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1 I'erracon <br />ADDITEONAL ITEMS REQUlRED V!1lTH BID: The following items are additionally required as <br />part of this bid submittal. <br />1. INSURANCE CERTIFICATES. <br />2. CONTRACTOR'S QUALIFICATION STATEMENT: Completed AIA Document A305. <br />3. A notarized statement, signed by an officer of the company, containing the following <br />information of a statement of negative of the same: <br />a) A record of citations issued by Federal, State, or Local regulatory agencies relating <br />to asbestos, fungal(mold) and lead paint abatement activity for the Contracting <br />company and any and all affiliate. Include projects, dates and resolutions. <br />b) Situations in which an asbestos, fungal and lead related contract has been <br />terminated inciuding projects, dates and reasons for terminations. <br />c) A listing of any asbestos, fungal or lead -related legal proceedings/claims in which <br />the Bidder (or employees scheduled to participate in this project) have participated or <br />are currently involved. Include descriptions of role, issue and resolution to date. <br />4. Name of supervisor and/or supervisors who will work on the project. Include a detailed <br />description of his/her experience with references and years of experience. <br />5. Contractor will provide the name and appropriate permit information of the waste <br />transporter and their insurance certificate. <br />6. Contractor will provide the name of the landfill at which the asbestos, fungal and lead <br />waste will be disposed. <br />END OF BID FORM <br />BID FORM FOR HAZARDOUS MATERIAL ABATEMEI\.1T - PAGE 4 i <br />/ <br />