Contractor’s Qualification Statement

SUBMITTED TO:

ADDRESS:

SUBMITTED BY:

NAME: CHAVEZ INTERIORS LLC

ADDRESS: P.O. BOX 309 (480 Forum Parkway)

PRINCIPAL OFFICE: Rural Hall NC 27045

• Partnership
• Individual
• Joint Venture
• Corporation
• Other LLC

NAME OF PROJECT: (If applicable)
TYPE OF WORK: (File separate form for each Classification of Work)

• General Construction
• HVAC
• Electrical
• Plumbing
• Other (Please specify)  Metal Stud Framing-Drywall-Acoustical Ceilings

• ORGANIZATION
• How many years has your organization been in business as a Contractor? 10 years

• How many years has your organization been in business under its present business name? 2years
• Under what other or former names has your organization operated? CHAVEZ DRYWALL INC
• If your organization is a corporation, answer the following: N/A
• Date of incorporation:
• State of incorporation:
• President’s name:
• Vice-president’s name(s):
• Secretary’s name:
• Treasurer’s name:

•  If your organization is a partnership, answer the following: N/A
• Date of organization:
• Type of partnership, if applicable:
• Name(s) of general partner(s):

• If your organization is individually owned, answer the following:
• Date of organization
• Name of owner:

• If the form of your organization is other than those listed above, describe it and name the principals:

The company is composed of two owners:
Jose G. Chavez  (President)
Gonzalo Chavez  (Vice-President)

• LICENSING
• List jurisdictions and trade categories in which your organization is legally qualified to do business, and indicate registration or license numbers, if applicable:  N/A

•  List jurisdictions in which your organization’s partnership or trade name is files.  N/A

• EXPERIENCE
• List the categories of work that your organization normally performs with its own forces.

Metal Framing
Drywall
Acoustical Ceilings

3.2 Claims and Suits. (If the answer to any of the questions below is yes attach details.)
3.2.1 Has your organization ever failed to complete any work awarded to it? NO

3.2.2 Are there any judgments, claims, arbitration proceedings or suits pending or outstanding against your organization or its officers? NO

3.2.3 Has your organization filed any law suits or requested arbitration with regard to construction contracts within the last five years? NO

3.3 Within the last five years, has any officer or principal of your organization ever been an officer or principal of another organization when failed to complete a construction contract? (If the answer is yes, please attach details.) NO

3.4 List major construction projects your organization has in progress, giving the name of project, owner, architect, contract amount, present complete and scheduled completion date.

General Contractor: Triad Builders of King
Project Name: Moore Elementary School
Owner: Forsyth County Schools
Architects: Ersoy Brake Appleyard Architects
Contract Amount: $ 267,930.00

General Contractor: Triad Builders of King
Project Name: parkland HS New Classroom Bldn
Owner: Forsyth County Schools
Architect: Ersoy Brake Appleyard Architects
Contract Amount: $85,000.00

General Contractor: Davie Construction Co.
Project Name: Downtown Elementary School Addition-29008
Owner: Winston Salem/Forsyth County Schools
Architect: Ersoy Brake Appleyard Architects
Contract Amount: $187,299.53

Contractor: John S. Clark Company, LLC
Project Name: Guilford County Health Bldg
Owner: Guilford County
Architect: Guilford County
Contract Amount: $54,945.00

3.4.1 State total worth of work in progress and under contract: 2,500,000.00

3.5 List the major projects your organization has completed in the past five years, giving the name of project, owner, architect, contract amount, date of completion and percentage of the cost of the work performed with your own forces.

Project Name: Guilford County Courthouse Renovation
General Contractor: Morlando-H olden Construction Inc
Owner: County of Guildford
Architect: J. Hyatt Hammond Associates
Contract Amount:   $ 407,214.00

General Contractor: I.L. Long Construction Co Inc
Project Name: Administrative Office Carolina Farm Credit
Statesville, NC
Owner: Carolina Farm Credit
Architect: J. Aubrey Kirby Design
Contract Amount: $268,139.oo                                  

General Contractor: Davie Construction Co.
Project name: Jeff’s RV Superstore
Owner: Jeff’s RV Superstore
Architect: Wilson & Lysiak Inc
Contract Amount: $101,934.00

General Contractor: I.L. Long Construction Co Inc
Project Name: Windsor Jewelers
Architect: Walter Robbs Callahan & Piece Architects PA
Contract Amount: $153,410.00Owner: Windsor Jewelers

General Contractor: Davie Construction Co.
Project Name: Reynolds H.S. Performing Arts and Cafeteria-27002
Owner: Winston Salem/Forsyth County Schools
Architects: Ersoy Brake Appleyard Architects PA
Contract Amount: $111,818.00

100% of the cost of the work performed was made with Chavez Interiors , LLC own forces. (On all Projects)

3.5.1 State average annual amount of construction work performed during the last five years  $5,000,000.00

•  List the construction experience and present commitments of the key individuals of your organization.

• REFERENCES
• Trade References:
• Interior Distributors Inc
  Contact: Jeff Wilson

P.O. BOX 19266                                   Phone: 336-668-3652
7207 Cessna Drive                              Fax: 336-665-0677
Greensboro NC 27419

• Colonial Materials Inc
  Contact: Jeff Gibson

5201 Germantown Rd                       Phone: (336) 661-0193
Winston Salem NC 27105                Fax: (336) 661-0974

• HILTI Inc
  Contact: Showna Dacyczyn

P.O. BOX 21148                                   Phone: 1800-879-800
Tulsa, OK 74121                                  Fax: 1800-879-700

•  Bank References:

BB&T
Branch Banking & Trust Co.                 
6000 University Parkway                       Phone: 336-377-2107
Winston-Salem, NC 27105                     Fax: 336-377-2100

•  Surety
• Name of bonding company: Seen-Dunn

• Name and address of agent:

Bryan Beasley
3625 N Elm St. / P.O. BOX 9375
Greensboro, NC 274209

• FINANCING
• Financial Statement
• Attach a financial statement, preferably audited, including organization’s latest balance sheet and income statement showing the following items:
1. Current Assets (e.g., cash, joint venture accounts, accounts receivable, notes receivable, accrued income, deposits, material inventory and prepaid expenses);
2. Net Fixed Assets;
3. Other Assets;
4. Current Liabilities (e.g., accounts payable, notes payable, accrued expenses, provision for income taxes, advances, accrued salaries and accrued payroll taxes); and
5. Other Liabilities (e.g., capital, capital stock, authorized and outstanding shares per values, earned surplus and retained earnings).

• Name and address of firm preparing attached financial statement, and date thereof:

CIMA CORP 
Contact: Frank Iruela
421 Spring Garden St.
Phone: 336-508-5387
Greensboro, NC 27407

• Is the attached financial statement for the identical organization named on page one? YES

• If not, explain the relationship and financial responsibility of the organization whose financial statement is provided (e.g., parent-subsidiary). N/A

•    Will the organization whose financial statement is attached act as guarantor of the contract for construction? YES

• SIGNATURE

6.1 Dated this                                       day of                                                20
Name of organization: CHAVEZ INTERIORSD LLC

                  By:                  Jose G. Chavez

                  Title:               President/Owner

6.2 M  being duly sworn deposes and says that the information provided herein is true and sufficiently complete so as not to be misleading.

                  Subscribed and sworn before me this                                     day of                        20

                  Notary Public:

                  My Commission Expires: