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TOSHIBA 6401 Nob Hill Road <br />Tamarac, FL 33321 <br />Leading Innovation »> <br />12. State the name and address of attorney, if any, for the business of the Proposer: <br />Jason White — 9740 Irvine Blvd., Irvine CA, <br />13. State the names and addresses of all businesses and/or individuals who own an interest of more than <br />five percent (5%) of the Proposer's business and indicate the percentage owned of each such business <br />and/or individual: <br />N/A <br />14. State the names, addresses and the type of business of all firms that are partially or wholly owned by <br />Proposer. <br />N/A <br />15. List the following information concerning all Proposer's contracts in progress as of the date of submission <br />and completed projects over the last five (5) years. (In case of any co- venture, list the information for all co- <br />ventures.) <br />Name of Project Owner Total Contract Contracted Date % of <br />Value of Completion Completion to Date <br />Mapes Brian Lynn $22,300 1/2010 100% <br />Intcomex Brian Lynn $50,400 9/2009 100% <br />Grady Brian Lynn $45,500 8/2009 100% <br />16. Do you have a complete set of documents, including drawings and addenda, if applicable? <br />Yes X No ❑ <br />The Proposer acknowledges and understands that the information contained in response to this <br />Qualification Statement shall be relied upon by City in awarding the contract and such information is <br />warranted by Proposer to be true. The discovery of any omission or misstatement that materially affects <br />the Propo er's qualifications to perform under the contract shall cause the City to reject the proposal, and <br />if after, the16ward, to Cancel and terminate the award and /or contract. <br />Proposer's Signature Date <br />Toshiba's Recommendations for The Clty of Coconut Creek's RFP for Managed Print Services, 12 -01 -10.10 <br />Page 35 of 42 <br />