APPENDIX B.11

**NEW YORK CITY TRANSIT AUTHORITY**

**Division of Materiel**

**Procurement Sub-Division**

**Schedule J**

**BIDDER\'S QUALIFICATION QUESTIONNAIRE**

**[PART I - INSTRUCTIONS]{.underline}**

1 a. All Bidders/Proposers submitting a Bid/Proposal for public work
contracts (IFB & RFP); personal service (including Architectural and
Engineering) contracts (RFP); RFPs for supply, material, equipment
(including transit vehicles and rolling stock); RFPs for miscellaneous
procurement and service contracts; non-competitive/sole source contracts
(including preferred source and existing public contracts) equal to or
in excess of \$10,000 are to complete and submit Parts I, II, III, IV
and VIII with their Bid or Proposal.

b\. PUBLIC WORK CONTRACTS (IFB & RFP)

> If this Questionnaire is submitted in response to an Information for
> Bidders (IFB), the apparent low bidder will receive written
> notification requesting submission of Parts V, VI and VII. If this
> Questionnaire is submitted in response to a Request for Proposal
> (RFP), and the proposal submitted equals or exceeds \$25,000 all
> Proposers are to complete and submit all Parts of the Questionnaire
> with their Proposal.

c.  PERSONAL SERVICE INCLUDING ARCHITECTURAL AND ENGINEERING CONTRACTS
    (RFP)

> Where the proposal submitted equals or exceeds \$20,000 for a personal
> service (consultant) contract, all Proposers are to complete and
> submit all Parts of the questionnaire with their Proposal.
>
> d\. RFPs FOR SUPPLY, MATERIAL, OR EQUIPMENT (INCLUDING TRANSIT
> VEHICLES AND ROLLING STOCK), AND MISCELLANEOUS PROCUREMENT AND SERVICE
> CONTRACTS
>
> Where the proposal submitted equals or exceeds \$250,000 for supplies,
> materials, or equipment (including transit vehicles and rolling
> stock), and miscellaneous procurement and service contracts all
> Proposers are to complete and submit all Parts of the questionnaire
> with their Proposal.
>
> e\. NON-COMPETITIVE/SOLE SOURCE CONTRACTS (INCLUDING PREFERRED SOURCE
> AND EXISTING PUBLIC CONTRACTS
>
> Where the proposal submitted equals or exceeds \$25,000 for
> non-competitive public work contracts, \$20,000 for non-competitive
> personal service (Consultant) contracts, and \$250,000 for all other
> non-competitive contracts, all Proposers are to complete and submit
> all Parts of the questionnaire with their Proposal.

2\. Please state \"not applicable\" in questions clearly not applicable
to Bidder/Proposer in connection with this solicitation. Do not omit any
question. If any representation is not accurate and complete at the time
Bidder/Proposer signs this Questionnaire, Bidder/Proposer must, as part
of its Bid/Proposal, identify the provision and explain the reason in
detail in the space provided below. If additional space is needed, add
additional sheet(s) to this Questionnaire. If this space is left blank,
Bidder/Proposer shall be deemed to have represented and warranted the
accuracy and completeness of the representations on this Questionnaire:

3.  All information must be legible.

4\. Completed Questionnaire must be sworn to by a partner (if
partnership), a duly authorized officer or individual (if a
corporation), or a principal (if a sole proprietorship).

5.  The term \"Proposer\" includes the term \"Bidder\" and also refers
    to the firm awarded the Contract. The term \"Proposal\" includes the
    term \"Bid\".

6\. If during the performance of this Contract, either of the following
occurs, Bidder shall promptly give notice in writing of the situation to
the Authority's Chief Procurement Officer, and therefore cooperate with
the Authority\'s review and investigation of such information.

i\) Proposer has reason to believe that any representation or answer to
any question contained in this Questionnaire was not accurate or
complete at the time this Questionnaire was signed; or

> ii\) events occur or circumstances changes so that an answer to any
> question in Part IV is no longer accurate or complete.
>
> In the Authority\'s sole discretion, the following shall constitute
> grounds for the Authority to take remedial action up to and including
> immediate termination of the Contract for convenience without payment
> for profit and overhead for work not performed if: i) Proposer fails
> to notify the Chief Procurement Officer as required by \"6\" above:
> ii) Proposer fails to cooperate with the Authority\'s request for
> additional information as required by \"6\" above.

7.  The Authority reserves the right to inquire further with respect to
    Proposer\'s responses; and Proposer consents to such further inquiry
    and agrees to furnish all relevant documents and information as
    requested by the Authority. Any response to this document prior or
    subsequent to Proposer\'s Proposal which is or may be construed as
    unfavorable to Proposer will not necessarily automatically result in
    a negative finding on the question of Proposer\'s responsibility or
    a decision to terminate the Contract if it is awarded to Proposer.

# [PART II - IDENTITY OF PROPOSER]{.underline}

1\. Proposer\'s Full Legal Name:

2.  The Proposer represents that it operates as the following form of
    legal entity: (Check whichever applies and fill in any appropriate
    blanks.)

 an individual or sole proprietorship

 a general partnership

 a limited partnership

 a joint venture consisting of:

and

(List all joint venturers on a separate sheet if this space is
inadequate.)

 a non-profit organization

>  a corporation organized or incorporated under the laws of the
> following state or country:

on the following date:

3\. Proposer\'s federal taxpayer identification number:

4\. Proposer\'s legal address:

Telephone Number: (\_\_\_\_) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Fax
Number: (\_\_\_\_)

5\. Proposer\'s local or authorized point of contract address:

Name: Title:

Address:

Telephone Number: (\_\_\_\_) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Fax
Number: (\_\_\_\_)

6\. a. If Proposer is a corporation, has a Certificate of Incorporation
been previously filed with the New York City Transit Authority?

YES  NO  If answer is \"NO\", attach a certified copy.

b\. Attach a certified copy of the By-Laws and Resolution of the
Corporation giving the names and titles of the corporate officers other
than President, as well as non-officer employees, who are authorized to
sign contracts, bonds, bills of sale and other legal instruments in
connection with the Contract, if the same have not been previously
filed.

c\. If a foreign corporation, has proof of authority to transact
business in the State of New York been previously filed with the New
York City Transit Authority?

YES  NO  If answer is \"NO\", attach a certified copy.

> In the event that any of Proposer\'s previous submissions to the
> Transit Authority in response to the above (questions a-c) no longer
> represent the Proposer\'s current corporate status, Proposer must
> attach a certified copy of any documents amending its previous
> submissions.

7.  a\. How long has the Proposer been in business?

    b\. Have Proposer\'s major shareholders, officers or principals been
    in business under another name? If so, identify name and dates used.

    c\. How many years experience as a prime contractor/consultant?
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

> d\. How many years experience as a subcontractor/subconsultant?
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

8.  List below the names, business addresses, titles, and telephone
    numbers of the following people: if a corporation, identify the
    president, executive officers, and any other officers directly
    responsible for this Proposal; if a partnership, identify the
    partners directly responsible for this Proposal; or, if another form
    of business entity, identify the principals directly responsible for
    this Proposal.

> [Name]{.underline} [Address]{.underline} [Title]{.underline}
> [Telephone No.]{.underline}

9.  If your firm considers itself to be an MBE, WBE or DBE, then within
    the past three years has the Proposer had any MBE, WBE, or DBE
    certification (or application for such certification) revoked or, if
    you made application for such certification during such period was
    same denied?

YES  NO  If answer is \"NO\", attach a certified copy.

## [PART III-PROPOSER\'S REPRESENTATIONS]{.underline}

1.  By submission of this Proposal, the undersigned and each person
    signing on behalf of the undersigned certifies, and in the case of a
    joint proposal each party thereto certifies, as to its own
    organization, as required by Section 2878 of the Public Authorities
    Law of the State of New York, under penalty of perjury, that to the
    best of its knowledge and belief:

    a\. the prices in this Proposal have been arrived at independently
    without collusion, consultation, communication, or agreement for the
    purpose of restricting competition, as to any matter relating to
    such prices with any other proposer or with any competitor;

> b\. unless otherwise required by law, the prices which have been
> quoted in this Proposal have not been knowingly disclosed by the
> Proposer arid will not knowingly be disclosed by the undersigned prior
> to opening, directly or indirectly, to any other proposer or to any
> competitor prior to the closing date for proposals;

c\. no attempt has been or will be made by the Proposer to induce any
other person, partnership or corporation to submit or not to submit a
proposal for the purpose of restricting competition;

> A Proposal shall not be considered for award nor shall any award be
> made where a, b, and c, above, have not been complied with provided,
> however, that if in any case the Proposer cannot make the foregoing
> certification, the Proposer shall so state and shall furnish with the
> Proposal a signed and notarized statement which sets forth in detail
> the reasons therefor. Where a, b, and c, above, have not been complied
> with, the Proposal shall not be considered for award nor shall any
> award be made unless the Vice President, Division of Materiel of the
> Authority, or his/her designee, determines that such disclosure was
> not made for the purpose of restricting competition.
>
> The fact that a Proposer (i) has published price lists, rates, or
> tariffs covering items being procured; (ii) has informed prospective
> customers of proposed or pending publication of new or revised price
> lists for such items; or (iii) has sold the same items to other
> customers at the same prices being proposed, does not constitute,
> without more, a disclosure within the meaning of a, b, and c above

2\. Statement of no-conflict of interest

> a\. No appointed or elected official, member or other officer or
> employee of the City or State of New York, or of the Metropolitan
> Transportation Authority (\"MTA\"), or MTA\'s affiliates arid
> subsidiaries which consist of the New York City Transit Authority,
> Manhattan & Bronx Surface Transit Operating Authority, Staten Island
> Rapid Transit Operating Authority, Metro-North Commuter Railroad, Long
> Island Rail Road, Triborough Bridge and Tunnel Authority, Metropolitan
> Suburban Bus Authority, and Metropolitan Transportation Authority Card
> Company: i) is interested directly or indirectly, in any manner
> whatsoever in or in the performance of the Contract or in the
> supplies, work or business to which it relates or in any portion of
> the profits thereof; or ii) has been or will be offered or given any
> tangible consideration in connection with this Proposal/Contract.

b.  Proposer covenants that neither Proposer nor, to the best of the
    Proposer\'s knowledge after diligent inquiry, any director, officer,
    owner or employee of the Proposer has any interest nor shall they
    acquire any interest, directly or indirectly, which would conflict
    in any manner or degree with the faithful performance of the
    Contract hereunder.

c.  In the event Proposer has no prior knowledge of a conflict of
    interest as set forth in \"a\" and \"b\" above and hereafter
    acquires information which indicates that there may be an actual or
    apparent violation of any of the above, Proposer shall promptly
    bring such information to the attention of the Authority\'s Chief
    Procurement Officer, Proposer shall thereafter cooperate with the
    Authority\'s review and investigation of such information, and
    comply with any instruction it receives from the Chief Procurement
    Officer in regard to remedying the situation.

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3.  The following statements apply to any proposal or contract between
    Proposer and the City or State of New York, any other state, any
    public authority or other public entity, the United States
    government, the Metropolitan Transportation Authority (\"MTA\"), and
    MTA\'s affiliates and subsidiaries which are the New York City
    Transit Authority, Manhattan & Bronx Surface Transit Operating
    Authority, Staten Island Rapid Transit Operating Authority,
    Metro-North Commuter Railroad, Long Island Rail Road, Triborough
    Bridge and Tunnel Authority, Metropolitan Suburban Bus Authority,
    and Metropolitan Transportation Authority Card Company.

> a\. Statements b, c, d. e, f and g below also apply to i) Proposer\'s
> parent, subsidiaries and affiliates (if any), ii) any joint venture
> (including its individual members and any other form of partnership
> (including its individual members) which includes Proposer or
> Proposer\'s parent, subsidiaries, or affiliates; iii) Proposer\'s
> directors, officers, principals, and managerial employees and any
> person or entity with a 10% or more interest in Proposer; iv) any
> legal entity controlled, or 10% or more of which is owned, by
> Proposer, or by any director, officer, principal or managerial
> employee of Proposer, or by any person or entity with a 10% or more
> interest in Proposer; or v) any parent, subsidiary or affiliate of any
> legal entity controlled, or 10% or more of which is owned, by
> Proposer, or by any director, officer, principal or managerial
> employee of Proposer, or any person or entity with a 10 % or more
> interest in Proposer.

b\. Has the Proposer been declared not responsible. (Check \"YES\" or
**\"**NO**\",** as appropriate.)

> YES  NO 
>
> c\. Has the Proposer been debarred, suspended, proposed for debarment,
> declared ineligible, voluntarily excluded, or otherwise disqualified
> from bidding, proposing, or contracting. (Check \"YES\" or \"NO\", as
> appropriate.)
>
> YES  NO 
>
> d\. Has the Proposer been a defaulter, as principal, surety or
> otherwise. (Check \"YES\" or \"NO\", as appropriate.)
>
> YES  NO 
>
> e\. Has the government or other public entity requested or required
> enforcement of any of its rights under a surety agreement on the basis
> of a Proposer default or in lieu of declaring Proposer in default.
> (Check \"YES\" or \"NO\", as appropriate.)
>
> YES  NO 
>
> f\. Is the Proposer in arrears upon a contract or debt. (Check \"YES\"
> or \"NO\", as appropriate
>
> YES  NO 

g.  Are there any proceeding pending relating to Proposer\'s
    responsibility, debarment, suspension, voluntarily exclusion or
    qualification to receive a public contract. (Check \"YES\" or
    \"NO\". as appropriate.)

> YES  NO 
>
> h\. List the name and business address of each person or legal entity
> which has a 10% or more ownership or control interest in Proposer
> (attach additional pages as needed).

i.  Explain any \"YES\" answers to b, c, d, e, f and g in the space
    provided below (attach additional pages as needed).

**[PART IV]{.underline} - Q[UESTIONS WHICH MUST BE]{.underline}
[ANSWERED]{.underline} \"[YES\"]{.underline} [OR]{.underline}
\"[NO]{.underline}\"**

(In the event of a \"YES\", the Authority reserves the right to inquire
further with respect thereto.)

> To the best of your knowledge after diligent inquiry, in connection
> with the business of proposer or any other firm which is related to
> Proposer by any degree of common ownership, control, or otherwise, do
> any of the following statements apply to: i) Proposer; ii) Proposer\'s
> parent; iii) any Proposer subsidiary or affiliate; iv) any joint
> venture (including its individual members) or any other partnership
> (including its individual members) which includes Proposer or
> Proposer\'s parent, subsidiaries, or affiliates, v) any legal entity,
> or parent, subsidiary or affiliate of any legal entity, controlled. or
> 10% or more of which is owned, by Proposer, or by any director,
> officer, principal or managerial employee of Proposer, or by any
> person or entity with a 10% or more interest in Proposer. or vi) any
> person who is a director, officer, principal, or, managerial employee,
> or person or entity with a 10% or more interest in any of the
> aforesaid:
>
> 1 Has been convicted by a plea or verdict of guiltily of, or pleaded
> nolo contendere to, a misdemeanor or felony in any federal, state or
> local court. (Check \"YES\" or \"NO\", as appropriate.)
>
> YES  NO 
>
> 2 Have pending any state or federal grand jury or court an indictment
> or information for the commission of a crime which has riot been
> favorably,\' terminated. (Check \"YES\" or \"NO\", as appropriate.)
>
> YES  NO 
>
> 3\. Is the subject of any pending investigation by any grand jury,
> commission, committee or other entity or agency or authority of any
> state or the federal government in connection with the commission of a
> crime. (Check \"YES\" or \"No\", as appropriate.)
>
> YES  NO 
>
> 4\. Is currently disqualified from selling or submitting
> bids/proposals to or receiving awards from or entering into any
> contracts with any federal, state or local governmental entity, any
> public authority or any public entity (Check \"YES\" or \"NO\", as
> appropriate.)
>
> YES  NO 
>
> 5\. Within the past five years,. has refused to testify or to answer
> any question concerning a bid or contract with any federal, state, or
> local governmental entity, any public authority or other public entity
> when called before a grand jury or other committee, agency or forum
> which is empowered to compel the attendance of witnesses and examine
> them under oath, upon being advised that neither the person\'s
> statement nor any information or evidence derived from such statement
> will be used against that person in any subsequent criminal
> proceeding. (Check \"YES\" or \"NO\" as appropriate.)
>
> YES  NO 
>
> 6\. Is currently disqualified from selling or submitting a bid to, or
> receiving an award from, or entering into any contract with any public
> entity or public authority within the State of New York because,
> within the past five years, such entity or person refused to testify
> or to answer any relevant question concerning a transaction or
> contract with the State of New York, any political subdivision of the
> State of New York, or a public authority or a public department,
> agency or official of the State of New York or of a political
> subdivision of the State of New York, when called before a grand jury
> or other state or local department, commission or agency which is
> empowered to compel the attendance of witnesses and examine them under
> oath. upon being advised that neither that person\'s statement nor any
> information or evidence derived from such statement will be used
> against that person in any subsequent criminal proceeding, (Check
> \"YES\" or \"NO\", as appropriate.)
>
> YES  NO 
>
> 7\. Has within a three year period preceding this Proposal been
> convicted of or had a civil judgment rendered against them for
> commission of fraud or a criminal offense in connection with
> obtaining, attempting to obtain. or performing a public (Federal,
> State or local) transaction or contract under a public transaction;
> violation of Federal or State antitrust statutes or commission of
> embezzlement, theft, forgery, bribery, falsification or destruction of
> records, making false statements, or receiving stolen property. (Check
> \"YES\" or \"NO\", as appropriate.)
>
> YES  NO 
>
> 8\. Explain any \"YES\" answers to 1, 2, 3, 4, 5, 6 or 7, in the space
> provided below (attach additional pages as needed).

### PART V-TECHNICAL

> 1\. List the name, title and business address of each director and
> principal officer of Proposer.

2\. Number of employees: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ including
\_\_\_\_\_\_\_\_\_\_\_\_ employees in the Greater New York Metropolitan
Area.

3.  Does the Proposer have any outstanding bids or proposals for
    contracts ([i]{.underline}.[e]{.underline}., bids or proposals
    pending where no contract has yet been awarded) with the State or
    City of New York, or any other public authority of the State of New
    York, or the Metropolitan Transportation Authority (\"MTA\"), and
    MTA\'s affiliates and subsidiaries which are the New York City
    Transit Authority, Manhattan & Bronx Surface Transit Operating
    Authority, Staten Island Rapid Transit Operating Authority,
    Metro-North Commuter Railroad, Long Island Rail Road, Triborough
    Bridge and Tunnel Authority, Metropolitan Suburban Bus Authority,
    and Metropolitan Transportation Authority Card Company? If none,
    state \"None\". If yes, please list them and provide the name of the
    requesting agency, the contract number, a brief description of the
    work effort and the status of the bid or proposal. Indicate if the
    bid/proposal was submitted by the Bidder as prime contractor or
    joint venture.

4.  Has the Proposer been awarded any contracts within the last three
    years by the State or City of New York, or any other public
    authority of the State of New York, or the Metropolitan
    Transportation Authority (\"MTA\"), and MTA\'s affiliates and
    subsidiaries which are the New York City Transit Authority,
    Manhattan & Bronx Surface Transit Operating Authority, Staten Island
    Rapid Transit Operating Authority, Metro-North Commuter Railroad,
    Long Island Rail Road, Triborough Bridge and Tunnel Authority,
    Metropolitan Suburban Bus Authority, and Metropolitan Transportation
    Authority Card Company? If none, state \"None\". If yes, describe
    those contracts beginning with the most recent. State the name of
    the contracting entity; give a brief description of the contract and
    the contract number; state the contract period, the status of the
    contract, and the name, address, and telephone number of a contact
    person at the agency. Indicate if award was made to Proposer as
    prime contractor or joint venture. Proposer need not provide more
    than six such descriptions.

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5.  Does the Proposer have any current private sector projects? If none,
    state \"None\". If yes, provide name and address of owner, a brief
    description of work, status of contracts and name, address and
    telephone number of contact person as to each, beginning with the
    most recent. Indicate if Proposer is acting as prime contractor or
    joint venture. Proposers need not provide more than six such
    descriptions.

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6.  For each of the following contracts, provide a brief description of
    the work performed, the contract number, the dollar amount at award
    and at completion, date completed, and the name and telephone number
    of the owner\'s representative.

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a.  Each contract completed during the last three years or, if less than
    three contracts have been completed during the last three years,
    list the last three contracts completed.

b.  Each contract completed during the last three years or, if less than
    three contracts have been completed during the last three years,
    list the last three contracts completed, for which liquidated
    damages or penalty provisions were assessed against you for failure
    to complete the work on time or for any other reason.

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7.  List each contract which, during the last three years, the
    person/entity contracting with you: i) terminated for default; ii)
    sued to compel performance; iii) sued to recover damages, including,
    without limitation, upon alleged breach of contract, misfeasance,
    error or omission or other alleged failure on your part to perform
    as required by your contract; or iv) called upon a surety to perform
    the work.

8\. Describe whether any present or anticipated commitments and/or
contractual obligations might have an influence on the capabilities of
the Proposer to perform the work called for by this Contract. Any
apparent conflicts as between the requirements/commitments for this
Contract and the matters listed in items 3, 4, 5 or 6, above, with
respect to the use of Proposer\'s resources, such as management or
technical expertise or financing, should be explained. If none, state
\"None\".

9\. Describe any litigation in which the Proposer is involved, which:

a.  has or may have an impact on the Proposer\'s ability to perform any
    work called for by this solicitation; or

b\. the demand or potential exposure is for more than \$250,000,
exclusive of personal injury litigation where the liability is covered
by insurance.

If none, state \"None.\"

10. During the past three years, has the Proposer\'s firm ever been a
    party to a bankruptcy or reorganization proceeding?

> YES  NO  If answer is \"YES\" explain below.

11\. a. If any professional or other licenses, permits, or
certifications are required to perform the work/services called for by
this solicitation, list the license, permit, or certification that the
Proposer or Proposer\'s employees or agents possess. If none, state
\"None\".

[License or Permit]{.underline} [Issuing]{.underline}

[or Certification]{.underline} [Name of Holder]{.underline} [State or
Entity]{.underline}

b.  Have any of the Proposer\'s officers, partners, owners, managers or
    employees had any project related licenses, permits or
    certifications revoked or suspended in the past three years.

YES  NO  If answer is \"YES\", explain details below.

12. Does the Proposer\'s firm share office space, staff or equipment
    (including telephone exchanges) with any other business or
    organization?

> YES  NO  If answer is \"YES\", list firm name, address and nature of
> shared facilities.

13\. Has Proposer\'s safety practices/procedures been evaluated or rated
as less then satisfactory by the City or State of New York, any other
state, any public authority or other public entity, the United States
government, the Metropolitan Transportation Authority (\"MTA\"), and
MTA\'s affiliates and subsidiaries which are the New York City Transit
Authority, Manhattan & Bronx Surface Transit Operating Authority, Staten
Island Rapid Transit Operating Authority, Metro-North Commuter Railroad,
Long Island Rail Road, Triborough Bridge and Tunnel Authority,
Metropolitan Suburban Bus Authority, and Metropolitan Transportation
Authority Card Company within the past five years?

> YES  NO  If answer is \"YES\", explain details below.

14\. Is your firm\'s Workers Compensation Experience Rating 1.2 or
greater?

> YES  NO  If answer is \"YES\", explain details below.

15. Does Proposer have either a history of claims loss or any
    substantial individual claim loss within the past five years due to
    general liability or workers compensation claims?

> YES  NO  If answer is \"YES\", explain details below.

16 List the names, titles and attach resumes which indicate the record
of skill and experience of your proposed project management team. (See
Specifications or the Scope - of - Work for the functions of the project
management team, as applicable, and other requirements in regard to
project management.)

17. Which of the individuals named in item 16, above, will be utilized
    exclusively on this Contract on a full-time basis? (The
    Specification or the Scope - of - Work may indicate requirements for
    certain dedicated staff.)

18 Which of the individuals named in item 16, above, are not presently
officers, partners, owners or employees of the firm?

19 Attach an outline of your proposed Quality Control program (see
appropriate section of the Specifications or the Scope - of Work) for
this Contract. Where the Specifications or the Scope-of-Work set out
required elements for the program, such outline must cover each element.

**[PART VI - ADDITIONAL QUESTIONS]{.underline}**

1\. List all Proposer\'s employees:

a.  who are currently employees of the Metropolitan Transportation
    Authority (\"MTA\"), or any MTA subsidiary or affiliate (New York
    City Transit Authority, Manhattan & Bronx Surface Transit Operating
    Authority, Staten Island Rapid Transit Operating Authority,
    Metro-North Commuter Railroad, Long Island Rail Road, Triborough
    Bridge and Tunnel Authority, Metropolitan Suburban Bus Authority,
    and Metropolitan Transportation Authority Card Company).

b.  who within the past two years have been MTA or MTA subsidiary or
    affiliate employees who were involved on behalf of Proposer with the
    preparation of this Proposal or would be involved in the performance
    of the Contract if it is awarded to Proposer.

2\. Does Proposer have a subsidiary or affiliate?

YES  NO  If answer is \"YES\", list firm name, address and affiliation

3\. Is Proposer a subsidiary of another entity?

YES  NO  If answer is \"YES\", list firm name, address and affiliation

4.  Does Proposer, any director, officer, principal or managerial
    employee of Proposer, or any other person or entity with a 10% or
    more interest in Proposer have an interest of 10% or more in any
    other firm or legal entity?

YES  NO  If answer is \"YES\", list individuals name and firm or
entity

5\. If the answer to 2, 3 or 4 is \"YES\", would Proposer\'s answers
pertaining to Parts III and IV be the same for each such parent,
subsidiary, affiliate, firm or legal entity?

YES  NO  If answer is \"NO\", explain below

[P**ART VII -- FINANCIAL**]{.underline}

1\. Provide certified financial statements for the last three fiscal
years. If certified financial statements are not available, provide
financial statements sworn to by the firm\'s Chief Financial Officer.

2\. The Proposer may submit its prior 3 years\' financial statements in
lieu of completing Section 1 (Balance Sheet), Section 2 (Comparative
Statement of Income & Retained Earnings), and Section 3 (Comparative
Statements of Cash Flows). However, Section 1, Schedules A, B, C, D, E
and F and Sections 4, 6 and 7 must be completed. If the Proposer is
required to submit a performance bond, Section 5 must also be completed.

**[SECTION 1]{.underline}**

COMPARATIVE BALANCE SHEET

as of[                     ]{.underline}

(\$000) 19\_\_\_ 19\_\_\_ 19\_\_\_

\$ \$ \$

I. [CURRENT ASSETS:]{.underline}

Cash \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

Marketable Securities \_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

Notes Receivable (Schedule A) \_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

Accounts Receivable (Schedule B) \_\_\_\_ \_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

Bid Deposits (Schedule C) \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

Inventories \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

Prepaid Expenses \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

Other Current Assets:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

TOTAL CURRENT ASSETS \$\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_
\$\_\_\_\_\_\_\_\_\_

II\. [OTHER ASSETS:]{.underline}

Investment in Affiliates \_\_\_\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_
\$\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_

Other Non-Current Assets:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

TOTAL OTHER ASSETS \$\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_
\$\_\_\_\_\_\_\_\_\_

III\. [PROPERTY, PLANT & EQUIPMENT:]{.underline}

NET PROPERTY, PLANT & EQUIPMENT

(Net of Depreciation) \$\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_
\$\_\_\_\_\_\_\_\_\_

**TOTAL ASSETS** \$\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_
\$\_\_\_\_\_\_\_\_\_

[LIABILITIES]{.underline}

(\$000) 19\_\_\_ 19\_\_\_ 19\_\_\_

\$ \$ \$

I. [CURRENT LIABILITIES]{.underline}

Notes Payable (Schedule D) \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

Accounts Payable (Schedule E) \_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

Loans Payable (Schedule F) \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

Taxes Payable \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

Current Portion of Long Term Debt \_\_ \_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

Accrued Liabilities \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

Other Current Liabilities:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

TOTAL CURRENT LIABILITIES \$\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_
\$\_\_\_\_\_\_\_\_\_

II\. [NON-CURRENT LIABILITIES]{.underline}

Long Term Debt \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

Other:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

TOTAL NON-CURRENT LIABILITIES \$\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_
\$\_\_\_\_\_\_\_\_\_

TOTAL LIABILITIES \$\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_
\$\_\_\_\_\_\_\_\_\_

III\. [EQUITY]{.underline}

Capital Stock Paid Up:

Common \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_
\$\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_

Preferred \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\$\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_

Surplus (net worth) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\$\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_

TOTAL EQUITY \$\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_
\$\_\_\_\_\_\_\_\_\_

**TOTAL LIABILITIES AND EQUITY \$\_\_\_\_\_\_\_\_\_
\$\_\_\_\_\_**\_**\_\_\_ \$\_\_\_**\_**\_\_\_\_\_**

**[DETAILS RELATIVE TO ASSETS]{.underline}**

**SCHEDULE A**

+--------------------------+----------+----------+----------+----------+
| > \(a\) due within 90    |          |          |          |          |
| > days                   |          |          |          |          |
| > \_\_\_                 |          |          |          |          |
| \_\_\_\_\_\_\_\_\_\$\_\_ |          |          |          |          |
| \_\_\_\_\_\_\_\_\_\_\_\_ |          |          |          |          |
| >                        |          |          |          |          |
| > **Notes Receivable**   |          |          |          |          |
| > (b) due after 90 days  |          |          |          |          |
| > \_\_\_                 |          |          |          |          |
| \_\_\_\_\_\_\_\_\_\$\_\_ |          |          |          |          |
| \_\_\_\_\_\_\_\_\_\_\_\_ |          |          |          |          |
| >                        |          |          |          |          |
| > \(c\) past due         |          |          |          |          |
| >                        |          |          |          |          |
| \_\_\_\_\_\_\_\_\_\_\_\_ |          |          |          |          |
| \_\_\_\_\_\_\_\_\_\$\_\_ |          |          |          |          |
| \_\_\_\_\_\_\_\_\_\_\_\_ |          |          |          |          |
+--------------------------+----------+----------+----------+----------+
| > Receivable From:       | Purpose  | Date of  | How      | Amount   |
| >                        |          |          |          |          |
| > Name                   |          | Maturity | Secured  |          |
+--------------------------+----------+----------+----------+----------+
|                          |          |          |          | \$       |
+--------------------------+----------+----------+----------+----------+
|                          |          |          |          |          |
+--------------------------+----------+----------+----------+----------+
|                          |          |          |          |          |
+--------------------------+----------+----------+----------+----------+
|                          |          |          |          |          |
+--------------------------+----------+----------+----------+----------+
|                          |          |          |          |          |
+--------------------------+----------+----------+----------+----------+
|                          |          |          |          |          |
+--------------------------+----------+----------+----------+----------+
|                          |          |          |          |          |
+--------------------------+----------+----------+----------+----------+
|                          |          |          |          |          |
+--------------------------+----------+----------+----------+----------+
| **TOTAL**                |          |          |          | \$       |
+--------------------------+----------+----------+----------+----------+

**SCHEDULE B**

+---------------+----------+----------+----------+----------+----------+
| **Aging of    |          |          |          |          |          |
| Accounts      |          |          |          |          |          |
| Receivable P  |          |          |          |          |          |
| A S T D U E** |          |          |          |          |          |
+---------------+----------+----------+----------+----------+----------+
| Current       | 1 to     | 31 to    | 61 to    | Over     | Total    |
|               |          |          |          |          |          |
|               | 30 days  | 60 days  | 90 days  | 90 Days  |          |
+---------------+----------+----------+----------+----------+----------+
| > Trade \$    | \$       | \$       | \$       | \$       | \$       |
+---------------+----------+----------+----------+----------+----------+
| > Other \$    | \$       | \$       | \$       | \$       | \$       |
+---------------+----------+----------+----------+----------+----------+
| > **Total     | \$       | \$       | \$       | \$       | \$       |
| > \$**        |          |          |          |          |          |
+---------------+----------+----------+----------+----------+----------+

SCHEDULE C

+--------------------------+--------------------------+---------------+
| **Bid Deposit**          | Description              | Amount        |
|                          |                          |               |
| Holder of Deposit: Name  |                          |               |
+--------------------------+--------------------------+---------------+
|                          |                          | \$            |
+--------------------------+--------------------------+---------------+
|                          |                          |               |
+--------------------------+--------------------------+---------------+
|                          |                          |               |
+--------------------------+--------------------------+---------------+
| **TOTAL**                |                          | \$            |
+--------------------------+--------------------------+---------------+

**[DETAILS RELATIVE TO LIABILITIES]{.underline}**

**SCHEDULE D**

+---------------------+----------+---------------+----------+----------+
| **Notes Payable**   | \(a\)    |               |          |          |
|                     | Not Past |               |          |          |
|                     | Due      |               |          |          |
|                     | \_\_     |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \$       |               |          |          |
|                     | \_\_\_   |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     |          |               |          |          |
|                     | \(b\)    |               |          |          |
|                     | Past Due |               |          |          |
|                     | \_\_     |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \$       |               |          |          |
|                     | \_\_\_   |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
+---------------------+----------+---------------+----------+----------+
| To Whom: Name       |          | Purpose       | When Due | Amount   |
+---------------------+----------+---------------+----------+----------+
|                     |          |               |          | \$       |
+---------------------+----------+---------------+----------+----------+
|                     |          |               |          |          |
+---------------------+----------+---------------+----------+----------+
|                     |          |               |          |          |
+---------------------+----------+---------------+----------+----------+
|                     |          |               |          |          |
+---------------------+----------+---------------+----------+----------+
| **TOTAL**           |          |               |          | \$       |
+---------------------+----------+---------------+----------+----------+

**SCHEDULE E**

+---------------------+----------+---------------+----------+----------+
| **Accounts          | \(a\)    |               |          |          |
| Payable**           | Not Past |               |          |          |
|                     | Due      |               |          |          |
|                     | \_\_     |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \$       |               |          |          |
|                     | \_\_\_   |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     |          |               |          |          |
|                     | \(b\)    |               |          |          |
|                     | Past Due |               |          |          |
|                     | \_\_     |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \$       |               |          |          |
|                     | \_\_\_   |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
+---------------------+----------+---------------+----------+----------+
| To Whom: Name       |          | Purpose       | Date     | Amount   |
|                     |          |               |          |          |
|                     |          |               | Payable  |          |
+---------------------+----------+---------------+----------+----------+
|                     |          |               |          | \$       |
+---------------------+----------+---------------+----------+----------+
|                     |          |               |          |          |
+---------------------+----------+---------------+----------+----------+
|                     |          |               |          |          |
+---------------------+----------+---------------+----------+----------+
|                     |          |               |          |          |
+---------------------+----------+---------------+----------+----------+
| **TOTAL**           |          |               |          | \$       |
+---------------------+----------+---------------+----------+----------+

**SCHEDULE F**

+---------------------+----------+---------------+----------+----------+
| **Loans Payable**   | \(a\)    |               |          |          |
|                     | Not Past |               |          |          |
|                     | Due      |               |          |          |
|                     | \_\_     |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \$       |               |          |          |
|                     | \_\_\_   |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     |          |               |          |          |
|                     | \(b\)    |               |          |          |
|                     | Past Due |               |          |          |
|                     | \_\_     |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \$       |               |          |          |
|                     | \_\_\_   |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
|                     | \_\_\_\_ |               |          |          |
+---------------------+----------+---------------+----------+----------+
| To Whom: Name       |          | Purpose       | Date     | Amount   |
|                     |          |               |          |          |
|                     |          |               | Payable  |          |
+---------------------+----------+---------------+----------+----------+
|                     |          |               |          | \$       |
+---------------------+----------+---------------+----------+----------+
|                     |          |               |          |          |
+---------------------+----------+---------------+----------+----------+
|                     |          |               |          |          |
+---------------------+----------+---------------+----------+----------+
|                     |          |               |          |          |
+---------------------+----------+---------------+----------+----------+
| **TOTAL**           |          |               |          | \$       |
+---------------------+----------+---------------+----------+----------+

**[SECTION 2]{.underline}**

COMPARATIVE STATEMENT OF INCOME & RETAINED EARNINGS

STATEMENT FOR PERIODS ENDED[                        ]{.underline}

19\_\_\_ 19\_\_\_ 19\_\_\_

SALES\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\$\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_

Less:

COST OF SALES:

Labor \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

Material \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

Depreciation \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

Other Overhead \_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

GROSS MARGIN \$\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_

Less: Selling, General and

Administrative Expenses \_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

Income Before Taxes \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

Less: Income Taxes \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

NET INCOME \$\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_

Retained Earnings Beginning

of Period \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_
\$\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_

Less: Cash Dividends Paid \_\_\_\_ \$\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_
\$\_\_\_\_\_\_\_\_\_

Other:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_
\$\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_

Net Retained Earnings End

of Period \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **\$\_\_\_\_\_\_\_\_\_**
**\$\_\_\_\_\_\_\_\_\_** **\$\_\_\_\_\_\_\_\_\_**

**[SECTION 3]{.underline}**

COMPARATIVE STATEMENTS OF CASH FLOWS

FOR THE YEARS ENDED[                   ]{.underline}

Increase (Decrease) in Cash

19\_\_\_ 19\_\_\_ 19\_\_\_

> Cash flows from operating activities:\_\_\_\_\_\_\_
> \$\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_\_

Cash received from customers \_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_

Cash paid to suppliers & employees \_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_

Interest Paid \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_

Income Taxes Paid \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_

Miscellaneous receipts (payments) \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_

Net cash provided by operating. activities \_\_ \$\_\_\_\_\_\_\_\_\_
\$\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_\_

Cash flows from investing activities: \_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_

Proceeds from sale of equipment:\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_

Payments for purchase of equipment:\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_

Net Cash Used in Investing activities:\_\_\_\_\_\_\_
\$\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_\_

> Cash flows from financing activities: \_\_\_\_\_\_\_\_\_\_
> \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_

Net increase in short-term debt: \_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_

Proceeds from issuance of long-term debt \_\_\_ \_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_

Repayment of long-term debt \_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_

Payment of Dividends \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_

Net Cash provided by (used in) financing

activities \$\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_
\$\_\_\_\_\_\_\_\_\_\_

> Net increase (decrease) in cash \_\_\_\_\_\_\_\_\_\_\_\_
> \$\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_\_
>
> Cash at beginning of year \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> \$\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_\_
>
> Cash at end of year \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> \$\_\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_ \$\_\_\_\_\_\_\_\_\_\_

**[SECTION 4 - IDENTITY OF OWNERS]{.underline}**

> Who are the principal owners or shareholders of the business
> enterprise and approximately what percentage does each own?

  ------------------------------------------------- ---------------------
  Name                                              Percent Owned

                                                    

                                                    

                                                    

                                                    

                                                    

                                                    

                                                    
  ------------------------------------------------- ---------------------

**[SECTION 5 - PERFORMANCE BOND INFORMATION]{.underline}**

> Section 5 is only applicable to solicitations in which the Proposer is
> required to provide a performance bond.
>
> Names and addresses of bonding company or companies that have agreed
> to furnish the performance bond required by the Contract.

  --------------------- --------------------- ------------- -------------
  Name                  Address               Amount        Expiration
                                                            Date

                                              \$            

                                                            

                                                            

                                                            

                                                            
  --------------------- --------------------- ------------- -------------

**[SECTION 6 - SUBCONTRACTS]{.underline}**

> What parts of this Contract, if any, does Proposer expect to
> subcontract?

+-----------------------+-----------------------------------------------+
| Portion of Work       | Name and Address of Proposed                  |
|                       |                                               |
|                       | Subcontractor, if known                       |
+-----------------------+-----------------------------------------------+
|                       |                                               |
+-----------------------+-----------------------------------------------+
|                       |                                               |
+-----------------------+-----------------------------------------------+
|                       |                                               |
+-----------------------+-----------------------------------------------+
|                       |                                               |
+-----------------------+-----------------------------------------------+

**[SECTION 7 - CERTIFICATION]{.underline}**

> I certify that the attached financial statements for this Proposal
> properly reflect the financial position of the company for the periods
> indicated on the financials.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Chief Financial Officer Date

**[PART VIII -VERIFICATION AND ACKNOWLEDGMENT]{.underline}**

> **STATE OF
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**
>
> **COUNTY OF \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**
>
> On the \_\_\_\_\_\_ day of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 199\_\_,
> before me personally came and appeared.
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> by me known to be said person, who swore under oath as follows:
>
> 1\. He/she is \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ of
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(Print title) (Print name of firm)

> 2\. He/she is duly authorizes to sign this Questionnaire on behalf of
> said firm and duly signed this document pursuant to said
> authorization.
>
> 3\. The answers to the questions set forth in this Questionnaire are
> true, accurate and complete.

4.  He/she acknowledged and understands that the Questionnaire includes
    provisions which are deemed included in the Contract if awarded to
    the firm.

> Sworn to before me this \_\_\_\_\_\_\_\_\_\_\_ day of
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_, 199\_\_
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(Notary Public)