Project Verification FormMail To: Registrar of Contractors P.O. Box 6688Phoenix, AZ 85005-6688

Visit our website at: www.azroc.gov

Part 1: Information to be Completed by the Qualifying Party Qualifying Party’s Name (Last, First, Middle) Project Name

Project Address City State Zip

Date Project Began Date Project Ended Project Size (e.g. building size, lot size) Project Contract Price

Instructions for Person Providing Verification: 1. Complete the information requested below (including having your signature notarized).2. Return this Project Verification Form to the qualifying party.

Part 2: Information to be Completed by Person Providing Verification Verifier’s Name (Last, First, Middle)

Verifier’s Mailing Address City State Zip

Verifier’s Phone Number Verifier’s Email Verifier’s Fax

Verifier’s Role for this Project

Journeyman Superintendent Contractor (list license # and classification)

Foreman Property Owner Other (please describe):

Qualifying Party’s Duties on this Project

I certify that I have direct knowledge of this qualifying party’s work covering the time period outlined above. I certify that I have reviewed the entire contents of this verification form and the information provided is true and accurate. I understand that providing false information is a violation of the Arizona Criminal Code in Arizona Revised Statutes, Title 13, Chapter 27. Printed Name Signature Date

Subscribed and sworn to me on the _____ day of ______________________, 20___ [Notary Seal]

__________________________________________________________________________

Notary Public

RCL200S1 1/15

27 March 15

John Notary

First Verifier

The number of project verifications submitted meets the guidelines in the instructions; for this classification 5 new and 5 maintenance projects.

The projects span the number of years’ experience required to qualify for the license; for this classification 4 years.

The projects cover the scope of work of the classification.SAMPLERoc, Alvin, Simon Parking garage

AZPhoenix123 N. First Street 85007-0001

1/1/2008 11/30/2008 200,000 sq. ft 1,200,000.00

Verifier, First, Project

9876 Verifier St. Phoenix AZ 85007-0001

(602) 111-1111 verifier@email.com (602) 222-2222

ROC # 001122 A-General Engineering

Alvin Roc was the project manager for this project. The project included cassion drilled shaft footings,

concrete piers, cast in place columns, slab on grade, slab on precast, topping slabs, and other sitework.

Alvin scheduled the subcontractors and employees and made sure the project finished on time and

within budget.

First Verifier 3/27/2015

Project Verification FormMail To: Registrar of Contractors P.O. Box 6688Phoenix, AZ 85005-6688

Visit our website at: www.azroc.gov

Part 1: Information to be Completed by the Qualifying Party Qualifying Party’s Name (Last, First, Middle) Project Name

Project Address City State Zip

Date Project Began Date Project Ended Project Size (e.g. building size, lot size) Project Contract Price

Instructions for Person Providing Verification: 1. Complete the information requested below (including having your signature notarized).2. Return this Project Verification Form to the qualifying party.

Part 2: Information to be Completed by Person Providing Verification Verifier’s Name (Last, First, Middle)

Verifier’s Mailing Address City State Zip

Verifier’s Phone Number Verifier’s Email Verifier’s Fax

Verifier’s Role for this Project

Journeyman Superintendent Contractor (list license # and classification)

Foreman Property Owner Other (please describe):

Qualifying Party’s Duties on this Project

I certify that I have direct knowledge of this qualifying party’s work covering the time period outlined above. I certify that I have reviewed the entire contents of this verification form and the information provided is true and accurate. I understand that providing false information is a violation of the Arizona Criminal Code in Arizona Revised Statutes, Title 13, Chapter 27. Printed Name Signature Date

Subscribed and sworn to me on the _____ day of ______________________, 20___ [Notary Seal]

__________________________________________________________________________

Notary Public

RCL200S1 1/15

27 March 15

John Notary

Second Verifier

Roc, Alvin, Simon Public Park

AZPhoenix123 N. First Street 85007-0001

12/1/2008 10/31/2009 500,000 sq. ft 600,000.00

Verifier, Second, Project

9876 Verifier St. Phoenix AZ 85007-0001

(602) 111-1111 verifier@email.com (602) 222-2222

City Engineer

Alvin Roc was the project manager for this project. The project included grading, sitework, laying water

and electrical lines, walkways, fences, benches, unenclosed ramadas, and restrooms.

Second Verifier 3/27/2015

SAMPLE

Project Verification FormMail To: Registrar of Contractors P.O. Box 6688Phoenix, AZ 85005-6688

Visit our website at: www.azroc.gov

Part 1: Information to be Completed by the Qualifying Party Qualifying Party’s Name (Last, First, Middle) Project Name

Project Address City State Zip

Date Project Began Date Project Ended Project Size (e.g. building size, lot size) Project Contract Price

Instructions for Person Providing Verification: 1. Complete the information requested below (including having your signature notarized).2. Return this Project Verification Form to the qualifying party.

Part 2: Information to be Completed by Person Providing Verification Verifier’s Name (Last, First, Middle)

Verifier’s Mailing Address City State Zip

Verifier’s Phone Number Verifier’s Email Verifier’s Fax

Verifier’s Role for this Project

Journeyman Superintendent Contractor (list license # and classification)

Foreman Property Owner Other (please describe):

Qualifying Party’s Duties on this Project

I certify that I have direct knowledge of this qualifying party’s work covering the time period outlined above. I certify that I have reviewed the entire contents of this verification form and the information provided is true and accurate. I understand that providing false information is a violation of the Arizona Criminal Code in Arizona Revised Statutes, Title 13, Chapter 27. Printed Name Signature Date

Subscribed and sworn to me on the _____ day of ______________________, 20___ [Notary Seal]

__________________________________________________________________________

Notary Public

RCL200S1 1/15

27 March 15

John Notary

Third Verifier

Roc, Alvin, Simon Public Road

AZPhoenix123 N. First Street 85007-0001

11/1/2009 12/31/2012 20 miles 20,000,000.00

Verifier, Third Project

9876 Verifier St. Phoenix AZ 85007-0001

(602) 111-1111 verifier@email.com (602) 222-2222

ROC 123456 A-General Engineering

Replace water, sewer, and storm drains; earthwork, grading, and concrete paving

Third Verifier 3/27/2015

SAMPLE

Project Verification FormMail To: Registrar of Contractors P.O. Box 6688Phoenix, AZ 85005-6688

Visit our website at: www.azroc.gov

Part 1: Information to be Completed by the Qualifying Party Qualifying Party’s Name (Last, First, Middle) Project Name

Project Address City State Zip

Date Project Began Date Project Ended Project Size (e.g. building size, lot size) Project Contract Price

Instructions for Person Providing Verification: 1. Complete the information requested below (including having your signature notarized).2. Return this Project Verification Form to the qualifying party.

Part 2: Information to be Completed by Person Providing Verification Verifier’s Name (Last, First, Middle)

Verifier’s Mailing Address City State Zip

Verifier’s Phone Number Verifier’s Email Verifier’s Fax

Verifier’s Role for this Project

Journeyman Superintendent Contractor (list license # and classification)

Foreman Property Owner Other (please describe):

Qualifying Party’s Duties on this Project

I certify that I have direct knowledge of this qualifying party’s work covering the time period outlined above. I certify that I have reviewed the entire contents of this verification form and the information provided is true and accurate. I understand that providing false information is a violation of the Arizona Criminal Code in Arizona Revised Statutes, Title 13, Chapter 27. Printed Name Signature Date

Subscribed and sworn to me on the _____ day of ______________________, 20___ [Notary Seal]

__________________________________________________________________________

Notary Public

RCL200S1 1/15

27 March 15

John Notary

Fourth Verifier

Roc, Alvin, Simon Bridge/Overpass

AZPhoenix123 N. First Street 85007-0001

12/1/2009 3/31/2010 200 feet across 200,000.00

Verifier, Fourth Project

9876 Verifier St. Phoenix AZ 85007-0001

(602) 111-1111 verifier@email.com (602) 222-2222

ROC #456789 A-General Engineering

Alvin Roc was the project manager for this project. The project included replacing a bridge consistent

with AASHTO/ADOT standards. The new bridge had vehicular traffic running below and required custom

steel mesh panels to provide pedestrial safety. The reconstruction required excavating and replacing the

concrete foundation. Alvin also engineered the shop drawings of the bridge.

Fourth Verifier 3/27/2015

SAMPLE

Project Verification FormMail To: Registrar of Contractors P.O. Box 6688Phoenix, AZ 85005-6688

Visit our website at: www.azroc.gov

Part 1: Information to be Completed by the Qualifying Party Qualifying Party’s Name (Last, First, Middle) Project Name

Project Address City State Zip

Date Project Began Date Project Ended Project Size (e.g. building size, lot size) Project Contract Price

Instructions for Person Providing Verification: 1. Complete the information requested below (including having your signature notarized).2. Return this Project Verification Form to the qualifying party.

Part 2: Information to be Completed by Person Providing Verification Verifier’s Name (Last, First, Middle)

Verifier’s Mailing Address City State Zip

Verifier’s Phone Number Verifier’s Email Verifier’s Fax

Verifier’s Role for this Project

Journeyman Superintendent Contractor (list license # and classification)

Foreman Property Owner Other (please describe):

Qualifying Party’s Duties on this Project

I certify that I have direct knowledge of this qualifying party’s work covering the time period outlined above. I certify that I have reviewed the entire contents of this verification form and the information provided is true and accurate. I understand that providing false information is a violation of the Arizona Criminal Code in Arizona Revised Statutes, Title 13, Chapter 27. Printed Name Signature Date

Subscribed and sworn to me on the _____ day of ______________________, 20___ [Notary Seal]

__________________________________________________________________________

Notary Public

RCL200S1 1/15

27 March 15

John Notary

Fifth Verifier

Roc, Alvin, Simon Fast Food Site Preparation

AZPhoenix123 N. First Street 85007-0001

1/1/2010 4/30/2010 3000 sq. ft. 110,000.00

Verifier, Fifth Project

9876 Verifier St. Phoenix AZ 85007-0001

(602) 111-1111 verifier@email.com (602) 222-2222

Mr. Fry Hamburger, restaurant owner

Site preparation for a fast food store. The project included site concrete; building slab of 4" concrete with

#3 rebar; parking curbs, drivethrough curbs, trash enclosure and footings, sidewalks, ADA ramp, light pole

bases, and security lighting in parking lot.

Fifth Verifier 3/27/2015

SAMPLE

Project Verification FormMail To: Registrar of Contractors P.O. Box 6688Phoenix, AZ 85005-6688

Visit our website at: www.azroc.gov

Part 1: Information to be Completed by the Qualifying Party Qualifying Party’s Name (Last, First, Middle) Project Name

Project Address City State Zip

Date Project Began Date Project Ended Project Size (e.g. building size, lot size) Project Contract Price

Instructions for Person Providing Verification: 1. Complete the information requested below (including having your signature notarized).2. Return this Project Verification Form to the qualifying party.

Part 2: Information to be Completed by Person Providing Verification Verifier’s Name (Last, First, Middle)

Verifier’s Mailing Address City State Zip

Verifier’s Phone Number Verifier’s Email Verifier’s Fax

Verifier’s Role for this Project

Journeyman Superintendent Contractor (list license # and classification)

Foreman Property Owner Other (please describe):

Qualifying Party’s Duties on this Project

I certify that I have direct knowledge of this qualifying party’s work covering the time period outlined above. I certify that I have reviewed the entire contents of this verification form and the information provided is true and accurate. I understand that providing false information is a violation of the Arizona Criminal Code in Arizona Revised Statutes, Title 13, Chapter 27. Printed Name Signature Date

Subscribed and sworn to me on the _____ day of ______________________, 20___ [Notary Seal]

__________________________________________________________________________

Notary Public

RCL200S1 1/15

27 March 15

John Notary

Sixth Verifier

Roc, Alvin, Simon Underground revitalization

AZPhoenix123 N. First Street 85007-0001

7/1/2010 5/31/2011 city block 2,000,000.00

Verifier, Sixth Project

9876 Verifier St. Phoenix AZ 85007-0001

(602) 111-1111 verifier@email.com (602) 222-2222

ROC #123456 A-General Engineering

replace water, sewer, and storm drains; earthwork, grading, and concrete paving

Sixth Verifier 3/27/2015

SAMPLE

Project Verification FormMail To: Registrar of Contractors P.O. Box 6688Phoenix, AZ 85005-6688

Visit our website at: www.azroc.gov

Part 1: Information to be Completed by the Qualifying Party Qualifying Party’s Name (Last, First, Middle) Project Name

Project Address City State Zip

Date Project Began Date Project Ended Project Size (e.g. building size, lot size) Project Contract Price

Instructions for Person Providing Verification: 1. Complete the information requested below (including having your signature notarized).2. Return this Project Verification Form to the qualifying party.

Part 2: Information to be Completed by Person Providing Verification Verifier’s Name (Last, First, Middle)

Verifier’s Mailing Address City State Zip

Verifier’s Phone Number Verifier’s Email Verifier’s Fax

Verifier’s Role for this Project

Journeyman Superintendent Contractor (list license # and classification)

Foreman Property Owner Other (please describe):

Qualifying Party’s Duties on this Project

I certify that I have direct knowledge of this qualifying party’s work covering the time period outlined above. I certify that I have reviewed the entire contents of this verification form and the information provided is true and accurate. I understand that providing false information is a violation of the Arizona Criminal Code in Arizona Revised Statutes, Title 13, Chapter 27. Printed Name Signature Date

Subscribed and sworn to me on the _____ day of ______________________, 20___ [Notary Seal]

__________________________________________________________________________

Notary Public

RCL200S1 1/15

27 March 15

John Notary

Seventh Verifier

Roc, Alvin, Simon Roadway project

AZPhoenix123 N. First Street 85007-0001

10/1/2012 1/31/2015 7 city blocks 3,000,000.00

Verifier, Seventh Project

9876 Verifier St. Phoenix AZ 85007-0001

(602) 111-1111 verifier@email.com (602) 222-2222

Mr. A.D.O.T. Supervisor

new traffic signals, street lights, concrete curb and gutter, underground water drainage for storm water,

earthwork, paving, striping and signage

Seventh Verifier 3/27/2015

SAMPLE

Project Verification FormMail To: Registrar of Contractors P.O. Box 6688Phoenix, AZ 85005-6688

Visit our website at: www.azroc.gov

Part 1: Information to be Completed by the Qualifying Party Qualifying Party’s Name (Last, First, Middle) Project Name

Project Address City State Zip

Date Project Began Date Project Ended Project Size (e.g. building size, lot size) Project Contract Price

Instructions for Person Providing Verification: 1. Complete the information requested below (including having your signature notarized).2. Return this Project Verification Form to the qualifying party.

Part 2: Information to be Completed by Person Providing Verification Verifier’s Name (Last, First, Middle)

Verifier’s Mailing Address City State Zip

Verifier’s Phone Number Verifier’s Email Verifier’s Fax

Verifier’s Role for this Project

Journeyman Superintendent Contractor (list license # and classification)

Foreman Property Owner Other (please describe):

Qualifying Party’s Duties on this Project

I certify that I have direct knowledge of this qualifying party’s work covering the time period outlined above. I certify that I have reviewed the entire contents of this verification form and the information provided is true and accurate. I understand that providing false information is a violation of the Arizona Criminal Code in Arizona Revised Statutes, Title 13, Chapter 27. Printed Name Signature Date

Subscribed and sworn to me on the _____ day of ______________________, 20___ [Notary Seal]

__________________________________________________________________________

Notary Public

RCL200S1 1/15

27 March 15

John Notary

Eighth Verifier

Roc, Alvin, Simon Commercial Sitework

AZPhoenix123 N. First Street 85007-0001

10/1/2011 12/31/2014 10 acres 1,000,000.00

Verifier, Eighth Project

9876 Verifier St. Phoenix AZ 85007-0001

(602) 111-1111 verifier@email.com (602) 222-2222

ROC#000000

clear and grub 10 acres of land, excavate, grade, add 22,000 cubic yards of fill, install 15,000 fine grade

pad, landscape, install utilities, add 7,000 of aggregate base, pave 3,000 tons of parking lot, add curbing

and sidewalk, and strip parking spaces

Eighth Verifier 3/27/2015

SAMPLE

Project Verification FormMail To: Registrar of Contractors P.O. Box 6688Phoenix, AZ 85005-6688

Visit our website at: www.azroc.gov

Part 1: Information to be Completed by the Qualifying Party Qualifying Party’s Name (Last, First, Middle) Project Name

Project Address City State Zip

Date Project Began Date Project Ended Project Size (e.g. building size, lot size) Project Contract Price

Instructions for Person Providing Verification: 1. Complete the information requested below (including having your signature notarized).2. Return this Project Verification Form to the qualifying party.

Part 2: Information to be Completed by Person Providing Verification Verifier’s Name (Last, First, Middle)

Verifier’s Mailing Address City State Zip

Verifier’s Phone Number Verifier’s Email Verifier’s Fax

Verifier’s Role for this Project

Journeyman Superintendent Contractor (list license # and classification)

Foreman Property Owner Other (please describe):

Qualifying Party’s Duties on this Project

I certify that I have direct knowledge of this qualifying party’s work covering the time period outlined above. I certify that I have reviewed the entire contents of this verification form and the information provided is true and accurate. I understand that providing false information is a violation of the Arizona Criminal Code in Arizona Revised Statutes, Title 13, Chapter 27. Printed Name Signature Date

Subscribed and sworn to me on the _____ day of ______________________, 20___ [Notary Seal]

__________________________________________________________________________

Notary Public

RCL200S1 1/15

27 March 15

John Notary

Ninth Verifier

Roc, Alvin, Simon New Wastewater Treatment Plant

AZPhoenix123 N. First Street 85007-0001

10/1/2011 12/31/2013 50,000 sq. ft. 10,000,000.00

Verifier, Ninth Project

9876 Verifier St. Phoenix AZ 85007-0001

(602) 111-1111 verifier@email.com (602) 222-2222

City Engineer

Alvin ROC was the superintendent on this city project to construct a new wastewater treatment facility;

including sitework, utilities, structural work, water filtration systems, pumps, piping, storage tanks, and

necessary structures

Ninth Verifier 3/27/2015

SAMPLE

Project Verification FormMail To: Registrar of Contractors P.O. Box 6688Phoenix, AZ 85005-6688

Visit our website at: www.azroc.gov

Part 1: Information to be Completed by the Qualifying Party Qualifying Party’s Name (Last, First, Middle) Project Name

Project Address City State Zip

Date Project Began Date Project Ended Project Size (e.g. building size, lot size) Project Contract Price

Instructions for Person Providing Verification: 1. Complete the information requested below (including having your signature notarized).2. Return this Project Verification Form to the qualifying party.

Part 2: Information to be Completed by Person Providing Verification Verifier’s Name (Last, First, Middle)

Verifier’s Mailing Address City State Zip

Verifier’s Phone Number Verifier’s Email Verifier’s Fax

Verifier’s Role for this Project

Journeyman Superintendent Contractor (list license # and classification)

Foreman Property Owner Other (please describe):

Qualifying Party’s Duties on this Project

I certify that I have direct knowledge of this qualifying party’s work covering the time period outlined above. I certify that I have reviewed the entire contents of this verification form and the information provided is true and accurate. I understand that providing false information is a violation of the Arizona Criminal Code in Arizona Revised Statutes, Title 13, Chapter 27. Printed Name Signature Date

Subscribed and sworn to me on the _____ day of ______________________, 20___ [Notary Seal]

__________________________________________________________________________

Notary Public

RCL200S1 1/15

27 March 15

John Notary

Tenth Verifier

Roc, Alvin, Simon Street Maintenance Project

AZPhoenix123 N. First Street 85007-0001

6/1/2014 1/31/2015 15 miles 500,000.00

Verifier, Tenth Project

9876 Verifier St. Phoenix AZ 85007-0001

(602) 111-1111 verifier@email.com (602) 222-2222

City Engineer

grading and repaving city street

Tenth Verifier 3/27/2015

SAMPLE