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Example AIA Document A305 - Electronic Format CONTRACTOR’S QUALIFICATION STATEMENT THIS DOCUMENT HAS IMPORTANT LEGAL CONSEQUENCES: CONSULTATION WITH AN ATTORNEY IS ENCOURAGED WITH RESPECT TO IT'S COMPLETION OR MODIFICATION. AUTHENTICATION OF THIS ELECTRONICALLY DRAFTED AIA DOCUMENT MY BE MADE BY USING AIA DOCUMENT D401. This form is approved and recommended by The American Institute of Architects (AIA) and The Associated General Contractors of America (AGC) for use in evaluating the qualifications of contractors. No endorsement of the submitting party or verification of the information is made by the AIA or AGC. The Undersigned certifies under oath that the information provided herein is true and sufficiently complete so as not to be misleading. SUBMITTED BY: Bates Electrical Services">
Example AIA Document A305 -
Electronic Format CONTRACTOR’S QUALIFICATION
STATEMENT THIS DOCUMENT HAS IMPORTANT LEGAL CONSEQUENCES:
CONSULTATION WITH AN ATTORNEY IS ENCOURAGED WITH RESPECT TO IT'S
COMPLETION OR MODIFICATION. AUTHENTICATION OF THIS ELECTRONICALLY DRAFTED
AIA DOCUMENT MY BE MADE BY USING AIA DOCUMENT D401. This form is approved and recommended by The American
Institute of Architects (AIA) and The Associated General Contractors of
America (AGC) for use in evaluating the qualifications of contractors. No
endorsement of the submitting party or verification of the information is
made by the AIA or AGC. The Undersigned certifies under oath that the information provided
herein is true and sufficiently complete so as not to be misleading. SUBMITTED BY: Bates Electrical Services, Inc.
[ X ] Corporation [ ]
Partnership [ ] Individual [ ] Joint Venture [ ] Other NAME: Bill
Goldthorp,
President ADDRESS: 7901 Hopi Place Tampa, FL 33634 PRINCIPAL OFFICE: 7901 Hopi Place
Tampa, FL 33634 TYPE OF WORK: [ ] General construction [ ] HVAC [ ] Plumbing [X] Electrical [
] Other 1. ORGANIZATION
1.1 How many years has your organization been in business as a
Contractor?
17 years 1.2 How many years has your organization been in business under its
present business name?
17 years 1.2.1 Under what other or former names has your organization
operated?
None 1.3 If your organization is a corporation, answer the following: 1.3.1 Date of Incorporation: March 1985 1.3.2 State of Incorporation: Florida 1.3.3 President’s name: Bill
Goldthorp 1.3.4 Vice-President’s name(s):
Diane Tupper, Pat Solley 1.3.5 Secretary’s name: Bill
Goldthorp 1.3.6 Treasurer’s name: Bill Goldthorp 2. LICENSING 2.1 List jurisdictions and trade categories in which your
organization is legally qualified to do business, and indicate
registration or license numbers, if
applicable. Electrical, Fire Alarm; EC0001305 2.2 List jurisdictions in which your organization’s partnership or
trade name is filed.
Florida 3. EXPERIENCE
3.1 List the categories of work that your organization normally
performs with its own forces.
Electrical, Fire Alarm 3.2 Claims and Suits. 3.2.1 Has your organization ever failed to complete any work
awarded to it?
No. 3.2.2 Are there any judgments, claims, arbitration proceedings or
suits pending or outstanding against your organizations or its
officers?
No. 3.2.3 Has your organization filed any lawsuits or requested
arbitration with regard to construction contracts within the last five
years?
No. 3.3 Within the last five years, has any officer or principal of your
organization ever been an officer or principal of another organization
when it failed to complete a construction contract? No. 3.4 On a separate sheet, list major construction projects your
organization has in progress, giving the name of project, owner,
architect, contract amount, percent complete and schedule completion
date. 3.4.1 State total worth of work in progress and under contract.
Upon Request 3.5 On a separate sheet, list the major projects your organization
has completed in the last five years, giving the name of the project,
owner, architect, contract amount, date of completion and percentage of
the cost of the work performed with your own forces.
Upon Request 3.5.1 State average annual amount of construction work performed
during the past five years:
Upon Request 3.6 On a separate sheet, list the construction experience and present
commitments of the key individuals of your organization. Upon Request 4. REFERENCES
4.1 Trade References:
Upon
Request 4.2 Bank References: 4.3 Surety:
4.3.1 Name of bonding company: 4.3.2 Name and address of agent: 5. FINANCING
5.1 Financial Statement. (submitted upon
request)
5.1.1 Attach a financial statement, preferably audited, including
your organization’s latest balance sheet and income statement showing
the following items:
Current Assets (e.g., cash, joint venture accounts, accounts
receivable, notes receivable, accrued income, deposits, materials
inventory and prepaid expenses); Net Fixed Assets; Other Assets; Current Liabilities (e.g., accounts payable, notes payable,
accrued expenses, provision for income taxes, advances, accrued
salaries and accrued payroll taxes); Other Liabilities (e.g., capital, capital stock, authorized and
outstanding shares par values, earned surplus and retained
earnings). 5.1.2 Name and address of firm preparing attached financial
statement, and date thereof: 5.1.3 Is the attached financial statement for the identical
organization named on page one?
N/A 5.1.4 If not, explain the relationship and financial
responsibility of the organization whose financial statement is
provided (e.g., parent-subsidiary).
5.2 Will the organization whose financial statement is attached act
as guarantor for the contract for construction?
Yes. 6. SIGNATURE
6.1 Dated this 25th day of January, 2002.
Bates Electrical Services, Inc. By: Bill Goldthorp Title: President Bill Goldthorp being duly sworn,
deposes and says that the information provided herein is true and
sufficiently complete so as not to be misleading. |