Cost Estimate Worksheet Page 2
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1
2Construction Contractor
Project Address__________________________
Name: _______________________________________________
Company Name: _______________________________________
Phone Number:_____________ E-mail:_____________________
Address:______________________________________________ City _______________ State ____ Zip __________
Has the above contractor or builder within the last 10 years ever failed to qualify as a responsible bidder, refused to enter
into a contract after an award has been made, or failed to complete a construction development contract? Yes ___ No___
If yes, please explain:
CERTIFICATION
I (we),________________________________________ ___________________________________________
printed name
printed name
Certify that the statements and estimates within this Application as well as any and all documentation submitted as
attachments to this Application or under separate cover are true and correct to the best of my (our) knowledge and belief.
------------------------------------------------------------------------------------------------------------------------------------------------------------------
Construction Contractor
Project Address_________________________
Name: _______________________________________________
Company Name: _______________________________________
Phone Number:_____________ E-mail:_____________________
Address:______________________________________________ City _______________ State ____ Zip __________
Has the above contractor or builder within the last 10 years ever failed to qualify as a responsible bidder, refused to enter
into a contract after an award has been made, or failed to complete a construction development contract? Yes ___ No___
If yes, please explain:
CERTIFICATION
I (we),________________________________________ ___________________________________________
printed name
printed name
Certify that the statements and estimates within this Application as well as any and all documentation submitted as
attachments to this Application or under separate cover are true and correct to the best of my (our) knowledge and belief.
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