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EXHIBIT Q (REVISED) <br />CITY OF SANTA ANA <br />REQUEST FOR PROPOSAL FOR <br />CONSTRUCTION SURVEYING SERVICES <br />RESPONSIBLE PROPOSER —SUPPLEMENTAL QUESTIONNAIRE <br />1. How many years has your organization been In business In California as a contractor under your present <br />business name and license number? 3& sores <br />If you performed same business under a different business name with some ownership and operation <br />management and changed name due to, but not limited to, bankruptcy, loss, or license, please oomplste <br />an additional and separate questionnaire. <br />2. What is your firm's average gross revenue for the last three years? g__ 3,100,000-00 <br />3. Is your firm currently the debtor In a bankruptcy case? El Yes Rr No <br />if "yes," Indicate the case number, bankruptcy court, and the date on which the petition was filed• <br />Cage Number Bankruptcy Court Data Filed <br />4. Was your firm in bankruptcy any time during the last five years? (This question refers only to a <br />bankruptcy action that was not described in answer to Question 2, above.) U Yes 9 No <br />if "yes," indicate the ease number, bankruptcy court, and the date on which the petition was riled, <br />Cass Number Bankruptcy Court pate Filed <br />6. Has any California State License Beard license held by your firm or Its responsible managing em oyee <br />er raaponoible managing office, been suspended within file fast five years? 0 Yoe aft NO <br />6. At any time in the last five years. has your firm boon assessed end paid liquidated damages attar <br />completion of a project, under a services oontractwith either a pubilo or private owner? Q Yells VJ q <br />No <br />7. Has your Ann ever defaulted on a contract? [l Yes Rr No <br />If "yes," explain on a separate page. <br />8, In the last five years has your firm, or any firm with which any of your company's owners, officers or <br />partners was associated, been debarred, disqualified, removed, or otherwise prevented from bidding on, <br />or completing, any government agency project for any reason? EJ Yes L No <br />If "yes," explain on a separate page. State the name of the organization debarred, the year of the event, <br />the owner of the project, and the basis for the action. <br />D. In the past Ave years, has any claim against your firm concerning your firm's work on a project, been filed <br />In court or arbitration? D Yes {r No <br />istruction Surveying Services f <br />Page 27 (ADDENDUM N0.3) <br />25E -33 <br />