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6.D. - Page 55 of 170 <br />Request for Qualifications: <br />General Park Building Construction, Retrofit, Maintenance, and/or Repairs <br />INFORMATION RELEASE FORM <br />By signing below, I hereby authorize, without any reservations, any person or company I have listed as a reference in my <br />Response 3 to disclose in good faith any information they may have regarding my qualifications for contracting. All <br />information obtained will be in connection with Responses for contracted work. My authorization releases the Company, <br />its agents, and all those who have provided information from any and all liability for damages arising from the investigation <br />and disclosure of the requested information. <br />By signing below, I agree not to assert any claims or causes or action of any kind against the City of Los Angeles. <br />I further release and discharge the City of Los Angeles from any and all claims, demands, damages, actions, cause of action, <br />or suits of any kind or nature arising from the City's investigations. <br />I hereby acknowledge that I have read the above disclosure statement and have understood it. <br />Name: 014ARLC-5 E. kAULFMhN Title: PP) E51LEN T <br />Signature: Vim'-- Date: <br />Firm's Name: IH6P08i-1C:.RE5rrQ0M do/nPANi Phone: <br />Firm's Address: 5T4 BLLSiNE55 PARKWO MI NOON, NV YCHA3 <br />Street, City, State Zip <br />IMPORTANT — RESPONDERS MUST SUBMIT ALL REQUIRED FORMS (COMPLETELY FILLED OUT) BY RFQ <br />SUBMITTAL DEADLINE. <br />Page 49 of 103 <br />138 <br />