Laserfiche WebLink
6.D. - Page 14 of 170 <br />Request for Qualifications: <br />General Park Building Construction, Retrofit, Maintenance, and/or Repairs <br />ITEM <br />INITIAL <br />FORM OF NON -COLLUSION AFFIDAVIT <br />Respondent read, signed and submitted the completed form. <br />01 , <br />l•�- <br />IRAN CONTRACTING ACT OF 2010 COMPLIANCE AFFIDAVIT <br />Respondent read, signed and submitted the completed form. <br />PROJECT QUALIFICATION FORM <br />Respondent read, signed and submitted one completed form for each qualifying project. <br />NAME OF RESPONDENT I 14p r u- 8 L L C P> C S T9000) 000) CDM PAN V <br />RESPONDENT'S ADDRESS <br />STREET 6U -S' N C S S P (R K W R / <br />CITY r VI lB b C M STATE NV ZIP CODE <br />A. RESPONDENT'S TELEPHONE NUMBER 0 � O' D � b � Q & Q <br />B. RESPONDENT'S FAX NUMBER b O u D o ) q ` a <br />C. RESPONDENT'S EMAIL ADDRESS djqu,Cl� PLLft1LAeS p)00M CO1Y)f41 J Y , CQ,M <br />D. BUSINESS TAX REGISTRATION CERTIFICATE NUMBER (BTRC) # 000oZ I 1 a 8'1 I <br />E. RESPONDENT'S CHECKLIST ��11 <br />Are all pertinent sections of the "Respondent's Check List" completed, signed and initialed? eQ Initial <br />BY: <br />(Signature) <br />L, V\,14 <", <br />PRINT NAME: 6 /- A LESS E. OUTMAN <br />ntN <br />TITLE OR POSITION: Ph e51 b Ig <br />Date 6-1 10 i � <br />IMPORTANT — RESPONDERS MUST SUBMIT ALL REQUIRED FORMS (COMPLETELY FILLED OUT) BY RFQ <br />SUBMITTAL DEADLINE. <br />Page 9 of 103 <br />97 <br />