AIA Document A305 - 1986
Contractor's Qualification Statement

The Undersigned certifies under oath that the information provided herein is true and
sufficiently complete so as not to be misleading.


Submitted By:
Name:
Address:
*Phone Number
* Email Address
Principal Office
 






Name of Project
Encore
Type Of Work







How many years has your organization been in business as a contractor?
How many years has your organization been in business under its present business name?
Under what other former names has your organization been in business?
If your organization is a corporation, answer the following:
Date of Incorporation:
State of Incorporation:
President's Name:
Vice President's Name:
Secretary's Name:
Treasurer's Name:
If y our organization is a partnership, answer the following:
Date of Organization:
Type of Partnership (if applicable):
Name(s) of General Partners:
If your organization is individually owned, answer the following:
Date of Organization:
Name of Owner:
If the form of your organization is other than those listed above, describe it and name the principals:

LICENSING:
List jurisdictions and trade categories in which your organization is legally qualified to do business, and indicate registration or license numbers, if applicable.
Is your company minority certified?
List jurisdictions in which your organization's partnership or trade name is filed.
EXPERIENCE:
List the categories of work that your organization normally performs with its own forces:
CLAIMS AND SUITES
Has your organization ever failed to complete any work awarded to it?
Are there any judgments, claims, arbitration proceedings or suits pending or outstanding against your organization or its officers?
Has your organization filed any law suits or requested arbitration with regard to construction contracts within the last five years?
Within the last five years, has any officer or principal of your organization ever been an officer or prinicpal of another organization when it failed to complete a construction contract?
If yes, explain here
List major construction projects your organization has in progress, giving the name of the project, owner, architect, contract amount, percent complete and scheduled completion date.
State total worth of work in progress and under contract:
List the major projects your organization has completed in the past five years, giving the name of the project, owner, architect, contract amount, date of completion and percentage of the cost of the work performed with your own forces:
State average annual amount of construction work performed during the past five years:
List the construction experience and present commitments of the key individuals of your organization:
REFERENCES:
Trade References
Bank References
Name of Bonding Company
Name and address of agent
FINANCING:
Attach a financial statement, preferably audited, including your organization's latest balance sheet and income statement showing the following items: Current Assets, Net Fixed Assets, Other Assets, Current Liabilities, Other Liabilities
Name and address of firm preparing the attached financial statement and date thereof:
Is the attached financial statement for the identical organization named at the top of this form?
If not, explain the relationship and financial responsibility of the organization whose financial statement is provided.
Will the organization whose financial statement is attached act as guarantor of the contract for construction?
SIGNATURE
Date
Year
Name of Organization
Signed
Title