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DocuSign Envelope ID:46276B05-79E0-4089-B879-E62E97F0B2A1 <br /> BDER'S QUALIFICATI IN STATE, I iNT <br /> A11111•110.....m..,• <br /> 8. List bank references. Include an individuals name and telephone number. <br /> YA-Dko? Smvk — -SA 91 yes 2 <br /> /14"4— q/9 4/1/9 <br /> aviveA-.as 9/9 <br /> 9. Bonding reference,name,address,telephone. <br /> /1/e1 Er(/ — 9/9 66 <br /> q3 ern') „.„„..)0v-itosto. 1 Z.77e, / <br /> la Are you on any list of debarred contractors maintained by the U.S.Department of Labor,the <br /> U.S.Department of Housing and Urban Development or the North Carolina Department of <br /> Transportation? <br /> Yes No 1/41-- <br /> 11. The undersigned hereby authorizes and requests any person, firm or corporation to furnish <br /> any information requested by Draper Aden Associates in verification of the recitals <br /> comprising this statement of contractor's qualifications. <br /> 12. State the true, exact, correct and complete name of the partnership, corporation or trade <br /> name under which you do business, and the address of the place of business, (If a <br /> corporation, state the name of the President and Secretary. If a partnership, state the names <br /> of all partners. If a trade name,state the names of the individuals who do business under the <br /> trade name.) It is absolutely necessary that this information be furnished, <br /> 1.--"%-zw.,•kee.„? CD <br /> Correct Name of :bidder <br /> — <br /> (a) The Business is a 040.10.4.6 "ib <br /> (b) The address of principal place of business is: <br /> 2:24 --,72„.78' <br /> (c) Phone number c\k:\ 7" .„5" L4L <br /> (d) The name of the corporate officers,or partners, or individuals doing business under a trade <br /> name,are as follows: <br /> 1.0 <br /> N\INK-t- <br /> 516. -Siz) <br /> Orange County Solid Waste-New Storage Building R15318N-01G <br /> Orange County,NC November,2015 <br /> BQS-3 <br />