Purchasing Department - University of Connecticut

9. Has your organization ever failed to complete a contract, or has any officer or partner of your
organization ever been an officer or partner of another organization that failed to complete a
contract? If so, indicate the circumstances leading to the project failure and the name of the
company which provided the bonding for the failed contract(s):
_____________________________________________________
10. List all legal or administrative proceedings currently pending or concluded adversely within the
last five years which relate to procurement or performance of any public or private
service/maintenance contracts.
1. Attached 2. N/A
Dated _________________________
Name of Organization: ________________________________________________________
Address:
_________________________________________________________
________________________________________________________
Telephone: _____________________ Fax: _______________________
Toll Free Telephone
Email Address
_____________________
_________________________________________
Signature _____________________________________________________________________
(Print Name) __________________________________________________________________
Title ________________________________________________________________________
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