HomeMy WebLinkAboutContract #: 004673 - From: To: - Exception - Exception9
(�C_r'i,Sie K
School Department Administration Building Kang Associates, Inc.
North Andover, MA January 2, 2014
FORM OF SUB -BID
To All General Bidders Except those Excluded:
A. The undersigned proposes to furnish all labor and materials required for completing, in accordant
with the hereinafter described plans, specifications and addenda, all work specified in �q51�
bi a6MP UL of the specifications and in any plans specified in
such section, prepared by Kang At4ociates, Inc. for the School Department Administration
Building,North Andover, MA for the contract sum of:
Gi it ix17 / %� Ila s A l � / 61
($ ).
For Alternate #1: ► /
Deduct $ dollars ($ ® ).
For Alternate #2:
Deduct $ V dollars ($ ® ).
For Alternate #3:
Deduct $ dollars ($ Q )
For Alternate #4:
Deduct $ V dollars ($
For Alternate #5:
Deduct $
B. This sub -bid includes addenda numbered 1
C. This sub -bid
❑ may be used by any general bidder except:
dollars ($
❑ may only be used by the following general bidders:
(To exclude general bidders, insert an "X" in one box only and fill in blank following that box. Do not
answer C if no general bidders are excluded.)
FORM OF SUB -BID - 1
School Department Administration Building
North Andover, MA
Kang Associates, Inc.
January 2, 2014
D. The undersigned agrees that, if he is selected as sub -bidder, he will within five days, Saturdays,
Sundays, and legal holidays excluded, after presentation of a subcontract by the general bidder
selected as the general contractor, execute with such general bidder a subcontract in accordance
with the terms of this sub -bid, and contingent upon the execution of the general contract, and, if
requested so to do in the general bid by such general bidder, who shall pay the premiums therefor,
or if pre -qualification is required pursuant to section 44D 3/4, furnish a performance and payment
bond of a surety company qualified to do business under the laws of the Commonwealth and
satisfactory to the awarding authority in full sum of the subcontract price.
E. The names of all persons, firms and corporations furnishing to the undersigned labor or labor and
materials for the class or classes or part thereof work for which the provisions of the section of the
specifications for this sub -trade requires a listing in this paragraph, including the undersigned if
customarily furnished by persons on his own payroll and in the absence of a contrary provisions in
the specifications, the name of each such class of work or part thereto and the Bid price for such
class of work or part thereof are:
Name Class of Work Bid Price
i
(Do not give bid price for any class or part thereof furnished by undersigned.)
F. The undersigned agrees that the above list of bids to the undersigned represents bona fide bids
based on the hereinbefore described plans, specifications and addenda and that, if the undersigned
is awarded the contract, they will be used for the work indicated at the same amounts stated, if
satisfactory to the awarding authority.
G. The undersigned further agrees to be bound to the general contractor by the terms of the
hereinbefore described plans, specifications, including all general conditions stated therein, and
addenda, and to assume toward him all the obligations and responsibilities that he, by those
documents, assumes toward the owner.
H. The undersigned offers the following information as evidence of his qualifications to perform the
work as bid upon according to all the requirements of the plansandspecifications:
1. Have been in business under present business name years.
2. Ever failed to complete any work awarded? �jy
3. List one or more recent buildings with names of the general contractor and architect on which
you served as a subcontractor for work of similar character as required for the above named
buildings.
,,BF0uil`di cl,U"1 I_— Architect eneral Contractor Amount of Cont act
(a)
1 A7 hi
rR90 Iq I M&
FORM OF SUB -BID - 2
School Department Administration Building
North Andover, MA
(b)
(c)
,.
4. Bank reference
Kang Associates, Inc.
January 2, 2014
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 of subcontracts subject to section
44F.
The undersigned further certifies under penalties of perjury that this sub -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.
flpuiAr)b
Date (Name of Sub -Bidder)
By
;�%�
Sig turand Title of Person Signing Bid
MQ.Vij n )W pwijw
VW6'1(L Du vii
Business Address
SUB -BIDDER'S CHECKLIST:
Addenda Recognized
'Bid Deposit
DCAM Certificate of Eligibility
Sub -Bidder Update Statement
Certificate of Corporate Bidder
City and State
FORM OF SUB -BID - 3
School Department Administration Building
North Andover, MA
CERTIFICATE OF CORPORATE BIDDER
Kang Associates, Inc.
January 2, 2014
certify that I am the
I
Cof the corporation named as Bidder in the
Bid Form, and that BVI n l mw who signed the Bid Form on
behalf of the Bidder was then the ffiLAA 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
&JA *At44
Secretary -Clerk
"-1 /I A�d
Date
CORPORATE BIDDER - 1
The Commonwealth of Massachusetts
Executive Office for Administration and Finance
Division of Capital Asset Management and Maintenance
One Ashburton Place
Boston, Massachusetts 02108 GLEN SHOR
DEVAL L. PATRICK Tel: (617) 727-4050 SECRETARY, ADMINISTRATION &
GOVERNOR -' FINANCE
Fax: (617) 727-5363
TIMOTHY P. MURRAY CAROLE CORNELISON
LIEUTENANT GOVERNOR COMMISSIONER
Filed Sub -Bid
Certificate of Contractor Eligibility
CONTRACTOR IDENTIFICATION NUMBER:8�¢1
This; C este Shall Be Used for Submitting Filed Sub -Bids Only
1. CERTIFICATION PERIOD: This Certificate is valid from 4/10/2013 to 4/10/2014
2. CONTRACTOR'S NAME: Acoustek, Inc.
3. CONTRACTOR'S ADDRESS: 20 Ventura Drive, North Dartmouth, MA 02747
4. WORK CATEGORIES: This Contractor is certified to file bids under Massachusetts General Laws Chapter 149,
Chapter 149A and Chapter ZSA In the following checked Categories of Work:
R'/ Acoustical Tile
Electrical Work
❑ Elevators
Fire Protection Sprinkler Systems
❑ Glass and Glazing
S. EVALUATIONS:
6. SUPPLIER
❑ HVAC ❑ Miscellaneous & Ornamental Iron
❑ Lathing & Plastering ❑ Painting
❑ Marble ❑ Plumbing
❑ Masonry Work ❑ Resilient Floors
❑ Metal Windows ❑ Roofing & Flashing
Number of Projects Evaluated: 15
Average Project Evaluation Rating: 94
Number of Projects Below Passing Score: 0
Taxan
for Cake J.
❑ Terrazzo
❑ Tile
❑ Waterproofing, Damp
proofing, and Caulking
rIFICATiON: N/A
�Df3
Counsel, Approval Date
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 CeaUkcation Period shown above. failure to submit Completed Applications timely may
result in a gap in Certification or a lapse in Certifxation altogether for your company.
Reviewer's Initials
Liberty
MUtUg,, The Ohio Casualty Insurance Company
SURETY BID OR PROPOSAL BOND
KNOW ALL MEN BY THESE PRESENTS, That we, Acoustek, Inc.
of 20 Ventura Drive, N Dartmouth,MA 02747
(hereinafter called the Principal) as Principal, and The Ohio Casualty Insurance Company with its principal
office in the City of Keene New Hampshire (hereinafter called the Surety), as Surety, are held and
firmly bound unto Town of North Andover
of 120 Main Street, N Andover, MA 01845
(hereinafter called the Obligee) in the penal sum of 5% of Bid
Dollars lawful money of the United States, for the payment of which sum well and truly to be made,
we bind ourselves, our heirs, executors, administrators, successors, and assigns.
THE CONDITION OF THIS OBLIGATION IS SUCH, that whereas, the Principal has submitted the accompanying
bid dated 1-21-2014 for Furnish & Install Acoustical Ceilings
New School Department Administration Bldg., 566 Main Street, N Andover, MA.
NOW, THEREFORE, if the Obligee shall make any award according to the terms of said bid and the Principal shall
enter into a contract with said Obligee in accordance with the terms of said bid and give bond for the faithful performance
thereof within the time specified; or if no time is specified within thirty days after the date of said award; or if the Principal
shall, in the case of failure so to do, indemnify the Obligee against any loss the Obligee may suffer directly arising by reason
of such failure, not exceeding the penalty of this bond, then this obligation shall be null and void: otherwise to remain in full
force and virtue.
Signed, sealed and dated: 1-17-2014
Acouste ,
(Principal)
B �
Kevin Elsn - President
The Ohio Casualty-triprance Company
By:
Lora H. Lowe - President (Attorney -in -Fact)
S -137 -Rev.
Principal: Acoustek, Inc.
Obligee: Town of North Andover
POWER OF ATTORNEY Agency Name: SOUTHEASTERN INSURANCE
TIM OHIO CASUALTY INSURANCE COMPANY AGENCY
Agent Code: 206174
Bond Number:
Know All Men by These Presents: That THE OHIO CASUALTY INSURANCE COMPANY, a New Hampshire Corporation, pursuant to the authority granted by
Article IV, Section 12 of the Code of Regulations and By -Laws of The Ohio Casualty Insurance Company, do hereby nominate, constitute and appoint: Kathleen S. Nightlinger,
Karen Bernier, Joanne Bretton, Lora H. Lowe of DARTMOUTH , Massachusetts its true and lawful agent(s) and attomey(ies)-in-fact, to make, execute, seal and deliver for
and on its behalf as surety, and as its act and deed any and all BONDS, UNDERTAKINGS, and RECOGNIZANCES, excluding, however, any bond(s) or undertaking(s)
guaranteeing the payment of notes and interest thereon.
And the execution of such bonds or undertakings in pursuance of these presents, shall be as binding upon said Company, as fully and amply, to all intents and purposes, as if they
had been duly executed and acknowledged by the regularly elected officers of said Company at their administrative offices in Keene, NH, in their own proper persons. The
authority granted hereunder supersedes any previous authority heretofore granted the above named attomey(ies)-in-fact.
In WITNESS WHEREOF, the undersigned officer of the said The Ohio Casualty Insurance Company has hereunto subscribed his name and affixed the Corporate Seal
of said Company this 18th day of November, 2013.
�ZY INS/
,,p
021919Wa r �`
NA MP`'�
David M. Carey, Assistant Secretary
STATE OF PENNSYLVANIA
COUNTY OF MONTGOMERY
On this 18th day of November, 2013 before the subscriber, a Notary Public of the State of Pennsylvania, in and for the County of Montgomery, duly commissioned and qualified,
came David M. Carey, Assistant Secretary of The Ohio Casualty Insurance Company, to me personally known to be the individual and officer described in, and who executed the
preceding instrument, and he acknowledged the execution of the same, and being by me duly sworn deposes and says that he is the officer of the Company aforesaid, and that the
seal affixed to the preceding instrument is the Corporate Seal of said Company, and the said Corporate Seal and his signature as officer were duly affixed and subscribed to the said
instrument by the authority and direction of the said Corporation.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal at the City of Plymouth Meeting, State of Pennsylvania, the day and year first above
written.
el' Psr
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
OF
Teresa Pastella, Notary Public
Plymouth Twp., Montgomery County
v My Commission Expires March 28, 2017
Member, Pennsylvania Association of Notaries Notary Public in and for County of Montgomery, State of Pennsylvania
,
�Py My Commission expires March 28, 2017
This power of attorney is granted under and by authority of Article IV, Section 12 of the By -Laws of The Ohio Casualty Insurance Company, extracts from which read:
ARTICLE IV - Officers: Section 12. Power of Attorney.
Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject to such limitation as the Chairman or President
may prescribe, shall appoint such attorneys -in -fact, as may be necessary to act in behalf of the Corporation to make, execute, seal, acknowledge and deliver as surety any and all
undertakings, bond, recognizances and other surety obligations. Such attomeys-in-fact, subject to the limitations set forth in their respective powers of attomey, shall have full
power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed, such instruments shall
be as binding as if signed by the President and attested to by the Secretary.
Any power or authority granted to any representative or attorney-in-fact under the provisions of this article may be revoked at any time by the Board, the Chairman, the President
or by the officer or officers granting such power or authority.
This certificate and the above power of attorney may be signed by facsimile or mechanically reproduced signatures under and by authority of the following vote of the board of
directors of The Ohio Casualty Insurance Company effective on the 15th day of February, 2011:
VOTED that the facsimile or mechanically reproduced signature of any assistant secretary of the company, wherever appearing upon a certified copy of any power of attorney
issued by the company in connection with surety bonds, shall be valid and binding upon the company with the same force and effect as though manually affixed.
CERTIFICATE
I , the undersigned Assistant Secretary of The Ohio Casualty Insurance Company, do hereby certify that the foregoing power of attorney, the referenced By -Laws of the Company
and the above resolution of their Board of Directors are true and correct copies and are in full force and effect on this date.
IN WITNESS WHEREOF, I have hereunto set my hand and the seal of the Company this 17 day of January 12014
�SY INS/"
hJ poRPo�r y
2 `�o m
o Z 1919 0
� HAMP�'a ,aa
Gregory W. Davenport, Assistant Secretary
a
UPDATE UATEMENT
A COMPLETED AND SIGNED SUB- BIDDER UPDATE STATEMENT MUST BE
SUBMITTED WITH EVERY FILED SUB -BID PURSUANT TO M.G.L. c.149, §44F AND
EVERY TRADE SUB -BID PURSUANT TO M.G.L. C. 149A. ANY FILED SUB -BID OR
TRADE SUB -BID SUBMITTED WITHOUT AN APPROPRIATE SUB -BIDDER UPDATE
STATEMENT IS INVALID AND MUST BE REJECTED.
Caution; This form is to be used for submitting filed Sub -Bids and Trade
Sub -Bids. it is = to be used for submitting Prims/General Contract bids.
if the Awarding Authority determines that the sub -bidder Is not competent to perform
the work as specMed on the project, it should reject the bid.
SUB -BIDDER'S AFFIDAVIT
1 swear under the pains and penalties of per}ury that I am duly authorized • by the bidder
named below to sign and submit this Sub -bidder Update Statement on behalf of the bidder
named below, that I have read this Sub -bidder Update Statement, and that all of the
information provided by the bidder in this Sub -bidder Update Statement is true, accurate, and
complete as of the bid date.
L: L AWusteek.Inc
aroject
L Print Name of Sub -bidder or Trade Contractor
,1v n ; h MA 747
I Address
'�YII nl�itimber Business
name if no number)
Aw rding Autho�� Telephone Number
SIGNATURE0
Bidder's uthorlod Representative
Page t of 10
Division of Capital Abet Management
U
Nm
O�
WN
W�
J wo
aZ
�W
UQ
Qcc
10
2W
CC
M W
580
H 0
cr
=2
H
ON
20
OJ
$z
oW
g
�
O0
U2
Wnmm
292
a.mm
WLLS2
QJ
BZW
a�C
QW
Q (L
U%U.
Q_
U. F-
2
4' W 0
<OW
O
0
0
a
W
U
Z.
N=
Cy
W^
�W
aZ
OW
UQ
Q�
=O
�W
cc U
UL ;z
UJ
�x
OW
O
SZ
CC
QQQWv
O on
00
O -�
$Z
W
U
�Q
LL
00
H2
¢OJ
a¢m
QOM
LL�
ZW
�O
¢F:O
a
QW
CL
:3 UQ LL_
co
aWU
QpW
couu
NISD
m
O
0
o�
a
W
S
H
O
w
J
U
3
W
W
J
CLI
U
UQ
W
O
LL
O
Q
O
Z
U
W
ccW
LL
ujS
Z
O
OW
LL O
�a
O�
a�
as
0
0
a�
a
cc
CY
CM
9
�
ti
ti
co.
°�
m
�
�
�
m
�
a
m
co
�
co
UJ
..
m
CL
r
P
v
ro
0
til
_
cc
Q
W
CL
N
t
u
a'
s
r
�$
..
N
a
N
c
W
Z�Z
w
�cn�c7�3m
1Q
W
Z
('
I
W
Z
(rj
Q
W
CG
Z
t7
W
uu��IIz
Z
�?
W
C7
W
a
Z
O
tV'3
Z
O
tU'3
Z
CV7
Z
U
O
O
C7
Ul)
O
Q
O
W
O
N
o
H
a
0
0
a�
a
w
Z
O
W
W
O
a
W
U
U
6
crO
LL
O
Q
O
z
U
W
W
W
z
O
J
OW
wCO
a
DO
o I
as
vo 0
o
b.
c o
� E
c
fsz jZ
® �®
a N N
�a c
t
�G E
8
E •IA m
t a� w
o
CA
to
LUG
V
8 �
fs
�8 a8
O
CO)
cmc,
N
Al•
m
N
r
Os
a
r°D.
cq
14
a
N
m
Iq
2
O
m
ui
a
a
ani
EW-•
U
S
r
LP
o
m
--
`
O
O
a
a
W
t3
U_
U
F
c
c
_
Wm
�}
z
Z
QQ
Q
2
C7
Q
2
C7
Ir
W
Q
Z
U
Q
z
U
2
z
Ub
Z
Z
Z
L7
Z
G
(U70
t
O
C7
Z
C�
O
CSO
CV7
m
Wr
c
CL
IL
CL
_
a
Z
a
vo 0
o
b.
c o
� E
c
fsz jZ
® �®
a N N
�a c
t
�G E
8
E •IA m
t a� w
o
CA
to
LUG
V
8 �
fs
�8 a8
O
Z
O
F-
H
2
O
a
Q
�W
OU
}2
Q�
wCC�
0
03
O =
$�-
NW
U.
Ow
UQ
3 0
OZ
mi
w 3
Q0
>N
2Nw
a
Q�
v6
Jw
�it
aw
Jd
Q�
J F�
MISx
W
H
8
g
C�N
00
Q
O
C
V- N
N
co W
co
Ncc
Q
e
..
P
c
a
a
o
Z
O
Q
Q
F -
Z
0
Q
a
Q
crw
}2
Qwa
H�
Wks
OY
O
2
a:3
0gg=
O�
NW
69 _
OW
UQ
W 0
QW
iLS
H;,o
QO
>N
oL N
o.
W
Q�
U�
JW
Co CC
aW
Q
J F -
O
UJ
8
g
x
8
��s$
ul
8
S
coi�
S
�OWoW�g
�
c
g
NCY
G}'
N N
pO
CV
N N
co w
I
Fw�
r
H�
ug
I
CL
J m
i
3
0�
_
O
U
N
i
_
c
m
�
�
c
0
N
O
$
m
�
�
r
�
C
m
La
~
Lq
O
No
�Z
co
3Z
N
i
_
c
m
�
�
c
N
O
$
m
�
�
�
C
m
�
O
No
�Z
co
3Z
$ a
PL
c
m
c
m
E�
w�
o
CL
.0
E
Tr
C
c�
c
co
mt
w
o
m
c.
�
� c
o,
o
28
ad
T
=
PART 3 - PROJECT PERFORMANCE
For Parts 3 and 49 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) Sub -Bidder
Certificate of Eligibility. You must report all requested information not previously
reported on that Application. Include all details (project names) 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
3. Has your firm failed or refused to complete any puncli list work under any contract?
4. Has your firm filed for bankruptcy, 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 filed for bankruptcy?'
5. Has your surety taken over or been asked to complete any of your work under any
El
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
pay;ppat or performance bond invoked?
7. Has your surety made payment to a materials supplier or other party under your
payment bond on any contract?
S. Has any subcontractor filed a demand for direct payment with an awarding authority
fora public project on any of your contracts?
9. Have any of your subcontractors or suppliers filed litigation to enforce a mechanic's
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
any of your ro'ects?
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
Page 7 of 10
Division of Capital Asset Management 01 Q
Sub -bidder Update Statement Effective March 30, 2
p.4RT 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) Sub -Bidder Certificate of Eligibility. You must report all requested
information not previously reported on that DCAM Application.
The term dind' as used in this Sub -Bidder 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
t state or federal courts, or (H) any action taken
requirement, except for those brought � in s other
or
by a governmental agency, department or officer imposing penalties, fines,
or
sane dons for failure to comply with any such legal or contractual requirement.
The term ' =0 Wi a fi.,e....;�1 inters t in YQlir fire, as used in this Section -r,
shall any person and/or entity with a 596 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 detain (name'date action was commenced,
f court or administrative
agency, title of case or proceeding,se
ca
date judgment or decision was entered, tines or penalties imposed, etc.). YES NO
1. Have any civil, judicial or administrative proceedings involving your firm or a L
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
subcontracto su Tiers or others?
2, Have any erirainal proceedings involving your firm or a principal or officer or
d, or settled
anyone with a financial interest is your firm been
brought,
on contract including,
relating to the procurement or perforraaa�ce �•yfraud, graft, embezzlement,
but not limited to, any of the following
fore bribe falsification or destruction of records or receipt of stolen ro rt ?
involving your firm or a principal
3. Have any judicial or administrative pmeeedin8s our firm been brought, concluded,
or officer or anyone with a financial interest in Y Procurement laws arising
or settled relating to a violation of any state's or federal
out of the submission of bids or r involving your firm or a principal
4. Have any judicial or administrative proceedings
or officer or anyone with a .financial interestI— -zLAF� yam=A,firm the State Ethic Law?ed,
Page 8 of 10
Oiviaion of Capital Asset Mana9em''t
SO409r UPdate Statement Effeews 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 off cef 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 com nsation?
6. Have any judicial or administrative proceedings involving your firth 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 em to ent?
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 regxdating 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
YVAiY
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 re Latin the environment?
10. Has your
firm 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. ov
11. Has your firm been sanctioned for d eachieve on BE/Many P IW o' Pa s,
workforce owls or failure to file � � of this Section I, have any
12. Other than previously reported in the above paragrap
administrative proceedings or investigations ou°l�g_be n brought, concludedal �or
officer or anyone with a financial interest in� relating to the procurement or
settled by any local, state or federal agency
rformance of any construction contract?
7.-ztor?Are there any other issues that you am aware which may affect your firm's
snd intmmity as a buildin
Page 9 of 10
Division of Capital Asset � E ftcM �� 30, 2010
Sub -bidder Update
PART 5 - SUPERVISORY PERSONNEL
Ust all supervisory personnel who will be assigned to the project I 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 deteiis.
PART 7 — UST OF COMPLETED CONSTRUCTION PROJECTS SUBMITTED TO
THE DIVISION OF CAPITAL ASSET MANAGEMENT ALONG WITH
CERTIFICATION PAGE.
Attach here a copy of the list of completed construction projects which was submitted with your
firm's Application for your most recently issued (not extended or amended) Sub -Bidder
Certificate of Eligibility. The Attachment must include a complete copy of the entire Section F —
"Completed Projects" (Section G —"Completed Projects" for firms certified based upon their
Prime/General Application), and the final page — "Certification Page", (Section I in the Sub -bidder
Application or Section J in Prime/General Application) containing the signature and date that the
Completed Projects list (Section F or G) was submitted to the Division of Capital Asset
Management.
Division of Capital Asset agement
Page 10 of 10
Sub -bidder Update Statement Effeetwe March 30, 2010
ACOUSTEK,INC5
20 Ventura Drive • North Dartmouth. MA 02747
Tet: (508) 995.9563 • Fax: (508) 995-9582
KEVIN ELSNER
Ldl 1975.1914
New 9edtOrd regional vocational Technical High Schoo
l
NeW Bedtord, MA
Graduate.. Electricoi Major
war= f'Aa ; 1964. 1994 Plastering. portm0uth. MA
Cope Cod tothering 3
Carpenter 1984. 1991
Responsible for instoiling acoustico, ceilings.
metol Studs and drywall
Corpenter Foreman 1991 • 1994
Responsible for oft field operations including doily lops. layout and project
scheduling and monoged crews from 3 to 9 carpenters.
Completed Projects ton IOK to 1 OOK
1994.19"
Century Drywall- Lincoln. RI
Corpenter • Foremon
Responsible for oil field operations• project scheduling and managed crews ff0m
310 35 carPenters.
Completed Projects from IOK to 01
t99q • Present
ACoustek, Inc. Dorimouth. MA
Owner. lreosurer, i tcse dpot�a t, President
Resp
onsible for o rations• estimating and finonc'�ol decisions.
Parnola Martin
1 Schoolhouse lane Apt. 1, Dartmouth. MA 02747
Voice. 1.774.930.0222
Objective: To obtain a position utilizing abilities developed through experience with
opportunity for growth based on performance.
Experience: 1988 • ZMe Asdmk+idmW " General Contractor o Secretary Dartmouth, MA
Bonk and General ledger Reconciliation
Accounts Receivables / Payables
Payroll / W2's 11099 Forms / Year End Reconciliation
Account Summaries
President's Personal Red Estate - Income / Payables and Reconciliation's
Job Cost
Project Manager / Estimator Assistant
Purchase and Change Orders
Proposals
AIA Documents
Notary Public
Customer Relations
1988 • Present East COOst Form Co., Inc No. Dartmouth, MA
Me Adn+inl4tr4ter • teokkeeper • Corporate 8e00"
Bonk and General ledger Reconciliation
Accounts Receivables / Poyables
Payroll / W2's / 1099 Forms / Year End Reconciliation
Account Summaries
Job Cost
Project Manager / Estimator Assistant
Purchase and Change Orders
Proposals
AIA Documents
Notary Public
Customer Relations
2004 • Present U Mobile E`o �pnt Services No. Dartmouth. MA
BanReconciliation
n Receivables blob eation
2007 - Present A�nistrotor bookkeeper-
rtmouth, MA
OMtce Corporate Secretary
A
Bank and General ledger Reconciliation
Accounts Receivables ./ Payobles
Payroll / W2's / 1099 Forms / Year End Reconciration
Account Summaries
President's Personal Real Estate in Cost / Payables and Reconciliation's
Job
Project Manager / Estimator Assistant
Purchase and Change Orders
Proposals
AIA Documents
Notary Public
Customer Relations
Educotbn: 1987 Graduate Dartmouth High School Accounting 1 and 2
1988 Fisher Junior College, College Accounting 1 and 2
QuickBooks Pro
CF Data / Structure Software
Microsoft Word / Excel
References: Fernandes & Charest PC Bruce Fernandes 508.636.6556
Joe Vargas East Coast Inc. dent President
l 508 98913818.932.2225
Kevin Eisner Acoustek, I
Louie Bronco Souza & Bronco Electric 508.999.2414
. E. Projects in Progress
List all building construction projects your firm has in process on this date that are at least $20,000. Do
not list projects with contract value% of less than 520,000. If your firm has more than ten (10) projects in
process on this date, please re%trict your list to the ten (10) oldest contracts still in process. information on
randomly seletted projects is not acceptable. Answer all questions. When listing Categories of Work,
refer to categories requested on page 7 of this Application for Sub -Bidder Certificate of Eligibility and list
all relevant Categories of Work which your firm performed with its own employees for each project. With
respect to single contracts involving multiple categories of work, provide a dollar breakdown attributable
to each category listed. Do not list highway, bridge, tunnel, sewer, site work, or other horizontal projects
that do not involve buildings. Attach additional sheets, if necessary.
Project Title:Otis ANG Digital Ground Station
Enter all appropriate Categories) of Work and
include a dollar breakdown for each category:
Category 1) Acoustical Tile 578.000.00
Category 2) <click here> S
Category 3) <click here> $
Category 4) <click here> 5
Total Contract Amount: $78,000.00
Project Location (city & %tate):Bvurne. MA
Start / End dates:12/1/20111 / 3/112011
Percent Complete: 10 %
owner: USPFOfar Mas.%achuxelta
Contact PersonJean GreenwtNxl
Telephone Number] .508.233.6663
Fax Number:] .508.233-6691
Mailing Address:50 Maple Street Mi/j04
MA 01757
General Contractor or Designer:Ei0colt
Constructors
Contact Person: Cynthia Kostinden
Telephone Number: 1.781.246.1175
Fax Number:l.781.279.9941
Mailing Addre%s:591 North Avenue, Door B
Wakef eld, MA 01880
.sub -Bidder Application Jute 16, 2008
Computer
2. Project Title:Tisbury Emergency Service
Facility
Enter all appropriate Categories) of Work and
include a dollar breakdown for each category:
Category 1) Acoustical Tile 532,000.00
Category 2) <click here)- S
Category 3) %click here)- S
Category 4) <chck here)- S
Total Contract Amount: $32,000.00
Project Location (city & state): Vineyard Haven,
MA
Start / End dates:12/l/2010 / 2/1/2011
Percent Complete: 5 %
Owner: Town of Tisbury
Contact PersonJohn Rugbee
Telephone Number:1.508.696.4203
Fax Number:1.508.693.5876
Mailing Address:51 Spring Street Vineyard
Haven, MA 02568
General Contractor or Designer:Seaver
Construction
Contact Person:Kenneth DellaCroce
Telephone Number:1.781.935.0130
Fax Number: 1. 781-935-0048
Mailing Address:57 Russell Street, r. Floor
Woburn, MA 01801
Page 10 of 23
E. Projects in Progress (continued)
3. Project Titlethatham Police 1 Town Hall
Enter all appropriate Categories) of Work and
include a dollar breakdown for each category:
Category 1) Acoustical Tile 3119,800.00
Category 2) <click here> S
Category 3) <click here> $
Category 4) <click here> S
Total Contract Amount: S89,8IX).00
Project Location (city & state):Chadwi?4 MA
Start / End dates:9/1/2011121112011
Percent Complete: 40 %
Owner:Town of Chatham
Contact Person: William Hinchty
Telephone Number: 1.508.945.5101)
Fax Number: 1. 508.945.3550
Mailing Address:549 Main Street Chatham, MA
01633
General Contractor or DesignerZonsigh
Construction
Contact PersonJohn Hinckle
Telephone Number:1.508.473.2580
Fax Number: 1.508.473.3588
Mailing Address: 72 Sumner Street Milford MA
01757
Sub.Bidder Apptiution June 16, 2M
Computer
4. Project Title:
Enter all appropriate Catagorie(s) of Work and
include a dollar breakdown for --ach category:
Category 1) <click here> S
Category 2) <click here> S
Category 3) cclick here> S
Category 4) <click here> S
Total Contract Amount: S
Project Location (city & state):
Start / End dates: I
Percent Complete: 9b
Owner:
Contact Person:
Telephone Number:
Fax Number:
Mailing Address:
General Contractor or Designer:
Contact Person:
Telephone Number:
Fax Number: .
Mailing Address:
Page 11 of 23
F. Compkted Projects
List all building construction project% of at least $20,04 which your firm bas completed within the past
three years or the ten (10) most recent projects completed within the past three years that are at least
520,000. Do not list projects with contract value.% less than $20,000. Inforiaation on randomly selected
projects is not acceptable. Note. when listing Categories of Work, refer to the categories requested on
page 7 of this Application for Sub -Bidder Certificate of Eligibility. List all relevant Categories of Work that
your firm performed with its own employees for each project. With respect to single contracts involving
multiple categories of work, provide a dollar brakdown attributabie to each category listed. Do not list
highway, bridge, tunnel, sewer, site work, or other horizontal projects that do not involve buildings. Attach
additional sheets, if necessary.
Project Title -.Stop & Shop 0460
Enter all appropriate Categories) of work and
include a dollar breakdown for each category:
Category 1) Acoustical Tik $44,317-50
Category 2) <click here, S
Category 3) <click here, S
Category 4) <click here> S
Total Contract Amount: $44,317.50
Project Location (city & %tate)Acton, .MA
Start / End dates -8/l/2010 / 1111/2010
OwnerStop de Shop Companies
Contact Per%onArthur Joubert
Telephone Number]
Fax Number: 1.617.770.6229
Mailing Address:13.85 Hancock Street Quincy,
MA 02169
General Contractor or De%ignerThemeh
Bulders, Inc
Contact PersonJack Leary
Telephone Number: 1.50X.420.9209
Fax Number: 1.508.429.9255
Mailing Address:44 Boy10011 Road Hodistin,
MA 01746
SutrBidder Applicadoe luac 16.1008
r.owputer
2. Project Title:Stop do Shop 0057
Enter all appropriate Categories) of Work and
include a dollar breakdown for each category:
Category 1)Acoustical Tile $45,575.00
Category 2) <click here> S
Category 3) <click here> S
Category 4) <click here, S
Total Contract Amount: 545,575.00
Project Location (city & state):Grafton, MA
Start / End dates:8/1/2010 / 11-01-2010
Owner:Stop do Shop Companies
Contact PersonArthw Joubert
Telephone Number:1.617.770.8612
Fax Number:1.617.770.6229
Mailing Address:1385 Hankeosck Street
Quincy, MA 02169
Page 13 of 23
General Contractor or Designer:Ntmny
Construction
Contact PersonJim Chadwick
Telephone Number: 1.508.339.4747
Fax Number:1.508.339.4743
Mailing Address:905B South Main St, STE 204
Mansfield, MA 02048
F. - Completed Projects ("B'"u")
;3. Project TitleSedford Town Critter
Enter all appropriate Categories) of Work and
include a dollar breakdown for each category:
Category 1) Acoustical Tile $25,375.00
Category 2) <click here> S
Category 3) <click here> S
Category 4) <click here> S
Total Contract Amount: $25,375.00
Project Location (city & state)Idiford, MA
Start / End dates:9/1!2010 / 10/112010
Owner:Town of Bedford
Contact Person:Ron Scaltretc�
Telephone NumberI781.275.5290
Fax Number:). 781-275.H429
Mailing Address:10 Hudge Way Bedford, MA
01730
General Contractor or DesignerA & M
Construction, Inc.
Contact Persson:Donald Geralanra
Telephone Number1.781.246.5788 ext. 206
Fax Number:]. 781,246.0315
Mailing Address:36 West Water Street
Wakefield, MA 01880
.%b -Bidder ApPUcAdOR JOB* 16, 2008
Computer
4. Project Title:Stop & Shop 0721
Enter all appropriate Categories) of Work and
include a dollar breakdown for each category:
Category 1) Acoustical Tile 546,000.00
Category 2) <click here> S
Category 3) <click here> S
Category 4) <click here> $
Total Contract Amount: $4600.00
Project Location (city & state):Smithfield, RI
Stan / End dates:6/l/2010 18/112010
Owner:Stop & Shop Companies
Contact PersonArthur Joubert
Telephone Number: 1.617.770.8706
Fax Number:1.617.770.6229
Mailing Addres0385 Hancock Street Quincy,
MA 02169
General Contractor or Designer: Torrey
Company
Contact Person: Tim Doyle
Telephone Number: 1.508.695.6005 ext. 238
Fax Number1.508.695.2123
Mailing Address:25 Messenger Street
Plainville, MA 02762
Pop 16 of 23
ComplaW Projatf (continued)
5. Project Title:Stop & Shop 493
Enter all appropriate Categories) of Work and
include a dollar breakdown for each category:
Category 1) Acoustical Tilr $39,000.00
Category 2) <click here> S
Category 3) <click here> S
Category 4) cclick here> S
Total Contract Amount: 539,000.00
Project Location (city & state):Darmulk MA
Start / End dates: 7/112010 / 811120 10
Owner:Stop & Shop Companies
Contact PersonArthurJoubert
Telephone NumberJ.617-770.8706
Fax Number: 1.617.770.6229
Mailing Address:1385 Huncock Street Quincy,
MA 02169
General Contractor or Designer:Old New
England Construction
Contact Person:Kelky DiLeu
Telephone Number:1.508.533.6000
Fax Number: 1.508.513.6055
Mailing Address:153 Main Street Medway, MA
02053
Sub -Bidder AppliestiON Juae Ilk WS
Computer
6. Project Title:Stop & Shop 427
Enter all appropriate Categories) of Work and
include a dollar breakdown for each category:
Category 1) Acoustical Tile $30,000.00
Category 2) <click here)- S
Category 3) cclick here)- S
Category 4) <click here> S
Total Contract Amount: $30,000.00
Project Location (city & state):Fairhaven, MA
Start / End dates:6/1/2010 r 7/1/2010
Owner:Stop & Shop Companies
Contact PersonArthur.loubert
Telephone Number: 1.617.770.8706
Fax Number:1.617.770.6229
Mailing Address:1385 Hancock .Street Quincy,
MA 02169
General Contractor or Designer: Torrey
Company
Contact Person:Mark Doran
Telephone Number: 1.508.692.6005 ext. 247
Fax Number: 1.508.695.9695
Mailing Address:25 Messenger Street
Plainville, MA 02762
Page 17 of 23
F.
Completed Projects (continued)
7. Project Title:Camp Edwards Barracks
Enter all appropriate Categories) of Work and
include a dollar breakdown for each category:
Category 1) Acoustical Tile 536,501.(X1
Category 2) <click here> S
Category 3) <click here> S
Category 4) <click here> S
Total Contract Amount: S36,501.00
Project Location (city & state):Buurne. MA
Start 1 End dates:5/1/2010 J 61112010
Owner:Commonwealth of MA National Guard
Contact Person:Paul Cacchioth
Telephone Number:1.508.233.6593
Fax Number: 1.508.233.7357
Mailing Address:50 Maple Street Milford, MA
01757
General Contractor or Designer:Contractors
Network
Contact Person:Dan Guyette
Telephone Number: 1.508.336.2825
Fax Number: 1.508.336.2826
Mailing Address: 190 Touton Avenue Seekonk
MA 02771
Sub -Bidder Application June 16.2008
Computer
8. Project Title:
Enter all appropriate Categorie(s) of Work and
include a dollar breakdown for each category:
Category 1) <click here), S
Category 2) <click here> S
Category 3) <click here> $
Category 4) <chck here), S
Total Contract Amount: S
Project Location (city & state):
Start J End dates: I
Owner:
Contact Person:
Telephone Number:
Fax Number:
Mailing Address:
General Contractor or Designer:
Contact Person:
Telephone Number:
Fax Number:
Mailing Address:
page 18 of 23
F. Completed Project: (continued)
9. Project Title:Hanover Senior Center
Enter all appropriate Categorie(s) of Work and
include a dollar breakdown for each category:
Category 1) Acoustical Tile S20,(XV.00
Category 2) cclick here> S
Category 3) cclick her" S
Category 4) cclick here> S
Total Contract Amount: S20,000.00
Project Location (city & state)-Hanover,MA
Start / End dates:3/1/2010 / 41112010
Owner1own of Hanover
Contact Person:Daniel Matta
Telephone Number:1.781.826.2261
Fax Numbec].781.826.7499
Mailing Address:530 Hanover Street Haitnver,
MA 01339
General Contractor or Designer:Seaver
Construction
Contact PersonJohn Johansson
Telephone Number:]. 781.935.0130 ext. 11
Fax Number: 1. 781-935.048
Mailing Address:57 Russell Street 2" Floor
Woburn, MA 01801
Sub -Bidder ApplicSOM Just 16,2=
Cbmputer
10. Project Title:229 Waterman Street
Enter all appropriate Categories) of Work and
include a dollar breakdown for each category:
Category 1) Acoustical Tile $37,975.00
Category 2) cclick here> S
Category 3) <click here> S
Category 4) <click here> S
Total Contract Amount: 537,975.00
Project Location (city & sta►e):E. Providence,
RI
Start / End dala:3/1/2010 / 41112010
Owner:R! Acquisitions
Contact Person:Dave Leiton
Telephone Number:1.401.273.8600
Fax NumberJ.401.273.9678
Mailing Address:10 Memorial Drive STE 901
Providence, 8102903
General Contractor or Designer:DF Pray
General Contractors
Contact Person:Mike Carter
Telephone Number: 1.508.336.3366 ext. 143
Fax Number: 1.508.336.3384
Mailing Address:25 Anthony Street Seekonk,
MA 02771
Page 19 of 23
F. • Completed "acts (¢oetiautd)
9. Project Title:Marion Police Station
Enter all appropriate Categories) of Work and
include a dollar breakdown for each category:
Category 1) Acoustical Tile $24,000.00
Category 2) <click here> S
Category 3) <click here> S
Category 4) cclick here> S
Total Contract Amount: $24,000.00
Project Location (city & state):Marivn, MA
Start I End dates:5/1/2010 / 61112010
Owner:Town of Marion
Contact Person:Paul Dawson
Telephone Number: 1.508.748.3520
Fax Number: 1.508.748.2825
Mailing Address:2 Spring Street Marion, MA
01738
General Contractor or Designer:BC
Construction
Contact PersonJonathan Scully
Telephone Number:1.781.246.4232
Fax Number: 1. 781.246.3414
Mailing Address:P 0 Box 277 Wakefield, MA
01880
Sutr.O"r APPIkAtW .lust 16, 2008
Computer
10. Project Title:North Brookfield Police
Enter all appropriate Categories) of Work and
include a dollar breakdown for each category:
Category 1) Acrostical Tile 523,030.00
Category 2) <click here> S
Category 3) cclick here> S
Category 4) <click here> S
Total Contract Amount: $25,050.00
Project Location (city & state):Brookf eld, MA
Stan / End dams:3/1 /2010 / 41112010
Owner1own of North Brookfield
Contact PersonIeslie Burton
Telephone Number:].508.867.0200
Fax Number:1.508.867.0249
Mailing Address:215 North Main Street North
Brookfield MA 01535
General Contractor or Designer:P & P General
Contractors
Contact Person:Robert Puchalskie
Telephone Number: 1.508.943.4074
Fax Number:1 .508. 949.2690
Mailing Address:P 0 Box 518 Webster, MA
01370
page iP of 23
I. Certification (notarization required)
The undersigned, Kevin Elsner hereby certifies:
(type name)
That I am an owner or principal of Acoustek Inc.
(company name)
and that all answers and all statements contained in the attached application (including Sections E and
F) for certificate of eligibility are 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 accurate and true, under oath.
Signed and Sworn under the Pains and Penalties of Perjury.
Dated atjj��Djj artmouth. MA
This L�T'day of , 114
By (signature):
Print name: Kevin Elsner
Title or position: President
, r��I ss.
(county) (state)
Before me, m�l� �� personally appeared and
(notary public)
known to me to be Awn P ,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 act
and dee o the firm.
My commission expires: _ ( "'�4/5
(notary public signature)
PAMELA JEAN MARTIN
�"tl'YID 1�. d' I /l,►l' rl Notary Public
(print name) I OMMONWEALTHOFMASSACHUSETTS
My Commission Expires
June 04, 2015
** Upon completion of this Applica IN wo corresponding Excei Sp' readsheets, save
and email them to CertificationAoulication.dcam(&state.ma.us a*
Page 14 of 14
Sub -Bidder Application March 2011
Computer