New York City School Construction Authority APPLICATION ...

1 Write your SSN/EIN on every page of this APPLICATION . New York City School Construction Authority APPLICATION FOR PREQUALIFICATION/CERTIFICATION Page 1 Rev/2/2009 GENERAL INFORMATION Name of Applicant Firm: D/B/A Name, if any: SSN/EIN: This business address is: Home Business Both Building Number: Street Name: Suite / Apt.: City: Country: State/Region: ZIP/Postal Code: Mailing Address (if different) Note: Box only acceptable for mailing address. Street Address: City: State: Zip Code Company Phone # (not toll-free): Company Fax Number Web Address: Primary APPLICATION Contact Title: Miss Ms. Mrs. Mr. Dr. Contact Person: Primary Phone: Business Title: Home Office Cell Other Secondary Phone: Home Office Cell Other E-Mail Address: Secondary APPLICATION Contact Title: Miss Ms.

2 Mrs. Mr. Dr. Contact Person: Business Title: Primary Phone: Home Office Cell Other Write your SSN/EIN on every page of this APPLICATION . New York City School Construction Authority APPLICATION FOR PREQUALIFICATION/CERTIFICATION Page 2 Rev/2/2009 Secondary Phone: Home Office Cell Other E-Mail Address: Notification of Bidding Opportunities: E-Mail Fax Please Specify: Solicitation-specific communications: E-Mail Fax Please Specify: BUSINESS ORGANIZATION & HISTORY - SECTION 1 Type of Organization: Date Applicant Firm founded (MM/YYYY): Sole Proprietorship County in which business certificate is filed: Please attach a copy of Applicant Firm's business certificate filed with the local County Clerk's office. Corporation State Incorporated: Date Incorporated: Number of shares authorized to the corporation: Number of shares issued to individuals or entities: Limited Liability Company (LLC) State Formed: Date Incorporated: Number of members of the LLC: General Partnership Limited Partnership Limited Liability Partnership County where partnership agreement filed: State where partnership agreement filed: Write your SSN/EIN on every page of this APPLICATION .

3 New York City School Construction Authority APPLICATION FOR PREQUALIFICATION/CERTIFICATION Page 3 Rev/2/2009 Joint Venture State Formed: Date Formed: Are all partnering firms qualified by the SCA? Yes No Joint Ventures must submit a prequalification APPLICATION for the Joint Venture and each JV partner. Association Not for Profit Organization Professional Corporation Other Please specify: Is the Applicant Firm registered with NYS Division of Corporations? Yes No Is the Applicant Firm currently involved in the bidding process with the SCA or other contract/purchase order negotiations with any governmental agency, department or Authority ? Yes No If yes, please identify agency, department, or Authority : Please select from Appendix B ALL trade codes for which you are requesting prequalification, and enter code(s) in the box(es) below.

4 (The SCA uses these codes to help determine the type and dollar value of jobs on which you will be able to bid and/or work as a subcontractor.) Please also indicate whether the average of commercial references for each code is over or under $1 million. For each trade code selected, you will be required to provide sufficient commercial references for work completed within the past three (3) years (see Work History & References Section 2). <$1m >$1m <$1m >$1m <$1m >$1m <$1m >$1m <$1m >$1m <$1m >$1m <$1m >$1m <$1m >$1m <$1m >$1m <$1m >$1m Describe principal products/commodities sold or services offered: Write your SSN/EIN on every page of this APPLICATION . New York City School Construction Authority APPLICATION FOR PREQUALIFICATION/CERTIFICATION Page 4 Rev/2/2009 BUSINESS ORGANIZATION & HISTORY - SECTION 2 Identify all locations used by the firm including its office, plant, warehouse, and any other commercial facility.

5 Also list heavy equipment and machinery. Type Address Own, Lease, or Rent? Name of Landlord or Mortgage Holder Affiliation with Applicant firm or Key Person Payment Terms At present or during the past five (5) years has the Applicant Firm shared office space, plants, warehouses, staff, equipment, telephone or fax exchanges, etc. with any other business or organization? Yes No Firm Name EIN Address Nature of Shared Facility or Staff Date Range At present or during the past five (5) years, has the Applicant Firm changed address(es) or operated under any other name(s) or ownership type? Yes No Firm Name Ownership Type Change Type Address Date Range Write your SSN/EIN on every page of this APPLICATION . New York City School Construction Authority APPLICATION FOR PREQUALIFICATION/CERTIFICATION Page 5 Rev/2/2009 Has your Certificate of Incorporation or Business Certificate been amended?

6 Yes No If yes, please explain: At present or during the past five (5) years: a) has the Applicant Firm been a subsidiary or affiliate of any other firm? (answer should be yes if you are owned by a holding company as well) Yes No b) has the Applicant Firm consisted of a partnership in which one or more partners are other firms? Yes No c) has any other firm owned 5% or more of the Applicant Firm? (includes venture capitalists, holding companies and other similar investors) Yes No d) has the Applicant Firm joint ventured with any other firms? Yes No Applies To (a-d) Firm Name & EIN Address Relationship to Applicant Firm % of Applicant Firm Owned Date Range Representative Name & Title At present or during the past five (5) years: a) has the Applicant Firm had any subsidiaries?

7 Yes No b) has the Applicant Firm owned 5% or more of any other firm? Yes No Write your SSN/EIN on every page of this APPLICATION . New York City School Construction Authority APPLICATION FOR PREQUALIFICATION/CERTIFICATION Rev/2/2009 Applies To (a-b) Firm Name & EIN Address Nature of Business Relationship to Applicant Firm % Owned by Applicant Firm Date Range KEY PEOPLE & PERSONNEL - SECTION 1 In the following table, provide the requested information for all current key people as defined below, and anyone who has owned 5% or more of the Applicant Firm within the past five (5) years. Each current key person of the Applicant Firm must attach a notarized certification ( , Appendix A, etc.). Also, please attach a resume for each key person. "Key People" include: Proprietor(s), partners, directors, officers, members.

8 Partners, including general, limited and limited liability. Members - admitted as members of a limited liability company (LLC) and have a membership interest in the LLC. Membership interest is a member's aggregate rights in an LLC, including, without limitation, the member's right to a share of the profits and losses of the LLC and the right to vote and participate in the management of the LLC. Any person in a position to control and direct the firm's overall operations and financial decisions. Signatories to bank accounts, whether or not considered "Key People." Holders of licenses necessary for the Applicant Firm to perform SCA work for which it is seeking Prequalification. Corporations - Publicly held corporations should list the President, Treasurer, Chief Financial Officer, shareholders of 5% or more of the firm's issued stock, and only those officers and managers who will have direct responsibility for SCA contracts.

9 Shareholders are owners of 5% or more of issued stock or other securities (stock options, secured or unsecured bonds, warrants rights) that can be converted to stock that, if exercised, would constitute 5% or more of the firm's issued stock. Non-publicly held corporations should list all Corporate Officers and all Shareholders (owners of 5% or more of authorized shares). Be sure to include all those who fit the definition of Key People. Please note that subsequent questions may pertain to present and past Key People within the time periods specified in the question. The term "Key Person", as defined above, controls throughout this APPLICATION . Copy the table on the following page if more space is required. Provide current proper legal name and specify any name change, including maiden or married names or aliases.

10 Page 6 Write your SSN/EIN on every page of this APPLICATION . New York City School Construction Authority APPLICATION FOR PREQUALIFICATION/CERTIFICATION Rev/2/2009 Table of Key People (complete all boxes, provide resume for each current Key Person listed) Key Person #1 Key Person #2 Key Person #3 Title & Name Home Phone # and Address Date of Birth Social Security Number Alien Registration Number, if not a Citizen Business Title Employment Start Date Commencement Date of Current Position Employment End Date Percentage of Ownership & Total Amount/Value of Contributions Number of shares owned Date shares were acquired Method of Acquisition & Amount paid when purchased Specify any name change, maiden name, or aliases Gender Ethnicity Page 7 Each current Key Person of the Applicant Firm must file a NOTARIZED certification on the form attached (Appendix A) and submit a resume.