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BIDDER'S QUALIFICATION STATEMENT <br /> <br />High Rock Road Waste & Recycling Center Improvements R00592-213N <br />Orange County, North Carolina MARCH 2019 <br />BQS-3 <br /> <br />8. List bank references. Include an individuals name and telephone number. <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />9. Bonding reference, name, address, telephone. <br /> <br /> <br /> <br /> <br /> <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 <br /> <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 /> <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 /> <br /> Correct Name of Bidder <br /> <br />(a) The Business is a <br /> <br />(b) The address of principal place of business is: <br /> <br /> <br /> <br />(c) Phone number <br /> <br />(d) The name of the corporate officers, or partners, or individuals doing business under a trade <br />name, are as follows: <br /> <br /> <br /> <br /> <br /> <br />DocuSign Envelope ID: BBF56E0A-3618-497E-AA70-92F097E8F598