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6.D. - Page 91 of 170 Request for Qualifications: General Park Building Construction, Retrofit, Maintenance, and/or Repairs CITY OF LOS ANGELES RESPONSIBILITY QUESTIONNAIRE RESPONSES TO THE QUESTIONS CONTAINED IN THIS QUESTIONNAIRE MUST BE SUBMITTED ON THIS FORM. In responding to the Questionnaire, neither the City form, nor any of the questions contained therein, may be retyped, recreated, modified, altered, or changed in any way, in whole or in part. Bidder or Bidders that submit responses on a form that has been retyped, recreated, modified, altered, or changed in any way shall be deemed non-responsive. The signatory of this questionnaire guarantees the truth and accuracy of all statements and answers to the Questions herein. Failure to complete and return this questionnaire, any false statements, or failure to answer (a) question(s) when required, may render the Bid non-responsive. All responses must be typewritten or printed in ink. Where an explanation is required or where additional space is needed to explain an answer, use the Responsibility Questionnaire Attachments. Submit the completed form and all attachments to the awarding authority. Retain a copy of this completed form for future reference. Contractors must submit updated information to the awarding authority if changes have occurred that would render any of the responses inaccurate in any way. Updates must be submitted to the awarding authority within 30 days of the change(s). A. CONTACT INFORMATION CITY DEPARTMENT INFORMATION Wl OF L05 ANGELO DEPT Or-AECAEATION LID PARKS ;711481 NEWSOM J13 -ava-16-7s City Department/Division Awarding Contract City Contact Person Phone % NER{�L PRRKBUI�pINGCl�NSiRI�L'T/Dl� PROFIT, MAIN iENAACE Amar` RFPMS 6a1-4 City Bid or Contract Number and Project Title (if applicable) Bid Date BIDDER/CONTRACTOR INFORMATION TkE PU8WC16E5 A0 0A1 OW)PAN`l Bidder/Responder Business Name Contractor's License Number X58 P,(�SiNE�S PARk�Ry �l►!�DEN N1/ Street Address City State Zip tp,MURI-ES E KAUFMAN P8E5r n�N ►' �'iS�- fig$-� 060 Contact Person, Title I Phone Fax TYPE OF SUBMISSION: The Questionnaire being submitted is: ® An initial submission of a completed Questionnaire. ❑ An update of a prior Questionnaire dated ❑ No change. I certify under penalty of perjury under the laws of the State of California that there has been no change to any of the responses since the last Responsibility Questionnaire dated / / was submitted by the firm. Attach a copy of that Questionnaire and sign below. PALES C . k'AUFMAN, PPS E5 M EAI i Print Name, Title L�o� IC-, Signature TOTAL NUMBER OF PAGES SUBMITTED, INCLUDING ALL ATTACHMENTS: Responsibility Questionnaire (Rev. 1/25/12) 4 �� Date 02 3 IMPORTANT — RESPONDERS MUST SUBMIT ALL REQUIRED FORMS (COMPLETELY FILLED OUT) BY RFQ SUBMITTAL DEADLINE. Page 85 of 103 174