Standard Qualification Questionnaire (SQQO) (2)

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If a corporation, answer this: Capital paid in cash, $ When Incorporated In what State Date registered in Hawaii President's name Vice - President's name Secretary's name Treasurer's name If a partnership, answer this: Date o f organization Date registered in Hawaii State whether partnership is general or limited Name and address of partners: Age The undersigned hereby declares: that the foregoing is a true statement of the financial condition of the individual, partnership or corporation herein first named, as of the date herein first given; that this statement is for the express purpose of inducing the party to whom it is submitted to award the offeror a contract; and that any depository, vendor or other agency herein named is hereby authorized to supply such party with any information necessary to verify this statement. NOTE: A partnership must give firm name and signatures of all partners. A corporation must give full corporate name, signature of official, and affix corporate seal. Affidavit for Individual STATE OF HAWAII COUNTY OF being duly sworn, deposes and says that the foregoing financial statement, taken from his books, is a true and accurate statement of his financial condition as of the date thereof and that the answers to the foregoing interrogatories are true. Sworn to before me this day of 20 Notary Public Affidavit for Partnership STATE OF HAWAII COUNTY OF (Applicant must also sign here) being duly sworn, deposes and says that he is a member oI the firm o- and that he is familiar with the books of the said—f—irm showing its tinanciaT con&rtion: tha�ie foregoing tinanciaT statement, taken the books of the said firm, is a true and accurate statement of the financial condition of the said firm as of the date thereof and that the answers to the foregoing interrogatories are true. Sworn to before me this day of 20 Notary Public Affidavit for Corporation STATE OF HAWAII COUNTY OF (Members of firm must also sign here) being duly sworn, deposes and says that he is of the , the corporation described in and which executed the foregoing statement; that he is familiar with the books of the said corporation showing its financial condition; that the foregoing financial statement, taken from the books of the said corporation, is a true and accurate statement of the financial condition of said corporation as of the date thereof and that the answers to the foregoing interrogatories are true. Sworn to before me this day of 20 Notary Public 17 (Officer must also sign here)