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PEST CONTROL SERVICES <br />RFB PWD 24.408 <br />Page | 8 <br />CONTRACTOR INFORMATION <br />(Required) <br />CONTRACTOR: <br />(Company Name) <br />Year <br />Est.: <br />BUSINESS ADDRESS: <br />WEBSITE: <br />LICENSE(S)#: <br />SUBMITTED BY: Name: <br />Title: <br />TELEPHONE:Office: <br />Cell: <br />EMAIL: Email: <br />Email: <br />Questionnaire (please circle): <br />1.Has the contractor license been suspended in the past? (If Yes, please explain) <br />Yes No If, Yes__________________________________________ <br />2.Do you have any contracts terminated by Owner in the past? (If Yes, please explain) <br /> Yes No If, Yes__________________________________________ <br />3.Has the company been debarred or suspended by Owner in the past? (If yes, please <br />explain)Yes No If, Yes__________________________________________ <br />SIGNATURE: DATE: <br />PRINTNAME: TITLE: <br /> <br />I declare under penalty of perjury that I have the authority to execute this bid and that the <br />foregoing is true and correct. <br />Pestmaster Services, L.P.1979 <br />4901 Patata Street, Suite 401-402 Cudahy, California 90201 <br />https://pestmaster.com <br />DPR: 30261, 44787, 45556 <br />SPCB: 5739, 8998 <br />Brian WilkContracts Manager <br />(775) 858-7378 <br />contracts@pestmaster.com <br />Contracts ManagerBrian Wilk <br />17 May 2024 <br />Brian Wilk (May 17, 2024 12:49 PDT) <br />Brian Wilk <br />DocuSign Envelope ID: 16D1C412-7260-4260-8A87-C870C0BEE374