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DocuSign Envelope ID:418ADAA3-2F7B-4243-AF32-4541C164B6FA <br /> BIDDER'S QUALIFICATION STATEMENT <br /> 8. List bank references. Include an individuals name and telephone number. <br /> 67 444 <br /> Tft <br /> #40,1364-71 P <br /> '11.1 <br /> 9. Bonding reference, name,address,telephone. <br /> c's • <br /> 4111 4 40' <br /> 10. 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 X, <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 /> 00„ 02, IF Q--6 57 he LAC:VA <br /> Correct Name of Bidder <br /> (a) The Business is a „ no/ i41 6 64,9064,3-1-2,24) <br /> (b) The address of principal place of business is: <br /> 81:A9,c, A/c z7 4-#7 <br /> (c) Phone number 3-7" gss— ey-e3 <br /> (d) The name of the corporate officers, or partners, or individuals doing business under a trade <br /> name, are as follows: <br /> D ,2/ -1-7;„ , PZ":71--- <br /> oeliS° ,11,1747./ -Cie gdre <br /> Eubanks Rd.Waste &Recycling Center Improvements R00592-167N <br /> Orange County Solid Waste September 2016 <br /> BQS-3 <br />