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Renewal of Regular Contractor’s License Application (Sole Proprietorship)

PCAB-F-SVD-002a. Revision No. 00, 11/19/2018


This Form is NOT for sale. Reproduction is Allowed
Page 1 of 1

STATEMENT OF ANNUAL VALUE OF WORK ACCOMPLISHED/ON-GOING PROJECTS


As of the Balance Sheet Date _______________
Note: See instructions at the next page before filling-out this form. Please use additional sheets if necessary.
PROJECT PARTICULARS 1 2 3

Title of Project:

Project Owner:

Location:

Classification/Total Cost: /P /P /P

CONTRACT PARTICULARS 1 2 3

Date of Contract:

Contract Completion Date:

Scope of Work:

Amount of Contract: P P P

Name of Main Contractor or


Joint Venture Partner, if
any:

WORK ACCOMPLISHMENT 1 2 3

As of start of year: P______________ %_____ P______________ %_____ P_____________ %______

As of end of year : P______________ %_____ P______________ %_____ P_____________ %______

TECHNICAL EMPLOYEE(S) 1 2 3

Name and Profession:

Position Title:

__________________________________________
Authorized Managing Officer (AMO)
(Signature over printed name)

__________________________________________
Date

AMO must sign here:

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