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12. Background and experience of the principal members of your organization, including the <br />officers and the proposed project manager. <br />G 17 '`025 <br />ec6772~~"7'LL r3~~~>»n- <br />-l°7 y25 L-~ <br />13. List two major suppliers from whom you purchase the majority of your supplies. <br />-4~'ii~VEi 5 - ~91~~ S, <br />14. List two financial institutions with which you have established credit. <br />F"~/-~G._C ~~11L K. J~fI721 l JC <br />.5TA -7-~. 13A/, 61- r i-- 7e--/e,4 Z-/:3 <br />15. State the name, address and phone number of each of your Workmen's Compensation <br />insurance carriers for the last 5 years. <br />16. List any claim made against you by your employees or third parties for personal injury, <br />death, or property damage in each of the last 3 yeazs. c1-us, <br />17. List any and all litigation including arbitration, administrative proceedings, and mediation in <br />which you have been a plaintiff or defendant involving any owner, architect or engineer over <br />the past 5 years This list should be in sufficient detail to explain the positions of the various <br />parties and the ultimate outcome as to damages awazded (if any). T'his list shall be <br />considered material as respe;cts the final awarding of any contract connected with the bid. <br />(state "none" or submit information on attached sheet. /uonrx-- <br />18. The undersigned hereby authorizes and requests any person, firm, or corporation to furnish <br />any information requested by the OWNER in verification of the recitals comprising this <br />Contractor Applicarion. <br />Dated at PA z i T x, , this SL n day of 2012. <br />T/-4 L4 L'-Y~ C'eJYY1 L. <br />Name of Bidder <br />~ 114 ~ . <br />By: ~ ~ ' L+L'_ <br />Title: ~"~/-f~'`:-r"N 492 <br />~ <br />~ <br />