Holder-Hunt-Russell-Moody, JV (HHRM) TRADE CONTRACTOR’S PREQUALIFICATION STATEMENT

Submitted To: Doretha R. Smith - HHRM, JV Submitted By: Contact’s Name Date: Date HHRM, JV Company & Location Information: 101 Marietta Street, Suite 2350 Firm: Company Legal Name Atlanta, Georgia 30303 Address: Office Address Please email this prequalification back to City: City Doretha R. Smith at State: State [email protected] Zip: Zip When emailing, please save the file name or Phone: Phone scan in the following format: Main Preconstruction Contact Person: Yourfirmname Prequalification Statement XX- XX-XXX. The X’s shall be the date submitted. Name: Name Title: Title Office Phone: Office Phone Extension: Office Phone Extension Cell: Cell Email: Email

References: Please list four different general contractors for whom you have performed similar scopes of work regarding similar facilities. 1. Project 2. Project (Project) (Project) General Contractor General Contractor (General Contractor) (General Contractor) GC’s Project Manager Name and Phone Number GC’s Project Manager Name & Phone Number (GC’s Project Manager Name & Phone Number) (GC’s Project Manager Name & Phone Number) Approximate Contract Value Approximate Contract Value (Approximate Contract Value) (Approximate Contract Value) 3. Project 4. Project (Project) (Project) General Contractor General Contractor (General Contractor) (General Contractor) GC’s Project Manager Name & Phone Number GC’s Project Manager Name & Phone Number (GC’s Project Manager Name & Phone Number) (GC’s Project Manager Name & Phone Number) Approximate Contract Value Approximate Contract Value (Approximate Contract Value) (Approximate Contract Value)

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Company Information: Self-Performed Scopes of Work: Scopes of Work Subcontracted Scopes of Work: Scopes of Work Type of Firm: Corporation ☐ Partnership ☐ Individual ☐ Other Other Parent Company: Same ☐ Name: Name Years in business as Contractor under present firm name: Years License Number: License Number. States in which your company will do business: List out all States. Is your organization union? Yes ☐ No ☐ If so list the affiliation(s) and local(s): Affiliation(s) and Local(s) Provide information which would indicate the size and capacity of your organization, including the number or permanent employees engaged in (do not count the same employee twice): Estimating: Number Field Supervision: Number Tradespeople: Number Clerical / Accounting: Number Management: Number Is your organization a registered DBE contractor? Yes ☐ No ☐ If so, is your firm certified with the City of Atlanta’s EBO program? Yes ☐ No ☐ If so list certification number Click here to enter text. Is your organization currently registered with Dun & Bradstreet? Yes ☐ No ☐ If yes, what is your D & B number? D & B Number What is your organization’s Experience Modification Rate (EMR)? Modification Rate Has your Yes ☐ No ☐ firm ever failed to complete a contract or been assessed schedule related damages? Has your Yes ☐ No ☐ firm had any subcontract ors fail to complete a contract in the last five years Are there Yes ☐ No ☐ any judgments, claims, liens, or suits pending or outstanding against your firm?

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Has your Yes ☐ No ☐ firm been a party to any lawsuits, arbitration, or mediation with regard to constructio n projects in the last five years? *(If answer to any of the above questions is yes, please attach explanation to this form)

Annual Billing: 2013 projected billing: $ Billing 2010 Billing: $ Billing 2012 Billing: $ Billing 2009 Billing: $ Billing 2011 Billing: $ Billing 2008 Billing: $ Billing

Five Largest Projects Completed in the Last Five Years: Project General Contractor, Contact and Phone Number Contract Amount Project General Contractor, Contact and Phone Number $ Contract Amount Project General Contractor, Contact and Phone Number $ Contract Amount Project General Contractor, Contact and Phone Number $ Contract Amount Project General Contractor, Contact and Phone Number $ Contract Amount Project General Contractor, Contact and Phone Number $ Contract Amount Major Projects Under Contract: Project % of Contract Completion Contractor Total Contract Value Complete Date Project % Complete Date Contractor $ Click here to enter text. Project % Complete Date Contractor $ Click here to enter text. Project % Complete Date Contractor $ Click here to enter text. Project % Complete Date Contractor $ Click here to enter text. Project % Complete Date Contractor $ Click here to enter text. Total value of projects under contract: (including those not listed above) $ Click here to enter text. Percent of negotiated / bid contracts % % Negotiated / % Bid

Current Pursuits: Current projects you are current a candidate for. (Indicate size and schedule) Project Start Date Contractor Total Contract Value Project Date Contractor $ Click here to enter text. Project Date Contractor $ Click here to enter text. Project Date Contractor $ Click here to enter text. Project Date Contractor $ Click here to enter text. Project Date Contractor $ Click here to enter text.

Bonding Information What is your bond rate for this project (as a percentage) % Rate Aggregate Limit: $ Aggregate Limit Single Project Limit: $ Single Project Limit Please list the names of your bonding agent and surety: Bonding Agent Surety (Bonding Agent) (Surety)

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Street Address Street Address (Street Address) (Street Address) City, State, Zip City, State, Zip (City, State, Zip) (City, State, Zip)

Please indicate the largest dollar amount bonded subcontract that your firm has held:

The answers to the foregoing questions and all statements herein contained are true and correct. Reviewer’s Name Reviewer’s Position (Reviewer’s Name) (Reviewer’s Position)

* HHRM, JV reserves the right to request Audited Financials which is defined as a Balance Sheet, and Income Statement, an Auditor’s Report and Footnotes.

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