Instructions: In the following Section, fill in the required information on all present and past Key People for the past five years. “Key People” include:
Principals, directors, officers.
Shareholder of 5% or more of the Company issued stock.
Any manager or individual who participates in overall policy-making or financial decisions for the Company.
Any person in a position to control and direct the firm’s overall operations.
Signatories to bank accounts and any debt instruments, whether or not otherwise considered Key People.
“Shareholders” are owners of stock or other securities that can be converted to stock that, if exercised, would constitute 5% of the Company issued stock. Other securities include stock options, secured or unsecured bonds, warrants and rights.
Compliance Information
In the past five years has the Company or any of its affiliate firms been the subject of any of the following actions by any government agency (Government agencies include city, state, federal public agencies, quasi-public agencies, authorities and corporations, public development corporations and local development corporations):
Been suspended, debarred, disqualified, had its prequalification revoked or otherwise been declared ineligible to bid or to perform work? YesNo
Been barred from bidding or denied a contract as a result of refusal of Key People to testify before a grand jury or administrative board? YesNo
Been denied a contract despite being the low bidder for any other reason? YesNo
Been defaulted on any contract? YesNo
Had a contract terminated for “cause”? YesNo
Been given a final unsatisfactory performance determination or deemed a poor performer (by letter or formal proceedings)? YesNo
Been prevented, or barred from bidding for any other reason? YesNo
Been denied a contract for failure to obtain surety or otherwise provide required security? YesNo
Had liquidated damages assessed against it, upon completion of a contract or failure to complete a contract? YesNo
Compliance Information (Part II)
In the past ten years has the Company or any of its current or past Key People or affiliate firms:
Been under investigation, involving any alleged violation of criminal law relating to business activities? YesNo
An INVESTIGATION includes an appearance before a grand jury by representatives of a business entity, any oral or written inquiry or review of the entity’s documents by a public agency, temporary commission or other investigative body including, but not limited to, subpoenas and/or search warrants, or questioning of employees concerning the general operation or a specific project of activities of such business entity.
Had records in its or his/her control, custody or ownership subpoenaed by any law enforcement agency? YesNo
Been questioned by any officer or agent of a law enforcement agency regarding any practices or conduct relating to the providing of construction related services? YesNo
Been advised of being the target or subject of an investigation involving any violation of criminal law? YesNo
Been notified or being the subject of court ordered electronic surveillance? YesNo
Been arrested or indicted or otherwise named as an unindicted co-conspirator in any indictment or other accusatory instrument? YesNo
Been convicted, after trial or by plea, of any felony under state or federal law? YesNo
Been convicted of any misdemeanor involving business-related crimes? YesNo
Entered a plea of nolo contendere to a charge of embezzlement, theft, forgery, bribery, falsification or destruction of records, receiving stolen property or a violation of the antitrust law? YesNo
Entered into a consent decree? YesNo
Been granted immunity from prosecution for any business-related conduct constituting a crime under state or federal law? YesNo
Taken the Fifth Amendment in testimony regarding a business related crime? YesNo
