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�� ��{ �� ���f�� <br /> 5. Have you attached a notarized statement from an admitted surety insurer (approved by <br /> the Califomia Department of Insurance) and authorized to issue bonds in the State of <br /> Califomia, which states that your current bonding capacity is sufficient to bond the <br /> estimated $15,000,000 project? <br /> ❑ Yes ❑ No <br /> NOTE: Notarized statement must be from the surety company, not an agent or <br /> broker. <br /> 6. Has your contractor's license been revoked at any time in the last five years? <br /> ❑ Yes ❑ No <br /> 7. Has a surety firm completed a contract on your behalf, or paid for completion because <br /> your firm was default terminated by the project owner within the last five (5) years? <br /> ❑ Yes ❑ No <br /> 8. At the time of submitting this pre-qualification form, is your firm ineligible to bid on or <br /> be awarded a public works contract, or perform as a subcontractor on a public works <br /> contract, pursuant to either Labor Code secrion 1777.1 or Labor Code section 1777.7? <br /> ❑ Yes ❑ No <br /> If the answer is "Yes," state the beginning and ending dates of the period of debazment: <br /> 9. At any time during the last five years, has your firm, or any of its owners or officers been <br /> convicted of a crime involving the awarding of a contract of a govemment construction <br /> project, or the bidding or perFormance of a government contract? <br /> ❑ Yes ❑ No <br /> 10. Is the proposed engineer of record licensed to practice engineering in the State of <br /> California? <br /> ❑ Yes ❑ No <br /> 11. Does the proposed engineer of record have a minimum of 10 years experience perFomung <br /> marine design and has served as the lead designer on at least one bulk or container wharf? <br /> ❑ Yes ❑ No <br /> 12. Has disciplinary action been taken by the Califomia Board of Professional Engineers on <br /> the pmposed engineer of record? <br /> ❑ Yes ❑ No <br /> Pegs 1s o! t6 <br /> w-�,�/ <br />