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CityofElCerritoI S treetLightandS ignalM aintenanceR FP DueJune2,2015 City of El Cerrito I Public Works Department I [PHONE REDACTED] Page 1 of 3 AT T ACHM EN T 4 – P roposer’sS tatementofQ ualificationForm An electronic copy of this form in MS Word has been posted to the City’s website at http://www.el-cerrito.org/Bids.aspx . ContractorInformation Name of Contractor: Primary Contact: Title of Primary Contact: Legal Address of Contractor: Primary Contact Phone Number: Contractor’s License Number: Contractor’s DIR Registration Number: Contractor’s Signature: ---PAGE BREAK--- CityofElCerritoI S treetLightandS ignalM aintenanceR FP DueJune2,2015 City of El Cerrito I Public Works Department I [PHONE REDACTED] Page 2 of 3 1) L istofS ubcontractors:Provide a list of all subcontractors to perform work on this contract, including relevant licenses, permits, and certifications. S ubcontractorN ame W orktoBeP erformed L icenses,Certifications, P ermits DIR R egistration N umber 2) Contractor'sandsubcontractor’squalifications:Provide a description of company’s and any subcontractor’s core-competency and experience with similar work that is described in the Technical Specifications (Attachment1). 3) L istofR eferences:Please provide current references for 3 past or existing commercial clients doing similar work to that specified in this RFP. i. Client Contact Name and Title: Phone Number: ii. Client Contact Name and Title: Phone Number: iii. Client Contact Name and Title: Phone Number: 4) O therR elevantL icensesandCertifications:Provide a listing of any relevant certifications, permits, or licenses for Contractor’s and subcontractor’s personnel and equipment use. ---PAGE BREAK--- CityofElCerritoI S treetLightandS ignalM aintenanceR FP DueJune2,2015 City of El Cerrito I Public Works Department I [PHONE REDACTED] Page 3 of 3 5) P rojectP ersonnel:Provide a listing of Contractor and subcontractor personnel, including titles and relevant certifications, to be performing work under this contract. In a separate attachment, please provide resumes for all listed personnel. 6) P rojectEquipment:Provide a listing of equipment to be used in the performance of work under this contract. 7) P roofofInsurance:In a separate attachment, provide proof of commercial general and automobile liability insurance, as specified in Section 11 "Insurance" of the attached Agreement.