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| General |
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| Type of work
performed: |
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| Geographical
areas of operation (states/countries): |
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| Contractor's
State Licenses: |
| Number |
State |
Type of Work |
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| ORGANIZATIONAL
STRUCTURE |
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| If individually
owned, by whom: if partnership, list partners: |
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| Company is
% minority owned. EEO Classification:
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| Company is
% women owned |
| If Company is
at least 51% minority or women owned, is it operated
by this (these) individual(s)? |
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| List other companies
owned and type(s) of service(s) provided by each: (Submit
a “List of Services” for each company): |
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| Date founded:
under present management since:
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| Preferred job
cost range:
Minimum:
Maximum |
| Union Contractor:
Non-Union Contractor:
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| LEGAL AND FINANCIAL |
| Insurance in
Force: |
| (Complete the
following or attach current Insurance Certificates) |
| Comprehensive
General Liability Coverage: |
| Bodily Injury:
One Person $
Each Accident $
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| Property Damage:
Each Accident $
Aggregate $
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| Excess Liability
Coverage $
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| Miscellaneous: |
| a. Company
Net Worth $
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| b.
Annual sales volume (last 3 years) |
| 1.
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| 2.
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| 3.
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| 4.
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| c.
Largest dollar volume job in last 5 years
$
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| If yes,
attach a copy of your most recent audited financial
statement |
| d.
Do you furnish information to Dun and
Bradstreet? |
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| If yes, what
is your account number?
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| e.
Bonding Capacity:
Bonding Rate:
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| Surety (is):
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| f.
Has your company or any of its affiliates ever filed
for bankruptcy? |
| If
yes, provide the court case number and date of filing
below |
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| g.
Has your company or any of its affiliates assigned
any accounts receivable in the
last 5 years? |
| If
yes, provide details including dates, projects, credit
agencies/factoring agencies,
and amounts. |
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| h.
Is your company or any of its affiliates presently
or at any time in the past ever
entered into litigation or claim disputes with Jacobs
Engineering Group Inc. or any
of its affiliates? |
If
yes, provide a brief explanation below including offices
involved, dates and
principal individuals involved. |
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| PERFORMANCE |
| 1. Current projects
in progress: |
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| 2. Major projects
completed in last 3 years: |
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| The undersigned hereby
warrants that the information contained herein is true,
accurate and current as of the date first written.
The undersigned understands that this information
will be used in our bidder selection process, and
any mistakes or other inaccuracies may be grounds
for disqualification as a bidder and/or breach of
contract. |
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| Company |
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| Officer |
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| Date |
| Please return
this completed form by overnight courier to the address
shown below: |
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Fish &
Fisher, Inc.
P. O. Box 13741 405 Briarwood Dr. Ste. 105-B
Jackson, MS 39211
Attn.: info@fishandfisherinc.com |
| Phone:
(601) 899.9969; Fax: (601) 899.9972 |
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