. .....'. ........ .....'~... .... .~ ~.... ........ .'...............~ '....,; ....~ ~......;.~' ...'.....';,.... ...;"';' ';' ....'. j..... ......'....'. ;,............ ~ ..... ~.. ...... .... ............... ~........ ~ ........... ....... .................... .~. ..... ...............~.. ~.... .n. .............. .... ............ ~ 1 2 3 4 5 6 -7 i.: I""'~ /1.. 8 Real estate book value { (a) used for business purposes ................................................................ $ (b) not used for business purposes ...................................................... $ .....~.....~..~.......~....~~......~.......~...~ ..................~.. ...............~..........................~.......~.,.................... DESCRIPTION OF PROPERTY Th1.PROVEMENTS NATURE OF IMPROVEMENTS BOOK VALUE TOTAL BOOK VALUE ....~.~...................~ ....~..~~... .~........ .........~......................... ...~..~... ........................................ ....... ......... ......... ...........~~.. ........... ~......u...... ...... .......~..... ..~................................ .... ...~.....................~~...................... ...... ................... ................. ~~.......... ~ .......~.....~........... ..~...~.. ..~........ ..~....~........ ...... ................. ..~..~.. .... .....~......... u~~.... ......... .................. ........ .........~......~..... ..~....... ............. ... ...........~~....~~ ......... ..n..............~...... ........... ............ .....~.......... .~....... ....~................~.... ....... ~.~....~. ......... ............ ..... ............~.......~....~... ........~~.........~..... ........~...........~......... .~..... .................. ..~........... ~.............. ..... ................ ~....~ ...............................~. .......~..... ........~........ ...... ~.... ....... ~... ..~~........... ..~..........~.... .......... ........... ~ .... ................~.~......... . ~...~...~.............~......~.... ~........ ...... .... ..... ~ ....... .~.~.................................... . ......................................... .~.................. ......~...... ~..........~.. .... ..........~. ...............~. .............. ......~. ~..~.. .~~~.......... ........~...~.....~. ......... ......~...~.....u............... .................... .... ~..~........ ........ ....~.... ... ....................... ..... .....~~.~..... .................. .............~ ................ ....~.... ~.... ..... .......~.~.... .~............ ~~...........~....~.......~...... ............ ............ ~~.... ........... ~...... ~ ........ ..........~ ....~.......~.. .......... ...~~...... ...........~..... .................. .... ~~~............~... ..... ............... .....~~......... .n.~'" ...~......... ......... LOCATION HELD IN WHOSE NAME ASSESSED VALUE AMOUNT OF ENCUMBRANCES 1 2 3 4 ................~....................~~.....................~........ ~.....~ ........~..... ....~...............~ .........~. .........~~. .....~~... .. ............~........... .~~.... ........................~~..~ ..............~~~ .....~.~... .~..~..~..... .....~. . ~ ~...................................~.............. ............... .....~...~. .....~...~...~..~......... ...................... ~ ~...~. ~..~~.. ... ..~.. .~... ~~..~...~.. .... .............~~~............... . .............. ..~...... ~.. ~..... ...~...~ ... .~.....~. .... .........~........ ~........... ...........~... .......... ~.............. ....~.. ~........ .....~.......... ............... . ~.................~. ~........ ~..... ~..~......... ~...........~.... ..... .........~~ ..~.............. ........ ...~ ............ ..........~ ..... .~~.....~.... .........~........................ ~.." ..~.. .~... .......~...~.....~........ .............. .. ~.....~. ........... ................. ........ ~~ ..... ~....... ....... ....................~.................. ....~....... ..~.... .~........ ................~. ....... ...... ~.. ................. .........~ .. ~. ....~...........~...... ~.....~ ......~..... .....~..~.... .... ...~.....~........ ..... ~..... ~.............. .~..~ ~.........~. ~.... ..... ~.......~..~............... ..~ ........ .~..... .......~.... ~.....~......... ........ ..~.~...... ~.........~ ~.....~..................~~......... ........ ...... .......... .~. ~........ ~~.. ...~.... ........ ~...... .~.~.... ~~...... .... ....~...... ...... ................ ...... ~ ~..... ~~.. .......................~........~ .~....................~ ....... .......... .....'.... .~........~..~... ..~.......~.. .......... ~ ...... .... ............................ ........~'.......... ~~.. ....~~.~......~... .....~ ~ ~.......... .......... u.......... ~ ~..~ ...~.~......~.......... ".,... .~......... ~............... ....~~...~.......~.................... ..... "",', "-0: / j ",,,;"" r 7 I C,. ,> List separately each item amounting to 10 percent or more of the total and combme the remaInder. C,\Sydncy\wpdccs\miscellaneous\mastor\clivB. "'I'd B-115 . DETAILS RELATIVE TO ASSETS (Continued) 9 Stocks and bonds (a) Listed - present market value $ ......................................................... ........................................................ (b) Unlisted - present value $ ............................................................ .............................................................. ~, LIST NT. OR DIV. PRESENT ...JESCRIPTION ISSUING COMPANY PAID PAR MARKET QUANTITY AMOUNT VALUE VALUE ~. DATE % .............................................. ................................................................... ............................. ........................... ............................. ................................ .......................... 2 ............................................ ....................................................................... ............................ ............................... ............................. ............................... ............................. r' .............................................. ......................................................................... ................................... .............................. ................................ ................................ ............................... . t ~ t.... ........................................................ ............................................................................. ........................................... ..................................... ................................ .................................... ............................... 5 ............................................... ...................................................................... .................................... .............................. .................................... ........................................ ............................. rO .............................................. ......................................................................... ............................... .............................. .............................. ...................................... ........................... ~ 7 fAMOUNT WHO HAS IF ANY ARE PLEDGED OR IN ESCROW, STATE FOR WHOM AND [PLEDGED P'OSSESSION? REASON OR IN ESCROW 1 .............................................. ........................................................................................................................................................................................................................... ................................. 2 ............................................... .................................................................................................................................................................................................................................................. .............................. 3 ..............................~.................................................................................................................................................................................................... ................................................. ............................... 4 ................................................. ................................................................................................................................................................................................................................. ............................. 5 ..................................................... ....................................................................................................................................................................................................................................... ............................. ............................................... .................................................................................................................................................................................................................................. ................................. Materials ill stock and not included in Item 4, Assets: 1 0 (a) For use on uncompleted contracts (present value) $ .................................. ..................................................................................... (b) Other materials (present valu.e) $ ............................................................................ ................................................................................... PRESENT VALUE DESCRIPTION OF MATERIAL QUANTITY FOR UNCOMPLETED OTHER MATERIALS CONTRACTS , ......................................................... ................................................................................. ................................................................................... ................................................................................................................... , ........................................................................................................ ........................................................ ..................................................................................... ........................................................................... ............................................................................................................ ........................................................ .................................................................................... ............................................................................... .............................................................................................................. .......................................................... ................................................................................... .................................................................................. 1 1 ~. .{' Equipment book value $ at ........................................................................................................................................ ..................................................................... QUANTITY DESCRIPTION AND CAPACITY OF AGE OF PURCHASE DEPRECIA nON BOOK ITEMS ITEM PRICE CHARGED OFF VALUE . ....................................... .......................................................................................................................................... ......................... ........................................ .................................................... ......................... .................................... ................................................................................................................................... .......................... ....................................... ....................................................... ........................... ...................................... .................................................................................................................................... ............................. ......................................... ....................................................... ........................ ! I I -., , .., there any liens against the above? If so, state total amount.......................................................... $ ........................................................ or more items are lumped above, give the sum of their ages. r.\~..l"~\=doc.\misc.Jlaneous\moster\divB.wpd B-116 Ii . DETAILS RELATIVE TO ASSETS Continued 12 Furniture an.d fixtures at book value..................................................................................... $ .......................................................... Other assets $ .~.u................................................................................................................................................. r DESCRIPTION AMOUNT ..................................................................................................................................................................................................................... ....................................................................... "" .. ...... .......... ....... ......... .......... ........ .................. ..... ............. ............. ............. .......... ........ .. ........................ ............ ... ..... .... ......... ... ............. ............... ........ .......... ..... ....... t.IJ I Total Assets: ~c 1.,,,,- ....::.., (a) To banks, regular $ ................................................................................................................. .......................................................................... 1 { (b) To banks for certified checks $ ..................................................................................................... ................................................................... (c) To others for equipment o b ligati 0 ns..................... ..................... ................. ....... $ ............................................................ (d) To others exclusive of eqmpment o b ligations. ........ ................ ............... ...... $ ................................................................... TO WHOM: NAME AND ADDRESS WHAT SECURITY WHEN DUE AMOUNT ................................................................................................................................. ............................................................. ...................................................... ............................................................................ .............................................................................................................................. ................................................................ ............................................................... ..................................................................................... 2 { (a) Not past due $ ............................................................................................................................................................... ........................................................................ (b) Past due $ .........-................................................................................................................................................................... ................................................................................ TO WHOM: NAME AND ADDRESS FOR WHAT DATE PAYABLE AMOUNT gP' ............................................................................................................................ .............................................................. ........................................................... ............ ..............................~...................................... ..........~.................................................................................................................. ............................................................ ........~.........~........"'.............~................. .........................................................."'.................. 3 Real estate encumbran.ces (see Item 8, Assets) $ .............................................................................. ...................................................................... 4 Other liabilities $ ............................................................................................................................................................... ........................................................................ DESCRIPTION AMOUNT ......................................................................................................................................................................................................................................... ........~.................................................................. ......................................................................................................................................................................................................................................................... ....................................................................... , .., '. 5 Reserves $ ......................................................................................................................................................................... ....................................................................... INTEREST INSURANCE BLDGS & FIX PLANT DEPT. TAXES BAD DEBTS $ $ $ $ $ $ 6 up{ (a) Common $ Capital Stock paid ...........................................................................................~................. .................................................................. (b) Preferred $ ................................................................................................................. ......................................................... 7 Surplus $ ....................................................................................................................................................................... ........................................................................... I Total Liabilities: DETAILS RELATIVE TO LIABILITIES i I l" I , !..... I, S II( I r- I r ! r" L.. i ~ ~ R-117 rf a corponition, answer this: [~~punt for which incorporated .................................~.Q..??.....=...................................................................................................................... (~ ~ . r1:>"""- t~ paid in cash ....................................h4...l:;.:S.......................................... .............................................. $ .............J,g.9..'Q.....:::::==......... ~;. i I When inco rpo rated ............ ............................ ....l..f...q.8............................ ............. ................................... .-......................................... ........... ................. r . . t.. n what state .....................................~...............?\:::t..\(9:?..L.~................................................................................................................................ [N ame~ and titles of all persons having authority to execute and receipt estimate vouchers and to conduct other business k Eor the corporation, including its officers, the signatures of whom are legally binding. .... t.... ...... ..T...................... .... ..................................... ............... ......... . .,. ............ ........ ......... ....................... .............. .. ........ ......... ......... ................. ........... ................. ........ ~ .............;........................................................................L.M:1.\::i............~.S::.~..~......:.=.........e~............................................................. .............J........................................................................~..~.....................~~~.~.~~.......=...........v...l....B............................................................ ..................................................................................................................................................................................................................................................................................................................... '............................................................................................................................................................................................................................................................................................................... Do you have the necessary "certificate of authority'! to transact corporate business in this state, under the terms of ["""Chapter 215, Acts of 1929, and acts amendatory thereto? .........................~::.i...~...................................................................................... .' .,. .,:,:.t f' ." -'1" ....... '.. .... .,'. ..... '.",' '.'. .... .' ..... ..... ..'.. . ...... '. ...... i. ......' .. . . .', r r co--partnership, answer this: Date I of 0 rganizati on . ........... ............. .......... .......... ......~.)..~..... .......... ......... ........... ......... ................ .... ..... ......... ..... ......... ........................ ....... ............ ...... State whether co-partnership is general, limited or association ....................................................................................................................... Give the names, addresses and proportional interests of all parties............................................................................................................... NAME ADDRESS SHARE ......................................................................... ..................................................................................................................................... $ .................................................................. $ ................................................................. $ ................................................................ $ ...................................................................... $ .................................................................. $ ............................................................... $ ................................................................. $ r: ..........;.. ...;............. .......... ........................ ..... l lie",,-! ......................................................................................................................... ................................................................................. ............................................................................................................................................. ................................................................................... .......................................................................................................................................................... ........................................................................................ ................................................................................................................................................ ................................................................................ ................................................................................................................................... ..................................................................................... ......................................................................................................................................... ..................................................................... .......................................................................................................................................... ...........................................................-.....~....... r.\""..l.._.\.~~_\~;_ll~~..\~......Iri:vtl.....l B-118 ..-T~ '. he name of the partnership firm under which the above partners are operating is......................................................................................................... :' ': ( l I : I ~. : J < t Gi:;~.~~.~d"titi~.~f.;Jfp~;;~.h~~g.~~th~ritY.~~.;~~t~.~~i";~~~ipt.~i~.~t~;;;~~~.~d.t~.~~~d;~..~th~.b~~~~.f~~.th~.p;;;~~;;bip; .Jhe signatures of whom are legally binding. ~. ; ,. .~... ..~........................... ....... ....... ...... ............... ....... ...... ........... .................. ...........".... ........ ................. ............. .......... ............... .......... ..................... ........ ....... ............ " \, ...........................................................................................................................................................................................................................................................................~ r-"' t, ... .... ....~. ......................... ....... .............. ... .............. . ...... .. ........................ ....... ~......... ....... ........... ........... ......... ........... .. ..... ..... ............. ..... ..... .................. .......... ............... 1:. .The ~dersigned hereby declares that the foregoing is a true statement of the financial condition of the individual, co-partnership or corporation t herein first named, as of the date herein first given; that this statement is for the express purpose of inducing the party to whom it is submitted r-"'to award the submitter a contract; and that any depository, vendor or other agency herein named is hereby authorized to supply such party ~ :with 'fY information necessary to verify this statement. NOTE: A co.partnership must give firm name and signature of all partners. A ~ ; corpo~ation must give full corporate name, signature of official and affix ~. ,corporate seal. Affidavit for Individual [STATEOF COUNTY OF ..... .... ..... .. ........... ........ . ....... ............. ) ) SS: ........ ........................... ............... ...... ) ..........~........................................................;.......................................................being duly sworn, deposes and says thereof that the foregoing financial statement, taken from his books, is a true and accurate statement of his financial condition as of the date thereof and that the answers to the foregoing interrogatories are true. (Applicant must sign here) Subsc:;ribed and sworn to me this...................................... day of ......................20 ............... I ,......................................................................................................................-.....-.... Notary Public COUNTY OF ..I.i1J..cl.l...~..Y.l.~.............. ) C'. \ ) 55: . C f \ ......,.... ....1..........(........................) Affidavit for Co-Partnership ~ r ' ^"f) .4fE OF .....:i;...,,' ...........................................................................................................................being du1y sworn, deposes and says that he is a member of the firm of ...........................................................................................................................and that he is familiar with the books of said firm showing its fmancial con9ition; that the foregoing fmancial statement, taken from the books of said fIrm, is a true and accura~e ~?m~. f financial condition of said firm as of the date thereof and that the answers to the foregoing interrogatories are t~~:.~~~~ .......................................... (Member 0 m must sign here) Sub~cribed and sworn to me this......................................day of ...................... 20 ............... .....................................................................-.............................................................................. Notary Public STATE OF ::r~P.1 ~~ ...... .......... ........ ......... ....................... ) CO~TY OF .....~;.~~.~....................... ~ 55: ........lw..;,..L\.I:..o....~,.......G.~>..l1.~...~Q...D...:.........................being. duly: sworn, d~poses and says that he i~ a member of the co~orati~~ of .....................~;~tl-.........~~~:.:......~......................descnbed 10 and whIch executed the foregomg statement; that he 18 familiar with the books of said corporation showing its financial condition; that the foregoing financial statement, taken from the books of said corpo~ati~n is a true ~d accurate statement of the f10ancial condition of said corporation as o~e ~'. <;~ reof d. the answer to the forego1Og Interrogatones are true. .~~-4 . ........ ~....................... (0 IC~ Affidavit for Corporation A~ed an~orn t~e this..........~.?~................day of ..t:!.9...-;........... 20 .~~........ ........~..~J.~.............................................. Notary~blic ," y........,," C,\Syclney\wpdc...\misce1lanecus\maslerldivB.wpd B-119