REQUEST FOR PRE-QUALIFICATIONS (RFQ) - Build LACCD

EXHIBIT 1: PREQUALIFICATION QUESTIONNAIREApplicants must provide all of the information requested. If additional space is needed, pleasecontinue on a separate page and attach it to this Prequalification Questionnaire.I. CONTACT AND BUSINESS INFORMATIONThe contact and general business information requested in this Section I shall be provided by theApplicant and Applicant Members. Although this information is required as a condition ofprequalification, the responses provided will not be included in the scoring of the Applicant’sPrequalification Submittal.A. Applicant and Contact Information1. Applicant Informationa. Name of Applicant:__________________________________________________________________(If a license is required by the Instructions, enter name as it appears on license)b. Address: ________________________ __________________ _______(Street) (City) (State)c. Phone: _________________________d. Fax: ___________________________ E-mail: __________________e. Business Form: (check one) Corporation Partnership Individual/Sole Proprietor Joint Venture LLC Other _______ (Describe _______________)f. Length of time in business in California: ___________. (If not continuous, state allstart and end dates)g. Name, telephone and e-mail address of contact person: _____________________2. Applicant Member InformationProvide the following information for each Applicant Member (any of the individuals,corporations, partnerships, joint ventures or other associations of persons or legal entities thatshares directly in the profits, losses and liabilities of the Applicant):a. Name of Applicant Member___________________________________________________(if an Applicant license is required by the Instructions and the Applicant Member is thequalifier for the license, enter name as it appears on the Applicant Member’s individuallicense)_________________________915 Wilshire Boulevard, Suite 810, Los Angeles, California 90017Exhibit 1: Prequalification Questionnaire: Page 3 of 13