Contract Identification: [insert [insert amount] [indicate [insert amount] year] complete contract name, number, and any other identification] Name of Employer: [insert full name] Address of Employer: [insert street/city/country] Matter in dispute: [indicate main issues in dispute] Party who initiated the dispute: [indicate “Employer” or “Contractor”] Status of dispute: [Indicate if it is being treated by the Adjudicator, under Arbitration or being dealt with by the Judiciary] Litigation History in accordance with Section III, Table 1 Qualification Criteria, and Requirements No Litigation History in accordance with Section III, Table 1 Qualification Criteria, and Requirements, Sub-Factor 2.4. Litigation History in accordance with Section III, Table 1 Qualification Criteria, and Requirements, Sub-Factor 2.4 as indicated below. Year of Outcome as Contract Identification Total Contract award percentage of Net Amount Worth (currency), USD Equivalent (exchange rate) Contract Identification: [insert [insert [indicate [insert amount] year] percentage] complete contract name, number, and any identification] Name of Employer: [insert full name] Address of Employer: [insert street/city/country] Matter in dispute: [indicate main issues in dispute] Party who initiated the dispute: [indicate or “Employer” “Contractor”] Reason(s) for Litigation and award decision [indicate main reason(s)] Form CON 3 – ESHS Performance Declaration [The following table shall be filled in for the Applicant, each member of a Joint Venture and each Specialized Subcontractor]
[insert year] [insert amount] Contract Identification: [indicate complete contract name, number, and any other identification] Name of Employer: [insert full name] Address of Employer: [insert street/city/country] Matter in dispute: [indicate main issues in dispute] Party who initiated the dispute: [indicate “Employer” or “Contractor”] Status of dispute: [Indicate if it is being treated by the Adjudicator, under Arbitration or being dealt with by the Judiciary] [insert amount] Litigation History in accordance with Section III, Table 1 Qualification Criteria, and Requirements No Litigation History in accordance with Section III, Table 1 Qualification Criteria, and Requirements, Sub-Factor 2.4. Litigation History in accordance with Section III, Table 1 Qualification Criteria, and Requirements, Sub-Factor 2.4 as indicated below. Year of award Outcome as percentage of Net Worth Contract Identification Total Contract Amount (currency), USD Equivalent (exchange rate) [insert year] [insert percentage] Contract Identification: [indicate complete contract name, number, and any identification] Name of Employer: [insert full name] Address of Employer: [insert street/city/country] Matter in dispute: [indicate main issues in dispute] Party who initiated the dispute: [indicate “Employer” or “Contractor”] Reason(s) for Litigation and award decision [indicate main reason(s)] [insert amount] Form CON – 3 ESHS Performance Declaration [The following table shall be filled in for the Applicant, each member of a Joint Venture and each Specialized Subcontractor]
Initial-selectionWorks-Design-build.docx