05-D Animal Shelter Contract - Laserfiche WebLink

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17. Credit available. - 18. Give three references, one of which must be a financial institution. 19. State the name and address of each of your Worktnen's Compensation insurance carriers for the last 5 yeazs. 20. List each claim made against you by your employees or third parties for personal injury, death, or property damage in each of the last 3 yeazs. 21. List any and all litigation including azbitration, administrative proceedings, and mediation in which you have a plaintiff or defendant involving any owner, azchitect or engineer over the past five years. This list should be in sufficient detail to explain the positions of the various parties and the ultimate outcome as to the damages awazded (if any). This list shall be considered material as respects the final awazding of any contract connected with the bid. (State "None" or submit information on attached sheet). 22. The undersigned hereby authorizes and requests any person, firm, or corporation to fiunish any information requested by the OWNER in verification of the recitals comprising this Statement of Bidder's Qualifications. Dated at at ; this -2±- day of ,6 u- r , 20eL ~t,7jUc+5 ~•v fT ~ ✓G 5 1-^'~ Name of Bidder By: ~ Title: C~ STATE OF 7 F- X A S - COLINTY OFi)A Lh, - e-Evc3 , being duly swom, deposes and says ~2)Avir ~P that he is CzO , of~i~ and that the , answers to the foregoing questions and all statements therein contained aze true and correct. Subscribed and sworn to before me this -2~day of 4v-, 200 Z-. or r~ SXplres ~l \ \ O ~ ,RtyqSo ssion expires: 15