Saturnino A. Pacubas - USAid

PRE-QJALIFICATION STATEMENT (Individual) .... Page -3­
i, Below are indicated Administrative or Judicial cases involving me or
the geodetic engineers under my employ and the status of the same cases:
TITLE OF BEFORE lHOM : SU3JECT
CASE : FILED/TRIED M1.TTER S T A T U S
3, That the Chif of Party who is a registered geodetic engineer under
Certificate No.
and who will handle and tklce charge
cf thiz
r~jcct i_
(Name of Geodetic Engineer)
a. Below are the nrojects which were completed by the Project Chief:
- N'ME OF FIOJECT : SUJAVEY NO. IAREA DATE CO.MPL2TED
&.4.1 -8'd.4
4. Attached hereto are copies of documents stated in item K and P.3t of
the Instructions to aidders nnd Terms and Conditions of Contract for
Cadastrnil Survey Projects.
5. That I hold myself resmcsible for the correctness of any statement
hereinabove made and any such statement found false or incorrect shall
be sufficient cause for disnualifyihg me from further participation
in this and in any subsequent bidding of survey projects irnthe Aureau
of Lands.
6. That I do not pos.ess any of the discu.allfications enumerated in the
Instructions to idor! and Terms and Conditions of ontri!ct fo Ondastral
Survey Projects.
IN MITNESS W;u.Ei'OF, I have hereunto affixed my s igunture this day of
19- at , Phili'pizws.
REPUBLIC OF THE HIILIPIN,,S)
- -. : S.S.
PROVINCE/CITY OF )
Affant
-SUBSC?.1 ED , D SWORN TO BHORE tC.this day of •_•_ _
19 , tho.affiant exhibiting to me his Residence Certificate No. ..,
issued on , 19 , at , Philippines.
Doc. No. ...
Page NO. _ __
Book No. --
Series of 198
NOTARY PUBLIC
Until Dec. 31, 198._
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