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HomeMy WebLinkAboutContract #: 004739 - From: To: - Exception - Exception%11 School Department Administration Building North Andover, MA FORM OF SUB -BID To All General Bidders Except those Excluded: Kang Associates, Inc. January 2, 2014 A. The undersigned proposes to furnish all labor and materials required for completing, in accordance with the hereinafter described plans, specifications and addenda, all work specified in © -I . � 0.0 d of the specifications and in any plans specified in such section, prepared by Kang Associates, Inc. for the School Department Administration Building,North Andover, MA for the contract sum of: �Va,, � tl (��1�O�A �CU?,n Vyr�iplG2-8 dollars ($ � For Alternate #1: Deduct $ �7 dollars ($ For Alternate #2: Add/ Deduct $ dollars ($ For Alternate #3: Deduct $ dollars ($ For Alternate #4: Deduct $ ® dollars ($ For Alternate #5: Deduct $ dollars ($ B. This sub -bid includes addenda numbered C. This sub -bid ❑ may be used by any general bidder except: ❑ 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 (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 plans and specifications: 1.. Have been in business under present business name —0 years. 2. Ever failed to complete any work awarded? NO 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. Building Architect . General Contractor Amount of Contract VIOt'01'iuN lapis- OVI CON (a) �Al .fn s1 Tirl - �1 R 0 SkAFFfc1z f�\')\ 1Nb cowST_ Inc cl foo FORM OF SUB -BID - 2 School Department Administration Building North Andover, MA 3 (c) 4. Bank reference Kang Associates, Inc. January 2, 2014 Sa\J,,AG>_S INN- V4400-,(4 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. 1--13— z-01 Li Date SUB -BIDDER'S CHECKLIST: Addenda Recognized Bid Deposit DCAM Certificate of Eligibility Sub -Bidder Update Statement Certificate of Corporate Bidder 0 �ycn_q_ �(XNIfn� okA co r\lfGn C (Name of Sub -Bidder) By: Eaw %,_� Signature and Title of Person Signing Bid Zl J L� �ctrrr\ Ra -0. Business Address Vino,r� `() e�SS o l � City and State FORM OF SUB -BID - 3 School Department Administration Building North Andover, MA CERTIFICATE OF CORPORATE BIDDER TO Kang Associates, Inc. January 2, 2014 certify that I am the QM)V� of the corporation named as Bidder in the Bid Form, and that �Q�I�LLI� ��"►� who signed the Bid Form on behalf of the Bidder was then the �� �'��' 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 1 Secretary -Clerk 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. Rl�---) ) -Z,&,71Signature �W Date � `JI QrNrn)(,k (3 (�N —�� S1��C�) ��%2Nft PP)tVTlt" CANO C0f(Z0(7/t)( /N(, Print Name & Title Company Name CERTIFICATE OF TAX COMPLIANCE Pursuant to Chapter 62C of the Massachusetts General Laws, Section 49�}A (b), I q (�S m o_ � V R Nkt , authorized signatory for 0 9)lm e YiA}n I n an� Gnk , �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. yj?ttl S:2v- Signature )-13 J� l 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 V,—W QKpu(_ 13��1ti' -�ii� X19 cls Print Name & Title Date �c�rn�, �a�n'►n�� cNnt! ��nl�cic`��►e� t� C- �i Company Name United. Cas'uAty and Surety Insurance Company Bond N.U.C180j".­ 6: KNOW ALL MEN BY THESE PRESENTS, that we O'BYRNE PAINTING AND CONTRACTING, INC. 21 OLD FARM ROAD WAYLAND MA 01778 as Principal, hereinafter called the Principal, and UNITED CASUALTY AND SURETY INSURANCE COMPANY of 1250 Hancock Street, Suite 803N, Quincy, Massachusetts 02169, a corporation duly organized under the laws of the State of Massachusetts as Surety, hereinafter called the Surety, are held and firmly bound unto TOWN OF NORTH ANDOVER OFFICE OF TOWN MANAGER 120 MAIN STREET NORTH ANDOVER, MA 01845 as Obligee, hereinafter called the Obligee, in the sum of NOT TO EXCEED 5 % OF ATTACHED BID ----DOLLARS ($----) for the payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has submitted a bid for NEW SCHOOL DEPARTMENT ADMINISTRATION BUILDING NOW, THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a Contract with the Obligee in accordance with the terms of such bid, and give such bond or bonds as may be specified in the bidding or Contract Documents with good and sufficient surety for the faithful performance of such Contract and for the prompt payment of labor and material furnished in the prosecution thereof, or in the event of the failure of the Principal to enter such Contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exceed the penalty hereof between the amount specified in said bid and such larger amount for which the Obligee 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. Signed and sealed this 13th of January 2014 O'BYRNE PAINTING AND CONTRACTING, INC. { �! Cness UN TED CASUALTY AND SURETY INSi1PCOIYtPi2�� =�� '9"_ Witness v SEAL t 0rn = Todd S. an v '?9Att8 n- p OC) �� ��ti , gCHUS•. daJ� JC&S Power No: UC18653 UNITED CASUALTY AND SURETY INSURANCE COMPANY QTANCY, MASSACHUSETTS POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That UNITED CASUALTY AND SURETY INSURANCE COMPANY, a corporation of the Commonwealth of Massachusetts, does hereby make, constitute and appoint Todd S. Carrigan is true and lawful Attorney -in -Fact, with full power and authority, for and on behalf ofthe Ccimpauy as surety, to execute and deliverand affixthe ;cal ofthe. Company thereto, if a seal is required, bonds, undertakings, recognizances, consents of surety or otherwritten obligations in the nature :hereof, as follows: Any and all bonds, undertakings, recognizances; consents of surety or other written obligations in the nawre thereof and to bind UNTIED CASUALTYAND SURETY INSURANCE COMPANY, thereby, and all of the acts of said Attorney -in -Fact pursuant to hese presents, are hereby ratified and confirmed - This power of attorney is signed and sealed by facsimile under and by authority ofthe following Resolutions adopted by the Board of Directors of UNITED CASUALTYAND SURETY INSURANCE COMPANY at a meeting duly called and held on the l° day of July, 1993 which Resolutions are now in full force and effect: Resolved that the President, Trcasu=r, or Semeraty be and they arc her by authorized and empowered to appoint Anomeys-in-Fact of the Company, in its came and as its acts, to execute and aclmowledge far and on its behalf as Surety any and all bonds, recogairmccs, contracts of indemnity waivers of citation and all other writings obligatory in the naturcthere4 with power to atmch thereto the seat ofthe Company. Any suchwritings so executed by such Artorneys-in-Fact shall be binding upon the Company as if they had been duly executed and acknowledged by theregulady elected Officers ofthe Company in their own proper persons. This power of attorney is signed and sealed by facsimile under and by the authority of the following Resolution adopted by the Board of Directors of UNITED CASUALTYAND SURETY INSURANCE COMPANY, at a meeting duly called and held on the 1" day of July,1993: that the signature of any officer and, rizcd by Resolutions of this Board and the Company seal may he acrd by farsuwie to any powmof-Varney or special power of mnmey or certification of either given for the execution of any band, undertaking, recognizance or other written obligation in the nawre-ihereof such signature and seal, ivbeo so used being hereby adopted by the Company as the original si mature of such officer and the original seal ofthe Company, to be valid nod binding upon the Company with the same farce and effect as though manually affixed. 1 11 1 I f f IN WITNESS WHEREOF, UNITED CASUALTY AND SURETY INSURANCE -COMPANY has caused�iQ `O�jig�ed by its proper officer and its corporate seal to behereunto affixed this 14th day ofJuly, 2010. �,�, GOR. S UNITED CAS U AND SURETY INSURANCE COMPANY EA1 1993'o� y Todd S_ Carrigan,CHUs�� ` a Commonwealth of Massachusetts, County of SufFolk ss-- On s:On this 14th day ofJuly in the year 2010 before me personally came Todd S. Carrigan tome known, who, being by me tdu y sworn, did depose and say_ that he resides in the Commonwealth of Massachusetts; that he is President of UNITED CASUALTYAND SURETY INSURANCE COMPANY the corporation described in and which executed the above instrument; that he signed his name thereto by the above quoted authority; that he lmows the seal of said corporation; that said seat affixed to said instrument is such corporate seal, and that it was so -affixed by authority of his office under the by-laws of said corporation / Caitlin L Flanagan I Notary Public Commonwealth of Massachusetts My•Commtssian Expires Notary Public 95MMIS I, Timothy M_ Carrigan, Treasurer of UNITED_ CASUALTY AND SURETY INSURANCE COMPANY, certify that the foregoing power of attorney, and the above quoted Resolutions of the Board -of Directors of July 1, 1993 have not been abridged or revoked and are now in full farce and effect Signed and sealed by its proper officer and its corporate seal to be hereunto affixed this day, 13th day of January, 2014 Timothy M_ Canig T assurer TO CONFIRM AUTHENTICITY OF THIS BOND OR DOCUMENT CALL (800) 829-2663 The Commonwealth qfMassa,j?,,jsett8 Executive Office for Administration awl P;nance A Division of'Capital Asset.lVlunagement anc Uointenance OneAshburion I'lace Bosion, Massachusetts 02 108 DEVAL L. PATRICK GLEN SHOR GOVERNOR Tel: (6/7) 727--4050 SECRETARY, ADMINISTRATION & TIMOTHY P. MURRAY hlx: (617) 727-5363 FINANCE LIEUTENANT GOVERNOR CAROLE CORNELISON COMMISSIONER Filed Sub -Bid Certificate of Contractor Elig. 1) 11 ity CONTRACTOR IDENTIFICATION NUMBER: 2762 ThILCertificate Shall Be Used for Subnilttine Filed S!t -.?,Jds Only 1. CERTIFICATION PERIOD: This Certificate is valid from 7/l:./:;D13 to 7/11/2014 2, CONTRACTOR'S NAME: O'Byrne Pailitilig & Contractlnj;, Inc, 3. CONTRACTOR'S ADDRESS: 6 Lodge Road,'Wayland,MA 4, WORK CATEGORIES: This Contractor is Certified to file bids unto FP I! ssachusetts General Laws Chapter 149, Chapter 149A and Chapter 25A In the foll(v?li il checked Categories of Work: - ,'AcousticalTile HVAC Miscellaneous & C na i cental Iroo Terrazzo :J Electrical Work Lathing &PIustering V Printing Tile ;Elevators I Fire Protection Sprinkler Systems Marble Masonry Work 'I'lurnbing Waterproofing, Damp Gloss and Glazing Metal Windows -.1 Resilient Floors Roofing & Floshin proofing, and Caulking S. EVALUATIONS: Number of Projects Lvaltinted: Average Project F.-Voluation Rating: 98 Number of Projects Below Passing Seo rt it 6. SUPPLIER DIVERSITY OFFICE CERTIFICATION: N/A �— Freya D st Ber S. nein, Deputy Gencral Counsel, .1 Approval Date for Carole J. Cornelison, corrinal5sloner NOTE TO CONTRACTORS: Complete Applications for Renewal of Can tractor Ellgiblilt , , i odue no later than three months PRIOR to the Expiration Date of the Certification Period shown above. Failure to Sul Ir ;:: Completed Applications timely may result in a 90P In Certification or a lapse In Certification oltoge Merfor your compan) Reviewer's Initials EFFECTIVE MARCH ;10, 2010 Commonwealth of M-assachusetts Division of Ca, itp al Assul; Management STUB-BIDDE;.R A COMPLETED AND SIGNED SUB -BIDDER UPDA'rE 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 APP:IOPRIATE SUB -BIDDER UPDATE STATEMENT IS INVALID AND MUST BE REJECTED. Caution: This form is to be used for submitting "Hed Sub -Bids and Trade Sub -Bids. It is D -at to be used for submitting Prime/Genera I Contract bids. `1 q►._ ■ 01411; 1111 If the Awarding Authority determines that the sub -bidder is not competent to perform the work as specified on ithe project, it :;hould reject the bid. SUB -BIDDER'S AFFIDAVIT I swear under the pains and penalties of perjury that I arr July 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 al of the information provided by the bidder in this Sub -bidder Update Statement is true, accurate, and :;omplete as of the bid date. L\ "'-Z.O 1 C1 Bid Date ('D� Project Number (or name if no number) -1,0vin J. 00r�k (\r�mx c Awarding Authority SIGNATURE => 0 Byrne Painting and Contracting Inc. Prini Name of Sub -bidder or Trade Contractor 21 Old Farm Road Wayland, MA 01778 Business Address (617) 699-5548 Telephone Number T cD W 0 J 1 w CD �� o 3c 07 m Q =3 CD - -0CD o 3 m w aCD CL CD o 0 3 0 co o 0 �-0 00' C0 OL 0 C 0 CD 3 CD -0 0 CD CD o 3 = CD 0 0 w cn w a 0 CD c CD Q 0 0 0 3 CD CCD 0 c 0 - CD l< 0 0 a (D w 7 OL D s a Q. o' w CD cD M (D ((DD cn En w W Clw CO CD CD mo ° X Xcn Q o oCD M 03 =o 00 0 �� cl< 0. 0 O o 0 c a 2 ° o (n r- o - (Q' - 0 3 w -0 W (n m Q o ai m o CyN C/)CD gow CT CD cn ocQ (n (a a y wC cno 0 0 3� 0c 0 (n CDD m K c 3 •c m ,3 CD mw .+ N0 ~ (un) b 7 Ccl D 3. (n 0 CD 0 wX c� c=3 fD cQ 0 fo N N W fA N Ln N �J O - Ln cn 0 CO w 0 0 0 0 0 0 0 0 0 o O CD _C N N N N N fl - O O O O O N N N N N CD 0 w 0 o m m w m o-4 con con -4 cn o 0 0 0 0 0-a 1 N 1 N J N J N J N CDQ m m m z D D T r D O r-_0 ry O Z OD K m cin O -� c 00 D M rm r C) �m p� C cFDn -1Cf) me pm -n z 00 �m Om zz 0 z 00 �O m D m� Om Cz U) M rm � O m0 u D O� mn Mm m� C O -n O� cm �O O cn r cn r C W r_ C) Z m LO D m 00 r z G) C— m m C) U) O m D n O TK V r m m 0 A c v z C) m A c v m 0 D m O n INSTRUCTIONS INSTRUCTIONS TO BIDDERS This form must be completed and submitted by all Prime/General contractors bidding on projects pursuant to M.G.L. c. 149, §44A and M.G.L. c. 149A. You must give complete and accurate answers to all questions and provide all of the information requested. MAKING A MATERIALLY FALSE STATEMENT IN THIS UPDATE STATEMENT IS GROUNDS FOR REJECTING YOUR BID AND FOR DEBARRING YOU FROM ALL PUBLIC CONTRACTING. This Update Statement must include all requested information that was not previously reported on the Application used for your firm's most recently issued (not extended or amended) Prime/General Contractor Certificate of Eligibility. The Update Statement must cover the entire period since the date of your Application, NOT since the date of your Certification. You must use this official form of Update Statement. Copies of this form may be obtained from the awarding authority and from the Asset Management Web Site: www.mass.gov/dcam. If additional space is needed, please copy the appropriate page of this Update Statement and attach it as an additional sheet. See the section entitled "Bidding Limits" in the Instructions to Awarding Authorities for important information concerning your bidding limits. Determination of Bidder Qualifications It is the awarding authority's responsibility to determine who is the lowest eligible and responsible bidder. You must consider all of the information in the low bidder's Update Statement in making this determination. Remember: this information was not available to the Division of Capital Asset Management at the time of certification. The bidder's performance on the projected listed in Parts 1 and 2 must be part of your review. Contact the project references. AWARDING AUTHORITIES ARE STRONGLY ENCOURAGED TO REVIEW THE LOW BIDDER'S ENTIRE CERTIFICATION FILE AT THE DIVISION OF CAPITAL ASSET MANAGEMENT. Telephone (617) 727-9320 for an appointment. Bidding Limits Single Project Limit: The total amount of the bid, including all alternates, may not exceed the bidder's Single Project Limit. Aggregate Work Limit: The annual value of the work to be performed on the contract for which the bid is submitted, when added to the annual cost to complete the bidder's other currently held contracts, may not exceed the bidder's Aggregate Work Limit. Use the following procedure to determine whether the low bidder is within its Aggregate Work Limit: Steffi Review Update Statement Question #2 to make sure that all requested information is provided and that the bidder has accurately calculated and totaled the annualized value of all incomplete work on its currently held contracts (column 9). Step 2 Determine the annual dollar value of the work to be performed on your project. This is done as follows: (i) If the project is to be completed in less than 12 months, the annual dollar value of the work is equal to the full amount of the bid. (ii) If the project will take more than 12 months to complete, calculate the number of years given to complete the project by dividing the total number of months in the project schedule by 12 (calculate to 3 decimal places), then divide the amount of the bid by the calculated number of years to find the annual dollar value of the work. Sten 3 Add the annualized value of all of the bidder's incomplete contract work (the total of column 9 on page 5) to the annual dollar value of the work to be performed on your project. The total may not exceed the bidder's Aggregate Work Limit. Correction of Errors and Omissions in Update Statements Matters of Form: An awarding authority shall not reject a contractor's bid because there are mistakes or omissions of form in the Update Statement submitted with the bid, provided the contractor promptly corrects those mistakes or omissions upon request of the awarding authority. [810 CMR 8.05(1)]. Correction of Other Defects: An awarding authority may, in its discretion, give a contractor notice of defects, other than mistakes or omissions of form, in the contractor's Update Statement, and an opportunity to correct such defects, provided the correction of such defects is not prejudicial to fair competition. An awarding authority may reject a corrected Update Statement if it contains unfavorable information about the contractor that was omitted from the Update Statement filed with the contractor's bid. [810 CMR 8.05(2)]. Division of Capital Asset Management Page 2 of 11 Prime/General Contractor Update Statement Effective March 30, 2010 0 0 n m D W U) C CD CD CD 0 1 0 0 w (D N 3 O c cr c W.m 0 0 w 3. CD 0 ° •J N 0 D�� CD o o c O N O N 0- 0 `< N0 o 0 N CD. l< CD cCnma 0-�� �a I c w c (D =r CL w o X0-0 o T. Ei N m cn w � 3 -0 0 CD WCD � �3 o l< 0 o SD = c o_ 0 3 �' c 0 0 `< o O 3 Q c CD w �� o 0 �, O 3 CD � a cQ CD cDcn (n�. O CDCD 0 O o m CD c � 0 m 2 m TI 0 0 z m m m m m z n m z m D O m m n O r m m Tp 0 C- m r m O z 2 m m O c D G) m X. co co m w M o °C� < 0 m ° p ma % c N �. 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O o c c co Z D N 0 2 = 2 0 m < a m� O Cl) m = 0 m z o, o, Cn rn rn Ul O -4 O 0) O m OD 000 0000 v -4 OD v 0 00 00 r V V rn O 0) v 0)00 00 m .46m Cn Ln W O (D 0) O cD 00 cD P O Cil Cn 00 CD O CD 1 v O W 2 O O W O Cn O Cn W N N Cn W O WN z CC � N � Ln 1 m 0 co -� �I 00 0 00 0) 1 0 N 0 m 2 m TI 0 0 z m m m m m z n m z m D O m m n O r m m Tp 0 C- m r m O z 2 m m O c D G) 3 CD 6 CD CD 0 0 0 0 0 0 0 C: CL 0) CD CD 3 CD D m CD co K ID 0 CA) 0 N O J 0 0 0 0 0 0 D 0 0 C w a� CD 3 CD a cn 0 O C— m n r m m m O z _2 m x -o z D i O z Cl) V Q r /O V 0 W 2 J H z w D V �4 w H Q 0 (n 2 I— z 0 U Q Cc z O Ir z Z) U) Q c2 G cc LL Cc D O Q w cr w OU �z w 02 00 oU O Y O � N 0 LL O W U~ w cc 3w 0= CC �— a w w= > °C 0 ccz aw 0z z3: U� O J � m U) D w a J J � Q � fn w J � T O CD am w CL 0 0--gi o ��a, 0 o , o C o com CU > O a X N 00 Vi 3 E N T r Lo U Q9- ?O 0 O cp C CL O O O O U O r O T O T i 0 CL 0 Lo cu co 0) CIZ OD a) iCY) C N �_ 06 U 6 cn (1) a),. ° U) _ N M � Ch M N O 0 r 0 0 r 0 0 r 0 0 C,) a C 'D N N N O N Q c4 «fco 70 O O T r0 MCI�./, l'! 0 0 T r 0 O 0) 0 N U C C C Y (L a a c0 •6� ` �o C 0 L 0 to Cl)C c:>, m cu 0 C O 0 0 2 C N o >� v 2> — �� c C r } F- cu 0— U> «.� L Y � � Q•�� U O co n :tl- N Q O E CO J m 0 U 0 C E CL 3 c° �Q~ 0 z Q T O CD am w CL 0 U) D LD> /w cr IL W z O 'D VJ J U LY O a 0 F - w J O z 2 Q W cr 0 z O cc O z w U Z w cc w LL w cr z O J J 0 W 2 w > W cr Q IL M W N O O T M *- O O N z OD N M O O COO M M OI, LO M Ln 0 t 0 w � 0) W � Cl) r- It N w M co J W 00 T co CD W T T N T H LO co Ln LO to It N m r- z �O `i± C W ZZ /L -C L C0 co Y W C O l.L .> O O X N C O � m 0 U Q U L N O m c o M ca z o E m Z Q � v~ Q U) U C Q O VF 0) Q) C Q 0 O c cp O O O 0 O W = m O Q _ Q Q ' d O U U 2 L O U O Q C O O Z0 Co L U } U) - O i Q v X o E c Q 1 o 0 H E o O z Q Q O CC Q cUn C) w Co`� > w w Z w Z (A 0 Q w O w C7 O w 0 W -C O J I.. - :3L Q =3 Q O C ~ O O Q w = 0 O O L O c CD U O ~ O N z N � ON , c O O L L C O O L U Q) L C O O) U in N O 0) -v cis c L C E O O C c O cz O C "a co ca c > T C O � N L E o O U C Q Q 0>, O UO U C O O C: CZ O 0- -C —C o CDICU m cz Lco cu O E u co vic> C: 'u, O O 0 cz 0 cu -C C m 3 rnE =3 cu O C U � C "a N 0 L (D a Q CU Qj U O � � U Q N a)_ U C O C C) c� U N N CO T N cl- c O as L ca O U W N C D cz L O L N L O O 0 z O Z J a x w z O_ H J w cc W J W 3 m IL 5 N c>s CL 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) Sub -Bidder Certificate of Eligibility. You must report all requested information not previously reported on that Application. Include all details [project name(s) and location(s), names of all parties involved, relevant dates, etc.]. Division of Capital Asset Management Page 8 of 11 Prime/General Contractor Update Statement Effective March 30, 2010 YES NO 1. Has your firm been terminated on any contract prior to completing a project or X 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 X under any contract prior to substantial completion? 3. Has your firm failed or refused to complete any punch list work under any X contract? 4. Has your firm filed for bankruptcy, or has any officer, principal or individual with X 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 X any contract? 6. Has a payment or performance bond been invoked against your current firm, or X 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 X your payment bond on any contract? 8. Has any subcontractor filed a demand for direct payment with an awarding X authority for a public project on any of your contracts? 9. Have any of your subcontractors or suppliers filed litigation to enforce a X 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 X with any of your projects? 11. Has any employee or other person suffered an injury in connection with any of X your projects resulting in their inability to return to work for a period in excess of one year? Division of Capital Asset Management Page 8 of 11 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) Sub -Bidder Certificate of Eligibility. You must report all requested information not previously reported on that DCAM Application. The term "administrative proceeding" 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 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.). Division of Capital Asset Management Page 9 of 11 Prime/General Contractor Update Statement Effective March 30, 2010 YES NO 1. Have any civil, judicial or administrative proceedings involving your firm or a X principal or officer or anyone with 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 X 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 X 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 X 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 9 of 11 Prime/General Contractor Update Statement Effective March 30, 2010 PART 4 - Legal or Administrative Proceedings; Compliance with Laws (continued) Division of Capital Asset Management Page 10 of 11 Prime/General Contractor Update Statement Effective March 30, 2010 YES NO 5. Have any judicial or administrative proceedings involving your firm or a X 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 X 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 X 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, X 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 X 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 firm been fined by OSHA or any other state or federal agency for X 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, X 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 X 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? 13. Are there any other issues that you are aware which may affect your firm's X responsibility and integrity as a building contractor? Division of Capital Asset Management Page 10 of 11 Prime/General Contractor Update Statement Effective March 30, 2010 PART 5 - SUPERVISORY PERSONNEL List all supervisory personnel who will be assigned to the project if your firm is awarded the contract. Attach the resume of each person listed below. NAME TITLE OR FUNCTION 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 [ ] PART 7 - LIST OF COMPLETED CONSTRUCTION PROJECTS SUBMITTED TO THE DIVISION OF CAPITAL ASSET MANAGEMENT WITH FIRM'S MOST RECENT APPLICATION FOR CERTIFICATION 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 Management Page 11 of 11 Prime/General Contractor Update Statement Effective March 30, 2010