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State of North Carolina <br />Prequalification for Single Prime Contractors <br />1 (yr) 2 (yr) 3 (yr) 4 (yr) 5 (yr) <br />Section 2. GENERAL REQUIREMENTS <br />Experience <br />2. a. (1) Number of years in business as a contractor under the company name listed in 1.a., above: years. <br />List any other names your firm operated under previously. <br />1 2 3 4 5 <br />2. a. (2) List date, State and type of incorporation, partnership, or proprietorship establishment: <br />Date State /Type (incorporation, partnership /proprietorship) <br />2. a. (3) List names of the firm principals appropriate to the type of the firm: <br />Corporation: President, Vice - president, Secretary, Treasurer <br />Partnership: Partners <br />Proprietorship: Owner <br />Other: List and explain <br />Title: <br />Title: <br />Title: <br />Title: <br />Full Name: <br />Full Name: <br />Full Name: <br />Full Name: <br />Yrs Service: <br />Yrs Service: <br />Yrs Service: <br />Yrs Service: <br />2. a. (4) Has your company ever performed construction work for the State of North Carolina and /or related public <br />agencies and /or this specific agency /institution? LL Yes LL No <br />If yes, list the name of the agency, project, dollar value, owner and architect names and contact phone numbers, <br />scheduled completion and actual completion dates for all Droiects completed within the last five to ten (5 -10) vears. <br />State /Public Agency <br />Project Name <br />Dollar Value <br />Owner Agency <br />Contact Info <br />Architect <br />Contact Info <br />Scheduled - Actual <br />Completion Date <br />Prequalification_Form_03 -01 -11 4 of 12 <br />Attachment number <br />F -1 Page 79 <br />