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6.D. - Page 97 of 170 <br />Request for Qualifications: <br />General Park Building Construction, Retrofit, Maintenance, and/or Repairs <br />I. BUSINESS INTEGRITY <br />25. For questions (a), (b), and (c) below, check Yes if the situation applies to your firm. For these <br />questions, the term "firm" includes any owners, partners, or officers in the firm. The term 'owner' does <br />not include owners of stock in your firm if the firm is a publicly traded corporation. If you check Yes to <br />any of the three questions below, explain on Attachment B the circumstances surrounding each <br />instance. <br />(a) Is a governmental entity or public utility currently investigating your firm for making (a) false claim(s) <br />or material misrepresentations(s)? <br />❑ Yes N No <br />(b) In the past five years, has a governmental entity or public utility alleged or determined that your firm <br />made (a) false claim(s) or material misrepresentation(s)? <br />❑ Yes 0 No <br />(c) In the past five years, has your firm been convicted or found liable in a civil suit for making (a) false <br />claim(s) or material misrepresentation(s) to any governmental entity or public utility? <br />❑ Yes *0 <br />26. In the past five years, has your firm or any of its owners or officers been convicted of a crime involving <br />the Bidding of a government contract, the awarding of a government contract, the performance of a <br />government contract, or the crime of fraud, theft, embezzlement, perjury, bribery? For this question, the <br />term "owner" does not include those who own stock in a publicly traded corporation. <br />❑ Yes A-No <br />If Yes, explain on Attachment B the circumstances surrounding each instance. <br />CERTIFICATION UNDER PENALTY OF PERJURY <br />I certify under penalty of perjury under the laws of the State of California that I have read and <br />understand the questions contained in this questionnaire and the responses contained on all <br />Attachments. I further certify that I have provided full and complete answers to each question, and <br />that ail information provided in response to this Questionnaire is true and accurate to the best of my <br />knowledge and belief. <br />NARLES E, kAUF <br />Print Name, Title <br />Responsibility Questionnaire (Rev. 1/25/12) <br />Ihf:NT <br />Signature <br />Date <br />/� w <br />IMPORTANT - RESPONDERS MUST SUBMIT ALL REQUIRED FORMS (COMPLETELY FILLED <br />OUT) BY RFQ SUBMITTAL DEADLINE. 180 <br />Page 91 of 103 <br />