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PART 11: BUSINESS TYPE & OTHER INFORMATION <br />i. If your company is a partnership, complete Type: Generel limited <br />Partners Names and Addresses: <br />2. If your company is a corporation, complete <br />Date incorporated: State incorporeted: <br />3. How many years has your organ'vation been in business as a: <br />Prime Contrector: Subcontractor: <br />4. Has your company defauked on any pubtlc proJect in the preceding ten (30) yearst Yes No <br />If yes, please indicate: <br />Governmental Agency: Project: Date: Lowtion: <br />Detailed Explanation: <br />5. Has your company or arry offker off your comparry been indicted, pled guiky or been comricted of Yes No <br />any offense that resuked in your flrm currendy being debarred or suspended from bidding or <br />performing work for any SWte, Local or Federal GovemmeM agenq? <br />Ifyes, piease indicate: <br />Government Agency: <br />Detailed Explanation: <br />6. Is your company under the protection of banlauptry court, has any pending petition in Yes No <br />eankruptcy court, or have you made assignment for the benefit of tredRors7 <br />If yes, please give a detailed explanation: <br />Page 2 of 6