Loading...
HomeMy WebLinkAboutContract #: 004182 - From: To: - Exception - ExceptionI School Department Administration Building North Andover, MA FORM OF GENERAL BID Kang Associates, Inc. January 2, 2014 To the Awarding Authority: A. The undersigned proposes to furnish all labor and materials required for the School Department Administration Building, North Andover, Massachusetts, in accordance with the accompanying plans and specifications prepared by Kang Associates, Inc. for the contract price specified below, subject to additions and deductions according to the terms of the specifications. B. This bid includes addenda numbered 1, 2, 3 C 17 The proposed contract price is: Two million six hundred forty seven thousand six hundred sixty one and 00/100 ----dollars($ 2,647,661.00 For Alternate #1: Deduct $ Seven thousand-------------- dollars ($ —7,000.00 For Alternate #2: Seventeen thousand Deduct $ eight hundred seventy seven— dollars ($ —17,877.00 For Alternate #3: Deduct $ Two thousand----------------- ollars($ —2,000.00 For Alternate #4: Seventy four thousand Deduct $ seven hundred--------------- dollars ($ —74,700.00 For Alternate #5: Deduct $ Seventeen thousand dollars ($ —17,000.00 The subdivision of the proposed contract price is as follows: Item 1. The work of the general contractor, being all work other than that covered by Item 2: Item 2. Sub -bids as follows: $ 1,730,728.00 Bond req'd Sub -trade Name of Sub -Bidder Amount Yes/No Mason : 04.21 .1 Brick Masonry 99,800.0099,800.00 Yes 04.72.00 Cast Stone Masonry y $ Roofing: 07.31.'f 3 Asphalt Shingles HE Engineering 07.53.00 Elastomeric Membrane Roofing 09.51.23 Acoustical Tile Ceilings K & K Acoustical Ceilings FORM OF GENERAL BID - 1 $ 74,000.00 Yes $ 16,570.00 Yes School Department Administration Building Kang Associates, Inc. North Andover, MA January 2, 2014 09.90.00 Painting and Coating O'Byrne Paninting $ 28,700.00 Yes 14.42.16 Vertical Wheelchair Lifts Division 21 Fire Protection Division 22 Plumbing Division 23 HVAC Division 26 Electrical Division 28 Fire Alarm Eagle Elevator $ 26,963.00 Yes Ebacher Plbg. & Htg. $ 74,000.00 Yes Thomas E. Snowden Jupiter Electric $ 324,000.00 Yes $ 214,900.00 Yes Total of Item 2: $ 916,933.00 E. The undersigned agrees that, if he is selected as general contractor, he will within five days, Saturdays, Sundays and legal holidays excluded, after presentation thereof by the awarding authority, execute a contract in accordance with the terms of this bid and furnish a performance bond and also a labor and materials or payment bond, each of a surety company qualified to do business under the laws of the commonwealth and satisfactory to the awarding authority and each in the sum of the contract price, the premiums for which are to be paid by the general contractor and are included in the contract price; provided, however, that if there is more than 1 surety company, the surety companies shall be jointly and severally liable. The undersigned hereby certifies that he is able to furnish labor that can work in harmony with all other elements of labor employed or to be employed on the work; that all employees to be employed at the worksite will have successfully completed a course in construction safety and health approved by the United States Occupational Safety and Health Administration that is at least 10 hours in duration at the time the employee begins work and who shall.furnish documentation of successful completion of said course with the first certified payroll report for each employee; and that he will comply fully with all laws and regulations applicable to awards made subject to section 44A. The undersigned further certifies under the penalties of perjury that this bid is in all respects bona fide, fair and made without collusion or fraud with any other person. As used in this subsection the word "person" shall mean any natural person, joint venture, partnership, corporation or other business or legal entity. The undersigned further certifies under penalty of perjury that the said undersigned is not presently debarred from doing public construction work in the commonwealth under the provisions of section twenty-nine F of chapter twenty-nine, or any other applicable debarment provisions of any other chapter of the General Laws or any rule or regulation promulgated thereunder. January 30, 2014 Date By: Builders Systems, Inc. General Bidder) President Sig Pure and Titl of Person Signing Bid imothy ooney 135 Southbridge Street Business Address Auburn, MA 01501 City and State FORM OF GENERAL BID - 2 School Department Administration Building North Andover, MA GENERAL BIDDER'S CHECKLIST: Addenda Recognized Bid Deposit Certificate of Corporate Bidder DCAM Eligibility Update Statement Certificate of Non -Collusion and Certificate of Tax Compliance Certification of Labor Harmony and OSHA Training Requirements FORM OF GENERAL BID - 3 Kang Associates, Inc. January 2, 2014 School Department Administration Building Kang Associates, Inc. North Andover, MA January 2, 2014 CERTIFICATE OF CORPORATE BIDDER Marybeth Looney certify that I am the Secretary of the corporation named as Bidder in the Bid Form, and that Timothy Looney who signed the Bid Form on behalf of the Bidder was then the President of said corporation and that I know his signature; that his signature thereto is genuine and that the Bid Form was duly signed, sealed and executed for and in behalf of said corporation by authority of its governing body. Corporate Seal Se tary-Clerk January 30, 2014 Date CORPORATE BIDDER - 1 CERTIFICATIONS CERTIFICATE OF NON -COLLUSION The undersigned certifies under penalties of perjury that this bid or proposal has been made and submitted in good faith and without collusion or fraud with any other person. As used in this certification, the word "person" shall mean natural person, business, partnership, corporation, committee, union, club or other organization, entity, or group of individuals. Signature Date January 30, 2014 Timothy Looney, President Builders Systems, Inc. Print Name & Title Company Name CERTIFICATE OF TAX COMPLIANCE Pursuant to Chapter 62C of the Massachusetts General Laws, Section 49A (b), I Timothy Looney , authorized signatory for Builders Systems, Inc. Name of individual Name of contractor do hereby certify under the pains and penalties of perjury that said contractor has complied with all laws of the Commonwealth of Massachusetts, and the Town of North Andover, relating to taxes, permit or other fees, reporting of employees and contractors, and withholding and remitting child support. January 30, 2014 Signature Ti4thy Looney_ Date CERTIFICATION LABOR HARMONY AND OSHA TRAINING REQUIREMENTS The undersigned certifies under penalties of perjury that he is able to furnish labor that can work in harmony with all other elements of labor employed or to be employed at the work and that all employees to be employed at the worksite and in the work will have completed an OSHA -approved construction safety and health course lasting at least ten (10) hours. Signature Timothy Looney, President Print Name & Title Date January 30, 2014 Builders Systems, Inc. Company Name CERTIFICATE OF VOTE At a duly authorized meeting the Board of Directors of the Builders Systems, Inc. held on May 7, 2013 it was VOTED,THAT Timothy Looney (Name) of Builders Systems, Inc. President (Officer) be and hereby is authorized to execute contracts and bonds in the name and on behalf of said Builders Systems, Inc. , and affix its corporate seal hereto; and such execution of any contract or obligation in the name of Builders Systems, Inc. on its behalf by such officer under seal of Builders Systems, Inc., shall be valid and binding upon Builders Systems, Inc.. I hereby certify that I am the clerk of the above named Builders Systems, Inc. and that Timothy Looney is the duly elected officer as above of said Builders Systems, Inc. , and that the above vote has not been amended or rescinded and remains in full force and effect as the date of this contract. January 30, 2014 (Date) d (Clerk) Marybeth Looney Certification of the Corporate Clerk School Department Administration Building Kang Associates, Inc. North Andover, MA January 2, 2014 FOREIGN CORPORATIONS CERTIFICATION AFFIDAVIT OF COMPLIANCE Form AF -4A 1/78 EXECUTIVE OFFICE FOR ADMINISTRATION AND FINANCE The Commonwealth of Massachusetts _— Massachusetts Business Corporation Non-profit Corporation Foreign (non -Massachusetts) Corporation Timothy Looney X President Clerk of Builders Systems, Inc. (Name of Corporation) whose principal office is located 135 Southbridge St., Auburn, MA 01501 do hereby certify that the above named Corporation has filed with the State Secretary all certificates and annual reports required by Chapter 156B, Section 109 (Business Corporation), by Chapter 181, Section 4 (Foreign Corporation), or by Chapter 180, Section 26A (non-profit Corporation) of the Massachusetts General Laws. SIGNED UNDER THE PENALTIES OF PERJURY this Signature of responsible Corporate Officer day of January 20 1/4 _ Ti;tj<pthy FOREIGN CORP - 1 DEVAL L. PATRICK GOVERNOR TIMOTHY P. MURRAY LIEUTENANT GOVERNOR The Commonwealth of Massachusetts Executive Office for Administration and Finance Division of Capital Asset Management and Maintenance One Ashburton Place Boston, Massachusetts 02108 Tel: (617) 727-4050 Fax: (617) 727-5363 GLEN SHOR SECRETARY, ADMINISTRATION & FINANCE CAROLE CORNELISON COMMISSIONER Prime/General Certificate of Contractor Eligibility CONTRACTOR IDENTIFICATION NUMBER: 0728 This Certificate Shall Be Used for Submitting Prime/General Bids Only 1. CERTIFICATION PERIOD: This Certificate is valid from 6/26/2013 to 6/26/2014 2. CONTRACTOR'S NAME: Builders Systems, Inc. 3. CONTRACTOR'S ADDRESS: 135 Southbridge St. / P.O. Box 635, Auburn, MA 01501 4. WORK CATEGORIES: This Contractor is certified to file bids under Massachusetts General Laws Chapter 149, i7 Alarm Systems Asbestos Removal 17 Deleading Demolition Q Doors & Windows ❑ Electrical (J Electronic Security Systems S. EVALUATIONS: Chapter 149A and Chapter 25A in the following checked Categories of Work: Elevators Energy Management Systems Exterior Siding J Fire Protection Sprinkler Systems Floor Covering [,/]-General Building Construction W Historical Building Restoration Historical Masonry Historical Painting Historical Roofing []HVAC Masonry Mechanical Systems Modular Construction/Prefab Number of Projects Evaluated: 34 Average Project Evaluation Rating: 95 Number of Projects Below Passing Score: 0 ❑ Painting Plumbing Pumping Stations F71Roofing Sewage & Water Treatment Plants 1]Telecommunication Systems 17 Waterproofing 6. PROJECT LIMITS: Single Project Limit (SPL): $4,049,000.00 Aggregate Work Limit (AWL): $25,000,000.00 General Building Construction Limit: $4,049,000.00 7. SUPPLIER DIVERSITY OFFICE QMIFICATION: N/A 0— �2' . - '6 h � JZ3 Freya S. Bernstein, Deputy General Counsel, Approval Date for Carole J. Cornelison, Commissioner NOTE TO CONTRACTORS: Complete Applications for Renewal of Contractor Eligibility are due no later than three months PRIOR to the Expiration Date of the Certification Period shown above. Failure to submit Completed Applications timely PRvok result in a gap in Certification or a lapse in Certification altogether for your comporny. Reviewer's Initia AIA Document A310T"' -2010 Bid Bond CONTRACTOR: SURETY: (Name, legal status and address) (Name, legal status and principal place Builders Systems, Inc. of business) Travelers Casualty and Surety Company of 135 Southbridge Street This document has important legal Auburn, MA 01501 America, 350 Granite Street, Suite 1201 consequences. Consultation with OWNER: Braintree, MA 02184 an attorney is encouraged with (Name, legal status and address) Town of North Andover, Town Hall respect to its completion ormodification. 120 Main Street Any singular reference to North Andover, MA 01845 Contractor, Surety, Owner or BOND AMOUNT: Five percent (5%) of the enclosed bid other party shall be considered plural where applicable. PROJECT: (Name, location or address, and Project number, if any) Construction of the School Department Administration Building, North Andover, MA The Contractor and Surety are bound to the Owner in the amount set forth above, for the payment of which the Contractor and Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, as provided herein. The conditions of this Bond are such that if the Owner accepts the bid of the Contractor within the time specified in the bid documents, or within such time period as may be agreed to by the Owner and Contractor, and the Contractor either (1) enters into a contract with the Owner in accordance with the.terms of such bid, and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted in thejurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof, or (2) pays to the Owner the difference, not to exceed the amount of this Bond, between the amount specified in said bid and such larger amount for which the Owner may in good faith contract with another party to perform the work covered by said bid, then this obligation shall be null and void, otherwise to remain in full force and effect. The Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in which the Owner may accept the bid. Waiver of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for an extension beyond sixty (60) days. if this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall be deemed to be Subcontractor and the term Owner shall be deemed to be Contractor. When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project, any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein. When so furnished, the intent is that this Bond shall be construed as a statutory bond and not as a mon law bond. Signed and sealed this 30th day of January, 2014 Builders Systems, Inc. (Principa (S"eal) O-Vitness) $_ _ Tr*elers Casualty and (Title) �— Sur y Compan of America C►t,MON:.You sh(wid sign an orfgfttst AIA charimm will not bo obscured. file)) Laurie A. Penniman r Attorney -in -Fact lmhkh this text appears In RED. An original assures that AIA Document A310TM —20110. Copyr]ght O 1963, 1970 and 2010 by The American Institute of Architects. All rights reserved. WARNtkGt This IIIA* I nit. Docwftltt Is prctoned by U.S. C<rpyright Lary srtd International Treatise. Ur4ulhort*d mptroductlon or dt strtbutlon of this AIA* document, of any portion of It, may maautt In severs cfw6 and criminal Wattles, anti will be praseetAed to the maximum extent pasribie corder ifit Law. I Purchasers are permitted to reproduce ten (1o) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright@aia.org. 061110 TH INVALID WITHOUT THE RED BORDER POWER OF ATTORNEY TRAVELERSFarmington Casualty Company St. Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters, Inc. Travelers Casualty and Surety Company of America St. Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St. Paul Guardian Insurance Company Attorney -In Fact No. 226776 Certificate No. 005524946 KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut, that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa, and that Fidelity and Guaranty Insurance Underwriters, Inc., is a corporation duly organized under the laws of the State of Wisconsin (herein collectively called the "Companies"), and that the Companies do hereby make, constitute and appoint Joseph B. Battaini, Darlene F. Beshaw, John J. Cahill, John Kurkulonis, Laurie A. Penniman, and James P. Wentzell of the City of Worcester , State of Massachusetts , their true and lawful Attomey(s)-in-Fact, each in their separate capacity if more than one is named above, to sign, execute, seal and acknowledge any and all bonds, recognizances, conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of.guaranteeing the fidelity of persons, guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. IN WITNESS WHEREOF, the Companies have caused this instrument to be signed and their corporate seals to be hereto affixed, this day of June 2013 Farmington Casualty Company Fidelity and Guaranty Insurance Company Fidelity and Guaranty Insurance Underwriters, Inc. St. Paul Fire and Marine Insurance Company St. Paul Guardian Insurance Company I Oth St. Paul Mercury Insurance Company Travelers Casualty and Surety Company Travelers Casualty and Surety Company of America United States Fidelity and Guaranty Company GASU,� FIRE 6',0 N SNS '1N3�"�'•,, DIY AN Y �' L �e�r, t J O Oar P 4 9 I�pR P°RA)F�i �Po.•APORA o• b" O COHPgiATED r m al . m I m =°° Tf `; d 1 9 81 O 1977 E i --_ . o: a HARTFORD t " HARtFORiI, F t :_ 1951 �`'• S E A Lie oAS w CONN. n , �fgp �N..•'r rg ...�.. ,,A b+ )a+ , ++ State of Connecticut City of Hartford ss. By: '44d Robert L. Raney, enior Vice President On this the 10th day of June 2013 before me personally appeared Robert L. Raney, who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, and that he, as such, being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. G,TET In Witness Whereof, I hereunto set my hand and official sea]. ��AA My Commission expires the 30th day of June, 2016. 58440-8-12 Printed in U.S.A. Marie C. Tetreault, Notary Public WARNING: THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company, which resolutions are now in full force and effect, reading as follows: RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President, any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary may appoint Attorneys -in -Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds, recognizances, contracts of indemnity, and other writings obligatory in the nature of a bond, recognizance, or conditional undertaking, and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her; and it is FURTHER RESOLVED, that the Chairman, the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company, provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary; and it is FURTHER RESOLVED, that any bond, recognizance, contract of indemnity, or writing obligatory in the nature of a bond, recognizance, or conditional undertaking shall be valid and binding upon the Company when (a) signed by the President, any Vice Chairman, any Executive Vice President, any Senior Vice President or any Vice President, any Second Vice President, the Treasurer, any Assistant Treasurer, the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary; or (b) duly executed (under seal, if required) by one or more Attorneys -in -Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED, that the signature of each of the following officers: President, any Executive Vice President, any Senior Vice President, any Vice President, any Assistant Vice President, any Secretary, any Assistant Secretary, and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents, Resident Assistant Secretaries or Attorneys -in -Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof, and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I, Kevin E. Hughes, the undersigned, Assistant Secretary, of Farmington Casualty Company, Fidelity and Guaranty Insurance Company, Fidelity and Guaranty Insurance Underwriters, Inc., St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company, St. Paul Mercury Insurance Company, Travelers Casualty and Surety Company, Travelers Casualty and Surety Company of America, and United States Fidelity and Guaranty Company do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies\whichrs in full force'and`effect and has not been revoked. vk IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seals of said Companies this 3Dffi day of .JanUarY 20 IAF, ' Kevin E. Hughes, Assistant Sec tary G�SUA< VF\RE 4�*N SNS j NSU\'o J �tY ANp Ipb'-"'�Y 11YY'Y ♦ J b �/ P ........A t P 'c F fLtOR PORA)t:Z u' 1 9 S 2�' O 19]% "' m �• . m ` f E 3 cP _. ATf .0 : a MARTFO 1RD� `3 HIRTFOR0. '# a �D �`+ �`.SEALf m c 1896 Z 951 SEALio3 CONN. 00+• 2 N .Y b` NJ � l� 0�".r� cJy''•........ - a�f o.-••.. .: `aD �i a� ��gCr �Oy�,p To verify the authenticity of this Power of Attorney, call 1-800-421-3880 or contact us at www.travelersbond.com. Please refer to the Attorney -In -Fact number, the above-named individuals and the details of the bond to which the power is attached. MARCH 309 2010 Commonwealth of Massachusetts OivEsion of Calital Asset Mang elment PRIMUCENERAL CONTRACTOR UPDATE STATEMENT A COMPLETED AND SIGNED PRIME/GEf�ERAL CONTRACTOR UPDATE STATEMENT MUST BE SUBMITTED WITH EVERY PRIME/GENERAL BID FOR A CONTRACT PURSUA147 TO M.G.L. c.149, g44A AND M.G.L. C. 149A. ANY PRIME/GENERAL BID SUBMITTED WITHOUT AN APPROPRIATE UPDATE STATEMENT IS INVALIDAND MUST BE REJECTED. Caution: This form is to be used for submitting PdmelGenersi Contract bids. It is not to be used for submitting Filed Sub -Bids or Trade Sub -Bids. AWARDING AUTHORITIES If the Awarding Authofrty determines that the bidder does not demonstrably possess the skill, ability, and integrity necessary to perform the work on the project, it must reject the bid. BIDDER'S AFFIDAVIT I swear under the pains and penalties of perjury that I am duly authorized by the bidder named below to sign and submit this Prime/General Contractor Update Statement on behalf of the bidder named belo<iu, that I have read this Prime/General Contractor Update Statement, and that all of the information provided by the bidder in this Prime/General Contractor Update Statement is true, accurate, and complete as of the bid date. January 30, 2014 Bid Date School Department Administration Building Project Number (or name if no number) Town of North Andover Awarding Authority Builders Systems, Inc. Print Name of Prime/General Contractor 135 Southbridge St., Aubum, MA 01501 Business Address 508-798-8797 Telephone Number SIGNATURE Bidder's Timothy Loone Division of Capital Asset 'Management page I of 10 EFFECTIVE PART 1- COMPLETED PROJECTS LIST ALL PUBLIC AND PRIVATE BUILDING PROJECTS YOUR FIRM HAS COMPLETED SINCE THE DATE OF APPLICATION FOR YOUR MOST RECENTLY ISSUED (NOT EXTENDED OR AMENDED) DCAM CERTIFICATE OF ELIGIBILITY. YOU MUST REPORT ALL REQUESTED INFORMATION NOT PREVIOUSLY REPORTED ON YOUR MOST RECENT DCAM APPLICATION* PROJECT TITLE & LOCATION WORK CATEGORY CONTRACT PRICE START DATE DATE COMPLETED DECCO/Intel Cooling Towers G.C. 44,920 2/13 5/13 Berkeley/IRS G.C. 319,925 2/13 5/13 Thompson Island G.C. 636,769 3/13 5/13 Sunovion G.C. 1 40,000 4/13 5/13 Fitchburg State MART West G.C. 147,320 4/13 6/13 Genzyme 4` Floor Train G.C. 571,422 2/13 6/13 Bentley Lacava/Rauch Reno G.C. 43,000 5/13 6/13 LDS Lynnfield G.C. 421,461 7/12 8/13 WPI Gateway 4`" Floor G.C. 97,345 6/13 8/13 WPI Bo on Hall 3d Floor G.C. 212,400 7/13 8/13 Octant/DCU Littleton G.C. 33,000 6/13 7/13 Quinsig CDC Entrance G.C. 271560 6/13 7/13 Bentley Smith Classrooms G.C. 70,000 7/13 8/13 Bentley Adamian Lobby Reno G.C. 70,000 7/13 8/13 Holy Cross Hogan Restrooms G.C. 154,863 5/13 9/13 Holy Cross Brooks Concert Hall G.C. 488,540 5/13 9/13 WPI Higgins Lab 031 & 26 G.C. 499,944 6/13 9/13 UMMHC Lakeside ED Reception G.C. 62,602 9/13 10/13 Quinsig CSET Lab G.C. 111,444 7/13 9/13 UMMC 3d & 5`h Flrs Demo G.C. 230,303 7/13 9/13 Attach additional sheets if necessary *If your firm has been terminated from a project prior to completion of the work or has failed or refused to complete its work under any contract, full details and explanation must be provided. See Part 3 of this Update Statement Division of Capital Asset Management Prime/General Contractor Update Statement Effective March 30, 2010 PROVIDE THE FOLLOWING REFERENCE INFORMATION FOR EACH COMPLETED PROJECT LISTED ON THE PREVIOUS PAGE. PROJECT TITLE COMPANY NAME CONTACT PERSON TELEPHONE Decco/Intel Cooling OWNER DECCO Stuart Hendrie 603-249-7484 Towers DESIGNER Johnson Structural Rob Johnson 508-832-3535 GC Builders Systems Edward Shea 508-798-8797 Berkley IRS OWNER Berkley Mgmnt. Cathy Hamacher 508-890-8885x222 DESIGNER Greg O'Connor Scott Dzik 508-757-1377 GC Builders Systems Kurt Schmucki 508-798-8797 Thompson Island OWNER Thompson Island Arthur Pearson 617-830-5108 DESIGNER Neshamkin French Linda Neshamkin 667-242-7422 GC Builders Systems Christopher Rae 508-798-8797 Sunovion 2"d Floor OWNER Sunovion Bruce St. Pierre 508-357-7720 Offices DESGINER Clifford Hoffman Tom Clifford 617-266-1271 GC Builders Systems Timothy Looney 508-798-8797 Fitchburg State Mart OWNER Fitchburg State Dough Thomas 978-665-4095 West Renovations DESIGNER Kang Associates Heather Crocker 978-443-6383 GC Builders Systems Timothy Looney 508-798-8797 Genzyme 4`h Floor OWNER Genzyme Train DESIGNER M+W Group Chris Ruta 508-480-4706 GC Builders Systems Edward Shea 508-798-8797 Bentley University OWNER Bentley University Debra Burbank 781-264-6371 Lacava/Rauch DESIGNER Lincoln Architects Dan Quaile 781-721-7721 Renovations GC Builders Systems Timothy Looney 508-798-8797 LDS Lynnfeld Roof OWNER LDS Church John Bezzant 603-882-9978 & Sitework DESIGNER Warnick Assoc. Tim Warnick 603-894-5117 GC Builders Systems George Cappoli 508-798-8797 WPI Gateway 4`h OWNER WPI Chris Salter 508-831-6060 Floor Office Fit -up DESIGNER Dave Krom Dave Krom 508-853-3305 GC Builders Systems George Cappoli 508-798-8797 WPI Boynton Hall OWNER WPI Chris Salter 508-831-6060 3rd Floor Reno DESIGNER Dave Krom Dave Krom 508-853-3305 GC Builders Systems George Cappoli 508-798-8797 Octant/DCU OWNER Octant Bus Svcs. Bob Cipriani 508-281-3003 Littleton DESIGNER Dave Krom Dave Krom 508-853-3305 GC Builders Systems Timothy Looney 508-798-8797 Quinsig CDC OWNER Quinsigamond College Don Hall 508-854-4515 Entrance DESIGNER Haynes/Lieneck/Smith Paul Lieneck 978-386-2473 GC Builders Systems Kurt Schmucki 508-798-8797 Bentley Smith OWNER Bentley University Debra Burbank 781-891-2000 Classrooms DESIGNER Lincoln Architects Dan Quaile 781-721-7721 GC Builders Systems Timothy Looney 508-798-8797 Bentley OWNER Bentley University Debra Burbank 781-891-2000 Adamian/Smith DESIGNER Lincoln Architects Dan Quaile 781-721-7721 GC Builders Systems Timothy Looney 508-798-8797 Holy Cross Hogan OWNER Holy Cross Lenny Raymond 508-793-2751 Restrooms DESIGNER Lamoureux Pagano Bill Senecal 508-752-2831 GC Builders Systems George Cappoli 508-798-8797 Holy Cross Brooks OWNER Holy Cross Lenny Raymond 508-793-2751 Concert Hall DESIGNER Lamoureux Pagano Bill Senecal 508-752-2831 GC Builders Systems George Cappoli 508-798-8797 WPI Higgins Lab OWNER WPI Chris Salter 508-831-3305 031 & 026 Reno DESIGNER Masiello Arch Bill Masiello 508-869-0597 GC Builders Systems George Cappoli 508-798-8797 UMMHC Lakeside OWNER UMass Memorial Ryan Burns 508-334-8414 ED Reception DESIGNER SLAM Collaborative David Neal 860-657-8077 GC Builders Systems Kurt Schmucki 508-798-8797 Quinsig CSET Lab OWNER Quinsigamond College Don Hall 508-854-4515 DESIGNER Haynes/Lieneck/Smith Paul Lieneck 978-386-2473 GC Builders Systems Kurt Schmucki 508-798-8797 UMMC 3rd & 5" OWNER UMASS Medical Ctr. Brain Duffy 508-856-3306 Floors Demo DESIGNER UMASS Medical Ctr. Brian Duffy 508-856-3306 GC Builders Systems Kurt Schmucki 508-798-8797 Is your company or any individual who owns, manages or controls your company affiliated with any owner, designer or general contractor named above, either through a business or family relationship? ❑ YES ® NO Are any of the contact persons named above affiliated with your company or any individual who owns, manages or controls your company, either through a business or family relationship? ❑ YES ® NO If you have answered YES to either question, explain. Division of Capital Asset Management Prime/General Contractor Update Statement Effective March 30, 2010 w W 0 Z D U) Q 2 LL w D 00 W UZ W W O 2 02 a0 Z Y O U0 W f- 2 U Z 0= C7 ~ Z W _ 2 J m0 ZZ OW ZZ LL = QO CD co Z �Q m WW Q W i W CL F- CL 0 Q U Z m0 a J Q J � Q �- U) 0 10 0) c 3 O U O O H Y Q' 0 cn C O E O L- a) -0 O 30 c N a) o N M a) a) U i cu a) E > 3 'V a) Q) U (n a) W •«J U t c m1 0 o o E aaa) a)_ 5 p c .S a) c NvCo a) „o O a) >, () = a) co U >,+ 7 (n co c Q O cE��o C N 0 0 U mM c 0 U c UL p O a) N Cfn L O w 0 O a) 0 o v7 E # E } .L W pOOMNOMOMMY-NONOCOr- 00 rl-l-(DO Olt0000(Oo LU LL� 00mmIg00r-N0m0000N N0J Y 0 0' 0 0 0( O C'tr M O L (6 J� 000r Wa N0 0r` I' MO LO 00 LO a' Q w O � 04 00 U') D r Q 0 � > Z U Q Z 0 w z co Q Z } W .. CD O OOMNOMOOM�NONOCD� O r• r` r` 0 O 1- O v 0 0 0 0 0 In OOW 000C' V CQ Or`C'OMOLr 0ON W Z W O O�(DOOCDO d V �N�(OOIn(O J U M x O N— O V- r N r 0 00 T- 0 Lr) 1- d �- M (D r LO 00 In JW2Ln O 3 O U W 0 o 0 0 0 0 0 0 0 0 0 0 0 0 0 o 0 o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 OOCOMNNN-LpN Lf) Il- 000v-0 OJ OOr- N� a)(D 00014-0 �- C40Za �0 00M0)LnMorl- LO000OvLO UU OOM�M�O�OOOOONO[t� Q W OON�T-o000VNOOLnO00N U ONr- MO� 00 V-C)M000N0 O� OOMNNMO 00tf)MCD Ln Z�' tl 0 N L N U W J c v Z ; to a) N ma) to N (L) cn a) 07 a) U (1)(1) U N a) (A a) CA (L) (n a) N a) N a) 07 a) N a) 0 W U z Z W � M( �- Mce) �•- � M r M r M r M r M r� r M r� Q f... Q c r- �- N r M r r N N v- s- e- N • - r M 0 � C' ate- (h e' A ``- c) 0�0 c) M M C' M QQ CT- O � T" MMMMM��M� r•(oo�rn��ao� N �W r��v14-U)w } � Y N U U U U U U U U U U U U U U U U 0 W �Q C�C�C�C�C�C�C�C7C�C�C�C7UC�C�C� U c o to c OO m c N o W o O w -0 X t a) c a) 'D {- Z O _N O N W (�D m D N O cu a) O N U) +- 0 = O 3 .• - tt= CL C O ooc — L.00�a) C'UU :3 0— 0V a)U a)�'O (L) -0 OJ N N 4) tl M fl a) N J 'C °b co '- ca ca v7 3 cn (n Y W U 'o E cu a) m (A CL oQ0 > —h- N UO L) r -0 U p)4 c (D p W O�� O i m)ac�,c �(a c_mec SI 3 — (D Dv) O O O O 0D>LLmm( S .- .L- a) m N <0E (0 0) c 3 O U O O H Y Q' 0 cn C O E O L- a) -0 O 30 c N a) o N M a) a) U i cu a) E > 3 'V a) Q) U (n a) W •«J U t c m1 0 o o E aaa) a)_ 5 p c .S a) c NvCo a) „o O a) >, () = a) co U >,+ 7 (n co c Q O cE��o C N 0 0 U mM c 0 U c UL p O a) N Cfn L O w 0 O a) 0 o v7 E # E } .L PROVIDE THE FOLLOWING REFERENCE INFORMATION FOR EACH INCOMPLETE PROJECT LISTED ON THE PREVIOUS PAGE. PROJECT TITLE COMPANY NAME CONTACT PERSON TELEPHONE Intel Hudson OWNER Intel Corp. Dan Bradbury 978-553-6161 Various DESIGNER Intel Corp. Dan Bradbury 978-553-6161 GC Builders Systems Timothy Looney 508-798-8797 Tufts Administrataion OWNER Tufts Jack McDonald 617-592-4110 Toilet Renovations DESIGNER Spagnolo & Gisness Bill Gisness 617-443-0680 GC Builders Systems Kurt Schmucki 508-798-8797 USPFO Warehouse OWNER Mass Military Div Bill Pentingell 508-233-6550 Renovation DESIGNER SMRT Inc. 978-474-1721 GC Builders Systems George Cappoli 508-798-8797 Soundings West OWNER B1ueGreen Corp. Gary Ehrlich 321-354-6085 Pavilion DESIGNER Dan Dixon Arch. Dan Dixon 407-513-2631 GC Builders Systems Christopher Raye 508-798-8797 West Tisbury Police OWNER West Tisbury Manny Ostrella 508-896-0102 Station DESIGNER Keenan & Kenny John Keenan 508-540-0075 GC Builders Systems Christopher Rae 508-798-8797 Holy Cross OWNER Holy Cross Lenny Raymond 508-793-2751 Millard II DESIGNER Lamoureux Pagano Bill Senecal 508-752-2831 GC Builders Systems George Cappoli 508-798-8797 Soundings OWNER BlueGreen Corp. Gary Ehrlich 321-354-6085 Nantucket Bldg. DESIGNER Dan Dixon Arch. Dan Dixon 407-513-2631 GC Builders Systems Christopher Raye 508-798-8797 UMMHC Kitchen OWNER UMASS Memorial Tom Shomphe 508-793-6501 Hood Exhaust DESIGNER RDK Engineers Tim Curran 413-387-4641 GC Builders Systems Kurt Schmucki 508-798-8797 UMMHC Employee OWNER UMASS Memorial Ryan Burns 508-334-8414 Health DESIGNER HAI Architecture Richard Katsanos 413-585-1512 GC Builders Systems Kurt Schmucki 508-798-8797 Fitchburg State OWNER Fitchburg State Doug Thomas 978-665-4095 Conlon Renovations DESIGNER Bertaux & Iwerks Leonard Bertaux 617-423-6500 GC Builders Systems David Putnam 508-798-8797 Biriyani Pointe OWNER SRI SAI Krupa Venu Gopal 857-272-5527 Restaurant DESIGNER David Krom Dave Krom 508-853-3305 GC Builders Systems Edward Shea 508-798-8797 Bentley University OWNER Bentley University Debra Burbank 781-891-2000 Various DESIGNER Bentley University Debra Burbank 781-891-2000 GC Builders Systems Timothy Looney 508-798-8797 Saint-Gobain 530 OWNER Saint-Gobain Ton Kulakusky 508-795-5832 Entrance DESIGNER David Krom Dave Krom 508-853-3305 GC Builders Systems Timothy Looney 508-798-8797 Allegro Executive OWNER Allegro Rich Higgins 508-855-5000 Office Area DESIGNER David Krom Dave Krom 508-853-3305 GC Builders Systems Kurt Schmucki 508-798-8797 Saint-Gobain Lab OWNER Saint-Gobain Dave Woodbury 508-826-7643 Upgrade DESIGNER Fleshman Arch. Steve Fleshman 508-612-7824 GC Builders Systems George Cappoli 508-798-8797 Fitchburg Senior OWNER Town of Fitchburg Joan Goodwin 978-829-1791 Center DESIGNER Haynes/Lieneck/Smith Paul Lieneck 978-386-2473 GC Builders Systems David Putnam 508-798-8797 Is your company or any individual who owns, manages or controls your company affiliated with any owner, designer or general contractor named above, either through a business or family relationship? ❑ YES ® NO Are any of the contact persons named above affiliated with your company or any individual who owns, manages or controls your company, either through a business or family relationship? ❑ YES ® NO If you have answered YES to either question, explain. Division of Capital Asset Management Prime/General Contractor Update Statement Effective March 30, 2010 PART 3 - PROJECT PERFORMANCE For Parts 3 and 4, if you answer YES to any question, please provide on a separate page a complete explanation. Information you provide herein must supplement the Application for your most recently issued (not extended or amended) DCAM Certificate of Eligibility. You must report all requested information not previously reported on that DCAM Application for Prime/General Certificate of Eligibility. Include all details (project name(s) and location(s), names of all parties involved, relevant dates, etc.]. YES NO 1. Has your firm been terminated on any contract prior to completing a project or has ❑ any officer, partner or principal of your firm been an officer, partner or principal of another firm that was terminated or failed to complete a project? 2. Has your firm failed or refused either to perform or complete any of its work under ❑ z any contract prior to substantial completion? ❑ 3. Has your firm failed or refused to complete any punch list work under any contract? 4. Has your firm filed for bankruptcy, or has any officer, principal or individual with a ❑ Z financial interest in your current firm been an officer, principal or individual with a financial interest in another firm that filed for bankruptcy? 5. Has your surety taken over or been asked to complete any of your work under any ❑ Z contract? 6. Has a payment or performance bond been invoked against your current firm, or has ❑ any officer, principal or individual with a financial interest in your current firm been an officer, principal or individual with a financial interest in another firm that had a payment or performance bond invoked? 7. Has your surety made payment to a materials supplier or other party under your ❑ payment bond on any contract? 8. Has any subcontractor filed a demand for direct payment with an awarding authority ❑ for a public project on any of your contracts? 9. Have any of your subcontractors or suppliers filed litigation to enforce a mechanic's ❑ Z lien against property in connection with work performed or materials supplied under any of your contracts? 10. Have there been any deaths of an employee or others occurring in connection with ❑ z any of your projects? 11. Has any employee or other person suffered an injury in connection with any of your ❑ projects resulting in their inability to return to work for a period in excess of one year? Division of Capital Asset Management Page 7 of 10 Prime/General Contractor Update Statement Effective March 30, 2010 PART 4 - Legal or Administrative Proceedings; Compliance with Laws Please answer the following questions. Information must supplement all judicial and administrative proceedings involving bidder's firm, which were instituted or concluded (adversely or otherwise) since your firm's Application for your most recently issued (not extended or amended) Certificate of Eligibility. You must report all requested information not previously reported on that DCAM Application for Prime/General Certificate of Eligibility. The term "administrative proceeding" as used in this Prime/General Contractor Update Statement includes (i) any action taken or proceeding brought by a governmental agency, department or officer to enforce any law, regulation, code, legal, or contractual requirement, except for those brought in state or federal courts, or (ii) any action taken by a governmental agency, department or officer imposing penalties, fines or other sanctions for failure to comply with any such legal or contractual requirement. The term "anyone with a financial interest in your firm" as used in this Section "I", shall mean any person and/or entity with a 5% or greater ownership interest in the applicant's firm. If you answer YES to any question, on a separate page provide a complete explanation of each proceeding or action and any judgment, decision, fine or other sanction or result. Include all details (name of court or administrative agency, title of case or proceeding, case number, date action was commenced, date judgment or decision was entered, fines or penalties imposed, etc.). YES NO 1. Have any civil, judicial or administrative proceedings involving your firm or a ❑ principal or officer or anyone with a financial interest in your firm been brought, concluded, or settled relating to the procurement or performance of any construction contract, including but not limited to actions to obtain payment brought by subcontractors, suppliers or others? 2. Have any criminal proceedings involving your firm or a principal or officer or ❑ anyone with a financial interest in your firm been brought, concluded, or settled relating to the procurement or performance of any construction contract including, but not limited to, any of the following offenses: fraud, graft, embezzlement, forgery, bribery, falsification or destruction of records, or receipt of stolen property? 3. Have any judicial or administrative proceedings involving your firm or a principal ❑ or officer or anyone with a financial interest in your firm been brought, concluded, or settled relating to a violation of any state's or federal procurement laws arising out of the submission of bids or proposals? 4. Have any judicial or administrative proceedings involving your firm or a principal ❑ or officer or anyone with a financial interest in your firm been brought, concluded, or settled relating to a violation of M.G.L. Chapter 268A, the State Ethics Law? Division of Capital Asset Management Page 8 of 10 Prime/General Contractor Update Statement Effective March 30, 2010 PART 4 - Legal or Administrative Proceedings; Compliance with Laws (continued) YES NO 5. Have any judicial or administrative proceedings involving your firm or a principal ❑ or officer or anyone with a financial interest in your firm been brought, concluded, or settled relating to a violation of any state or federal law regulating hours of labor, unemployment compensation, minimum wages, prevailing wages, overtime pay, equal pay, child labor or worker's compensation? ❑ 6. Have any judicial or administrative proceedings involving your firm or a principal or officer or anyone with a financial interest in your firm been brought, concluded, or settled relating to a violation of any state or federal law prohibiting discrimination in employment? ❑ 7. Have any judicial or administrative proceedings involving your firm or a principal or officer or anyone with a financial interest in your firm been brought, concluded, or settled relating to a claim of repeated or aggravated violation of any state or federal law regulating labor relations? ❑ 8. Have any proceedings by a municipal, state, or federal agency been brought, concluded, or settled relating to decertification, debarment, or suspension of your firm or any principal or officer or anyone with a financial interest in your firm from public contracting? 9. Have any judicial or administrative proceedings involving your firm or a principal or ❑ officer or anyone with a financial interest in your firm been brought, concluded, or settled relating to a violation of state or federal law regulating the environment? 10. Has your fine been fined by OSHA or any other state or federal agency for ❑ violations of any laws or regulations related to occupational health or safety? Note: this information may be obtained from OSHA's Web Site at www.osha.gov 11. Has your firm been sanctioned for failure to achieve DBE/MBE/WBE goals, ❑ workforce goals, or failure to file certified payrolls on any public projects? 12. Other than previously reported in the above paragraphs of this Section I, have any ❑ administrative proceedings or investigations involving your firm or a principal or officer or anyone with a financial interest in your firm been brought, concluded, or settled by any local, state or federal agency relating to the procurement or performance of any construction contract? Are there any other issues that you are aware which may affect your firm's F ❑ responsibility and integrity as a building contractor? Division of Capital Asset Management Page 9 of 10 Prime/General Contractor Update Statement Effective March 30, 2010 PART 5 - SUPERVISORY PERSONNEL List all supervisory personnel, such as project managers and superintendents, who will be assigned to the project if your firm is awarded the contract. Attach the resume of each person listed below. PART 6 - CHANGES IN BUSINESS ORGANIZATION OR FINANCIAL CONDITION Have there been any changes in your firm's business organization, financial condition or bonding capacity since the date your current Certificate of Eligibility was issued? ❑ Yes ® No If YES, attach a separate page providing complete details. PART 7 — LIST OF COMPLETED CONSTRUCTION PROJECTS SUBMITTED TO THE DIVISION OF CAPITAL ASSET MANAGEMENT. Attach here a copy of the list of completed construction projects which was submitted with your firm's DCAM Application for your most recently issued (not extended or amended) DCAM Certificate of Eligibility. The Attachment must include a complete copy of the entire Section G - "Completed Projects" and the final page - "Certification" (Section J) containing the signature and date that the Completed Projects list (Section G) was submitted to the Division of Capital Asset Management. Division of Capital Asset Management Page 10 of 10 Prime/General Contractor Update Statement Effective March 30, 2010 PART 5 - SUPERVISORY PERSONNEL Timothy Looney 2012 - Present President and Treasurer of Builders Systems, Inc. 2002-2012 Treasurer and Clerk of Builders Systems, Inc. 1999-2002 Vice President of Builders Systems, Inc. 1987-1999 Sr. Construction Supt./Estimator/Sales Engineer of Builders Systems, Inc. 1974-1987 General Superintendent for Builders Systems, Inc. 1972- 1974 Roofing Contractor ■ Has been in Construction for 39 years ■ Has been in Supervisory Capacity for 37 years ■ Has been with this firm 37 years ■ Licensed Construction Supervisor #031550 George Cappoli 2004 - Present Vice President of Builders Systems, Inc. 1996 —2004 Project Manager for Builders Systems, Inc. 1987- 1996 General Superintendent for Builders Systems, Inc. 1980- 1987 Residential Contractor 1975- 1980 Exhibit & Millwork Contractor ■ Has been in Construction for 36 years ■ Has been in Supervisory Capacity for 36 years ■ Has been with this firm 24 years ■ Licensed Construction Supervisor #008597 Kurt Schmucki 2012 — Present Vice President of Builders Systems, Inc. 1999-2012 Project Manager for Builders Systems, Inc. 1988- 1998 General Superintendent for Builders Systems, Inc. 1985- 1988 Construction Superintendent - CP Construction ■ Has been with this firm 23 years ■ Has been in Supervisory Capacity for 23 years ■ Licensed Construction Supervisor #062922 Christopher Rave Presently Branch Manager of Builders Systems, Inc., Sandwich, MA 1993-1999 General Superintendent for Builders Systems, Inc. 1990- 1993 Residential Construction ■ Has been with this firm 18 years ■ Has been in Construction for 21 years ■ Has been in Supervisory Capacity for 18 years ■ Licensed Construction Supervisor #063913 David Putnam Presently Project Manager for Builders Systems, Inc. 1991 -2006 General Superintendent for Builders Systems, Inc. 1989-1991 Lead Carpenter 1984- 1989 Residential Contractor ■ Has been with this firm 22 years ■ Has been in Construction for 28 years ■ Licensed Construction Supervisor #062850 Edward Shea Presently Project Manager for Builders Systems, Inc. 1996-2012 Site Manager/Superintendent for Builders Systems, Inc. at Intel Corp. 1994- 1996 Carpenter Foreman for Builders Systems, Inc. 1984- 1989 Carpenter Foreman — Longden Co., Inc. 1979- 1982 Lead Forman — U.S. Dismantling & Equipment Corp ■ Has been with this firm 19 years ■ Has been in Construction for 35 years ■ Licensed Construction Supervisor #CS64034 Marybeth Looney Presently Secretary/Clerk and Operations Manager of Builders Systems, Inc. 2011 -2012 Operations Manager of Builders Systems, Inc. 2009-2011 Head Nurse, CMG Urology/UMass Medical Center 2006-2009 Head Nurse/Office Manager, Hahnemann Urology 2003-2006 Staff Development Coordinator, Worker's Comp Manager, Radius Health Care Center 2002-2003 Unit Manager, Alzehimer's Unit, Radius Health Care Center 1997-2002 Staff Nurse, Long Term Care Unit, Radius Health Care Center 1982-1997 Office Manager, Worcester Family Institute — Cedar Associate ■ Worcester State College, Bachelor of Science in Nursing ■ Salter Secretarial School, Medical Secretarial Program Christine Ziarko 6/89 - Present Receptionist/Secretary for Builders Systems, Inc. 1985 -5/89 Administrative Assistant, Real Estate Department, Shawmut Bank 1983- 1985 Sales Secretary, L. Hardy Company 1979- 1983 Assistant to President, L.S. Miller, Inc. mo m m m m vt m D A I'�rvti". = U .. .... uN Eu S? u a m= - _ ¢ 5.? 5? m m Jy = E m d 17 a� uu n - r rc »^, z " 3 u m m 3 y:• �:�� �� N N N N � o ^ n o' o H n r o - a a "a a a a M+=- "'sb" •� C O A N ^ N N N N N N N N N ^ � � C � � ,'� �.•. S r o a s s S N ry � ry _ r � � � c � � -` o o o om u S vi ' � m r 16 !F��Y. '1D.�•�-`- N N O m cd 52 Y. y rr O a O •�".:. ..yam i-yy- a N N N 0 Q O01 ��VV CC C cc C C co S T; mE I; m =�.•;y�,,:�Iy-"-•-4tl • o• c V c V c c �j c V c V c d u° ° m u' m m u c ' d u c A u° C Om u c d U' c do m U' c d u' c m v u' c u E o w U c w U c e v c um c U Sa"�c•�-'�r � �'�: Ud' 0 �j (7 O O Ud 0 O t7 O Um' O (9 Um' O (7 O (9 (7 C7 t7 (7 - J�-�a�•..:-: z P u D u °m �'y�w +5::x•3• �'�`` 2 ¢ < m p �o c ZN m o c v o ^ 4 � _ ° n m' '^ - � °c � <{.,q:.'•eG^- I%nyr'<�` - N m 21 �;^.71w�`-,^moi•-�,'z'.-.;��=» �4'�"� i ; 3 a` � ¢ u `'I u a c7 � ^ mE u `•rte 'c.. `a x }uxW e z ° LL �^;�w Me* �..m Y J 1 C. �. •} I 3 - -Y' I ul =j.•„—nom,.: N e o n - s, .. e m v v 16 W � eS'�C'.. 'Y� (":•�;y�: �r m � Iml Dm o m m Dm n � Dm Dm m -'�-`•�`�. 'r .:: •w �.. �� m - n o e o o 0 0 a a a a a � '�""�;:�-i" •' a a a a a a a a a a x a a a a � ;;"'��..•'� m `""4`'•%--; 3 rn � � v 3 g m - c q m 3 3 w " 3 3 3 3 ;. S - .,4 •X .' _ o - m L `' �� 11 c G u i- c e e e e c s - e yv R'v x1 7m, �•.s�i-.�+-ir �. _ je +k.' � _.. '• xA = = � m � "f�,M��. - E u c U a e � c � � o o C � p -a `'•�..' {+-•ti "_l_• :s.n i (� m m p m m m ` - y a > i O O e O m H N N 4 v -e' 33 '- w�•e � ✓. C um O O O O O m O m O 0 p D 0 O O O O O O Oi O V O 1011 O O YOi O O - - = - - � •.',+tic, _ c 'i27`o;.J C m ^ q q =c C a W L ' e e a' S 1' 4: I =a � e V -E 2 E :S S O V ciciodid �..:: z✓- Ems:::-,. w Fid u c Zo m c U O j c s>l 3 Aim fcie O O o ^ i ci"ci0 Ilk O O n O o 16 J. Certification (notarization reqaired) The undersigned, TimothyLoonev hereby certifies: (type name) That I am an owner or principal of Builders Systems Inc; (company name) and that all answers and all statements contained in the attached application (including Sections F and G) for certificate of eligibility are complete, true and correct. Providing false or misleading information or failure to provide all required information will be considered grounds for denial, decertification and/or debarment. I attest to the accuracy of all information contained in this application and verify that the information submitted is in fact complete, accurate and true, under oath. Signed and Sworn under the Pains and Penalties of Perjury. Dated at March 5, 2013 This 5". day of March, 2013. By (signature): Type name: Title or position: President WOWS--, i }—y5, ss. (county) (state) Before me, Ck1Z\s7l+-. Pr-�2�£�� iT", personally appeared and (notary public) known to me to be 1 i Mm \7-k-1 LooNe: ,based (name of officer) on satisfactory evidence which was his/her driver's license and acknowledged that he/she is authorized to execute the foregoing and that its execution is his/her free act and deed and the free a7 deed of th LW My commission expires: 5 , 2u+ S (notary pub c signature) :CINtlgTME A. � Con�ononwe�aeMa rent name t*Cam�bn60ue . **Upon completion of this Application and the two c Excel spreadsheets, sage and email them to CertificationApislication.dcam a state.ma.us ** Page 16 of 16 Prime/General Revised March 2011 Computer