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Name Of Contract Date Of Contract Owner’s Name, Nature CONTRACTOR’S Total contract Date of Total contract
Contract Duration Address, Of Work ROLE value at award, completion value at
completion
Telephone
DESCRIPTI %
Numbers
ON
NONE
Attached NONE NONE NONE NONE NONE NONE NONE NONE
certificatio
n
Note: The Bidder Shall Support This Statement With The Duly Signed Notice To Award Or Notice To Proceed; And The Duly Signed Owner’s Certificate Of Final Acceptance, Or
Certificate Of Completion Or Constructor’s Performance Evaluation Summary (Cpes) Final Rating, Which Must Be Satisfactory. In Addition, The Bidder May Attach Herewith The Duly Signed
Contracts, Agreements, Pos Or Job Orders.
SUBMITTED BY:
JULIUS N. JAYME
(Printed Name & Signature)
Designation:__AUTHORIZED MANAGING OWNER__
Date: __________________