Request for Bids Demolition and Site Clearing Services - 4057 Evans

Exhibit B
Organization & Contact Information Form
Complete this form entirely. If an item does not apply, indicate "Not Applicable."
1. Business Information
Business Name: ____________________________________________________________
Mailing Address: ____________________________________________________________
Physical Address: ____________________________________________________________
(If different.)
Website: ____________________________________________________________
2. Primary Contact Information
Name: ____________________________________________________________
Title: ____________________________________________________________
Phone Number: ____________________________________________________________
Email Address: ____________________________________________________________
3. Legal Structure of the Business
Corporation
Limited Liability Company (LLC)
Partnership
Sole Proprietorship
Nonprofit Organization
Other (Specify): _____________________________________________
4. Ownership Information
List the top three owner(s) or managing member(s) in terms of percentage owned.
Name Title / Role Ownership Percentage
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

5. Key Management Personnel
List up to three (3) top managers who are involved with managing day-to-day operations.
Name Title Responsibilities
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
6. Year Business Was Established: ____________________
7. Number of Employees:
Full-Time Employees: ____________________
Part-Time Employees: ____________________
Check here if Owner-operated / No employees other than owner(s) __________________
8. Bankruptcy Disclosure
Disclose any declarations of bankruptcy by the firm or its principal owner(s) within the past ten
(10) years, if applicable.
No bankruptcies to disclose

Bankruptcy disclosed (Provide details below.)

Details (if applicable):
9. Legal Proceedings
Provide a brief description of any current or pending lawsuits related to the firm's professional
operations, if applicable. Routine claims, resolved matters, or unrelated personal matters need not be
disclosed.
No legal proceedings to disclose

Legal proceedings disclosed (Provide details below.)

Details (if applicable):

10. Tax and Business Compliance
Does your organization have a current business license in the City of St. Louis?
Yes
No
11. Is your organization delinquent on any federal, state, or City tax obligation?
No
Yes
If yes, please provide details of the delinquency(ies):
11. MBE / WBE / DBE / Certification Disclosure
Indicate whether the firm is certified as a Minority Business Enterprise (MBE) or Women Business
Enterprise (WBE) by the St. Louis Development Corporation's CertifySTL program.
Not Certified
Certified MBE
Certified WBE
Certified DBE Certifying agency: _____________________________________________
C. Background and Capability
Provide a brief description of your organization and the services it is qualified to provide relevant to
this solicitation. Include relevant experience, areas of expertise, and any distinguishing
qualifications. You may attach up to one additional double-sided page if necessary.

D. References
Include contact information from three (3) clients for whom your organization provided comparable
services. Briefly describe the services provided. Attach up to one single-sided page per project if
necessary.
Client Organization: ____________________________________________________________
Contact Name: ____________________________________________________________
Contact Phone: ____________________________________________________________
Contact E-mail: ____________________________________________________________
Services Provided: ____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Client Organization: ____________________________________________________________
Contact Name: ____________________________________________________________
Contact Phone: ____________________________________________________________
Contact E-mail: ____________________________________________________________
Services Provided: ____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Client Organization: ____________________________________________________________
Contact Name: ____________________________________________________________
Contact Phone: ____________________________________________________________
Contact E-mail: ____________________________________________________________
Services Provided: ____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________

STATE OF MISSOURI )
) ss
CITY OF ST. LOUIS )
CERTIFICATION OF BIDDER:
The undersigned hereby declares that all of the information provided with this response to the
Request for Bids is true and correct, and that he or she is authorized to make this representation on
behalf of the company listed below, the statements presented in this submission are true and correct
to the best of his or her knowledge and belief, and he or she understands they are subject to the
penalties provided for making a false declaration under Section 575.060 RSMo. The undersigned
further acknowledges the following:
Bidder certifies that the information provided in this form is true, complete, and accurate to the best
of my knowledge.
Bidder certifies that failure to provide all required forms as detailed in the Request for Bids may
result in my submittal being declared as non-responsive and eliminated from consideration.
Bidder acknowledges that it is Bidder's responsibility to become informed about all addenda that
may be posted on the solicitation website and that failure to account for any addenda my result in
Bidder submittal being declared as non-responsive and eliminated from consideration.
Bidder is familiar with and is satisfied to all federal, state and local Laws and Regulations that may
affect cost, progress, performance and furnishing of the Scope of Work.
Bidder agrees to hold this bid open for sixty (60) days after the date of receipt of bids. Bidder agrees
to accept the provision regarding the disposition and forfeiture of any bid security.
Bidder acknowledges that the Scope of Work associated with this Bid must be completed no later
than September 30, 2026. Authorized Representative:
___________________________________________
Signature of above Name: ___________________________________________
Title: ___________________________________________
Date: ___________________________________________
Subscribed and sworn to before me this _____ day of __________ 202__.
Notary Public
My commission expires: