Company Name

Contact Name and Title

Type of Company Type of Company Corporation Partnership Sole Proprietorship Other

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Address

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Services Provided

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License #

License Type and Expiration

In the past five years, has your current company or any predecessor organization been involved in any litigation or legal dispute with an owner, architect, or general contractor? In the past five years, has your current company or any predecessor organization been involved in any litigation or legal dispute with an owner, architect, or general contractor? No Yes

If 'Yes', please explain