Form Contractor Evaluation Lausd Formal Projects Page 4
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4Contractor Evaluation for LAUSD Projects
Contractor: ________________________________ Contract # _________________ Project# _______________
============================================================================================================
OWNER’S AUTHORIZED REPRESENTATIVE CERTIFICATION
I understand that the LAUSD has a legitimate interest in the contractor’s ability to perform work on public works
projects. This reference is to be used solely for the LAUSD prequalification process for public works projects. I
certify that the following evaluation is truthful, made without malice and based on evaluations of the contractor
pursuant to California Civil Code 47, subd. (c).
______________________________________________
_______________________________________
Print Name
Title/Position
___________________________________________________________________________________________
Company/Section/Division
______________________________________________
_________________
___________________
Signature
Date
Phone Number
INSPECTOR OF RECORD CERTIFICATION
I understand that the LAUSD has a legitimate interest in the contractor’s ability to perform work on public works
projects. This reference is to be used solely for the LAUSD prequalification process for public works projects. I
certify that the following evaluation is truthful, made without malice and based on evaluations of the contractor
pursuant to California Civil Code 47, subd. (c).
______________________________________________
_______________________________________
Print Name
Title/Position
___________________________________________________________________________________________
Company/Section/Division
______________________________________________
_________________
________________
Signature
Date
Phone Number
END USER CERTIFICATION
I understand that the LAUSD has a legitimate interest in the contractor’s ability to perform work on public works
projects. This reference is to be used solely for the LAUSD prequalification process for public works projects. I
certify that the following evaluation is truthful, made without malice and based on evaluations of the contractor
pursuant to California Civil Code 47, subd. (c).
______________________________________________
______________________________________
Print Name
Title/Position
___________________________________________________________________________________________
Company/Section/Division
______________________________________________
_________________
________________
Signature
Date
Phone Number
APPROVAL OF REGIONAL DIRECTOR REQUIRED ON ALL LAUSD PROJECTS
______________________________________________
_______________________________________
Print Name
Title/Position
___________________________________________________________________________________________
Company/Section/Division
______________________________________________
_________________
___________________
Signature
Date
Phone Number
Los Angeles Unified School District
Page 4 of 4
5/17/2016
Facilities Construction Contracts
LAUSD Contractor Evaluation
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