HomeMy WebLinkAboutContract #: 004988 - From: To: - Exception - ExceptionSchool Department Administration Building
North Andover, MA
FORM OF SUB -BID
)�Ce( r�PQ
Kang Associates, Inc.
January 2, 2014
To All General Bidders Except those Excluded:
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
(� �[' 5eC-lc% Zf �QI $�+rc h/r �► S`ty�u.-�-
/✓ 1 u` °�� �'- i�I� of the specifications and in any plans specified in
such section, prepared by Kang Associates, Inc. for the School Department Administration
Building,North Andover, MA for the contract sum of:
dollars ($ / z 200,
).
For Alternate #1:
Deduct $ 1i% / dollars ($ ).
For Alternate #2:
Add/
Deduct $ � dollars ($ SIA-
For
I A -For Alternate #3: %
Deduct $�� dollars ($
For Alternate #4:
�
�-
Deduct $ dollars ($ 774 q06- ).
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 years.
2. Ever failed to complete any work awarded? /Vo
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
(a)
Architect . General Contractor Amount of Contract
FORM OF SUB -BID - 2
School Department Administration Building
North Andover, MA
2
(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.
Date ` (Name of Sub -Bidder)
SUB -BIDDER'S CHECKLIST:
v Addenda Recognized
V Bid Deposit
il DCAM Certificate of Eligibility
Sub -Bidder Update Statement
Certificate of Corporate Bidder
gnature and Title of Person Signing Bid
h
usiness Address
City and State
FORM OF SUB -BID - 3
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.
dtxx-
Signature
Print Name & Title
Date y �%
ompany Name
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
e llle lie C 1;'mn Mf-)
Print Name & Title Company Name
CERTIFICATE OF TAX COMPLIANCE
Pursuant to Chapter 62C of the Massachusetts General Laws, Section 49A (b), I
authorized signatory for � ,
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.
Signature Date
School Department Administration Building Kang Associates, Inc.
North Andover, MA January 2, 2014
CERTIFICATE OF CORPORATE BIDDER
U certify that I am the
X078, � of the corporation named as Bidder in the
Bid Form, and that —i:::� who signed the Bid Form on
behalf of the Bidder was then the 62&,4 �11n��.--Z!=j 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
Secretary-Clerkt(I
%' zz�
Date
CORPORATE BIDDER - 1
- The Commonwealth o Massach
f usetts
Executive Office for Administration and Finance
a :3
Division of Capital Asset Management and Maintenance
One Ashburton Place
DEVAL L. PATRICK Boston, Massachusetts 02108
GOVERNOR Tel; (617) 727-4050GLEN SHOR
SECRETARY, ADMINISTRATION g
TIMOTHY PMURRAY Fax: (617) 727-5363 FINANCE
.
LIEUTENANT GOVERNOR
Vg:rpVF[1 -1
Filed Sub -Bid
Certificate of Contractor Eligibility
CONTRACTOR IDENTIFICATION NUMBER: 0593
a
This Certificate Shall Be Used for Submittin Filed Sub -Bids only
CAROLE CORNELISON
COMMISSIONER
1. CERTIFICATION PERIOD: This Certificate is valid from 10/10/2013 to 10/10/2014
2. CONTRACTOR'S NAME: X -Cel Fire'Protection, Inc.
3. CONTRACTOR'S ADDRESS: 11A Industrial Way, Unit #1, Salem, NH 03079
4. WORK CATEGORIES: This Contractor is certified to rile bids under Massachusetts General Laws Chapter 149,
Chapter 149A and Chapter 25A in the following checked Categories of Work:
❑ Acoustical Tile
❑ Electrical Work
❑ HVAC
❑ Miscellaneous & Omamental Iron
❑ Terrazzo
❑ Elevators
❑ Lathing & Plastering
❑ Marble
❑ Painting
❑ Tile
G Fire Protection Sprinkler Systems ❑ Masonry Work
❑ Plumbing
❑ Resilient Floors
❑ Waterproofing, Damp
❑ Glass and Glazing
❑ Metal Windows
❑ Roofing & Flashing
proofing, and Caulking .
5. EVALUATIONS: Number of Projects Evaluated: 7
Average Project Evaluation Rating: 94
Number of Projects Below Passing Score: 0
6. SUP9M D71
OFFICE CERTIFICATION: N/A
Taran Gri by, General Counsel, Approval Date
for Carole. 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 may
result in a gap in Certification or a lapse in Certification altogether for your company.
Reviewer's Initials_
\�J
Western Surety Company
BID BOND
(Percentage)
Bond Number: 71502637
KNOW ALL PERSONS BY THESE PRESENTS, That we xcel Fire Protection, Inc.
of
11 A Industrial Wav, Unit 1, Salem, NH 03079
referred to as the Principal, and Western Surety Compan
as Surety, are held and firmly bound unto 'town of North Andover
of 120 Main St., North Andover, MA 01845
, hereinafter
hereinafter referred to as the Obligee, in the sum of Five ( —5-0/6) percent of the greatest
amount bid, for the payment of which we bind ourselves, our legal representatives, successors and assigns,
jointly and severally, firmly by these presents.
WHEREAS, Principal has submitted or is about to submit a proposal to Obligee on a contract
School Denartment Administration Buildin
NOW, THEREFORE, if the said contract be awarded to Principal and Principal shall, within such time as may be
specified, enter into the contract in writing and give such bond or bonds as may be specified in the bidding or
contract documents with surety acceptable to Obligee; or if Principal shall fail to do so, pay to Obligee the
damages which Obligee may suffer by reason of such failure not exceeding the penalty of this., bond, then this
obligation shall be void; otherwise to remain in full force and effect.
SIGNED, SEALED AND DATED this 21st
Form F5876
day of January 2014 _
i
i.�ii�iP-1 i
Western Surety Company
POWER OF ATTORNEY - CERTIFIED COPY
Bond No. 71502637
Know All Men By These Presents, that WESTERN SURETY COMPANY, a corporation duly organized and existing under the laws
of the State of South Dakota, and having its principal office in Sioux Falls, South Dakota (the "Company"), does by these presents make,
constitute and appoint Tracy Lynn Blaisdell
its true and lawful attorney(s)-in-fact, with full power and authority hereby conferred, to execute, acknowledge and deliver for and on its
behalf as Surety, bonds for:
Principal: Xcel Fire Protection, Inc.
Obligee: Town of North Andover
Amount: $500,000.00
and to bind the Company thereby as fully and to the same extent as if such bonds were signed by the Senior Vice President, sealed with
the corporate seal of the Company and duly attested by its Secretary, hereby ratifying and confirming all that the said attorney(s)-in-fact
may do within the above stated limitations. Said appointment is made under and by authority of the following bylaw of Western Surety
Company which remains in full force and effect.
"Section 7. All bonds, policies, undertakings, Powers of Attorney or other obligations of the corporation shall be executed in the
corporate name of the Company by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President or by such other
officers as the Board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer
may appoint Attorneys in Fact or agents who shall have authority to issue bonds, policies, or undertakings in the name of the Company.
The corporate seal is not necessary for the validity of any bonds, policies, undertakings, Powers of Attorney or other obligations of the
corporation. The signature of any such officer and the corporate seal may be printed by facsimile."
All authority hereby conferred shall expire and terminate, without notice, unless used before midnight of April 21
2014 , but until such time shall be irrevocable and in full force and effect.
In Witness Whereof, Western Surety Company has caused these presents to be signed by its Vice President, Paul T. Bruflat, and its
corporates el:y¢,h_affixedthis 21st day of January 2014
ah`ur°.._=air WE8 SURE COMPANY
t _
- Paul T. uflat, Vice President
STNF?-,_I!= QTJTI-1�E�TA
ss
COUNTi€: j-.. AHA
On this 21st day of January in the year 2014 before me, a notary public, personally appeared
Paul T. Bruflat, who being to me duly sworn, acknowledged that he signed the above Power of Attorney as the aforesaid officer of
WESTERN SURETY COMPANY and acknowledged said instrument to be the voluntary act and dee f said co o at'on.
}444444444h44444444444444 }
a S. PETRIK +
NOTARY PUBLIC
r SEALMS f otary Public -South Dakota
ASOUTH DAKOTA(Ma
�44444444444444�44444444 +
My Commission Expires August 11, 2016
I the undersigned officer of Western Surety Company, a stock corporation of the State of South Dakota, do hereby certify that the
attached Power of Attorney is in full force and effect and is irrevocable, and furthermore, that Section 7 of the bylaws of the Company as
set forth in the Power of Attorney is now in force.
In testimony whereof, l have hereunto set my hand and seal of Western Surety Company this 21st day of
January 2014 .
WEST R/ SURE COMPANY
27-Zt5�� —
G-�
Paul T. Auflat, Vice President
Form F5306-8-2012
t
-- - j1,Jud ITI.M -11JU,Lulu
Commonwealth of Massachusetts
Division of Capital Asset Manal
SUB -BIDDER
UPDATE STATEMENT
B -BIDDERS, TRADE CONTRACTORS AND A
ment
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 not to be used for submitting Prime/General Contract bids.
AWARDING AUTHORITIES
If the Awarding Authority determines that the sub -bidder is not competent to perform
the work as specified on the project, it should reject the bid.
SUB -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 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.
_.Xcel Fire. Protection. Inc.
id Date Print Name of Sub -bidder or Trade Contractor
Project Number (or
name if no number)
Y'?wVang uthorit
Y
11A Industrial Way, Salem NH 03079
Business Address
603-890-3331
Telephone Number''
SIGNATURE*
Bidder's Authorized Representative
Division of Capital Asset Management Page i of 10
INSTRUCTIONS
INSTRUCTIONS TO SUB -BIDDERS
This form must be completed and submitted by all Filed
Sub -Bidders bidding on projects pursuant to M.G.L. c.
149, §44F and Trade Contractors bidding on projects
pursuant to 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
SUB -BIDDER UPDATE STATEMENT IS GROUNDS
FOR REJECTING YOUR BID AND FOR DEBARRING
YOU FROM ALL PUBLIC CONTRACTING.
This Sub -Bidder 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)
Sub -Bidder Certificate of Eligibility. The Sub -Bidder
Update Statement must cover the entire period since
the date of that Application, NOT since the date of
your Certification.
You must use this official form of Sub -bidder Update
Statement. Copies of this form may be obtained from
the awarding authority and from the DCAM Web Site:
www.mass.gov/dcam .
If additional space is needed, please copy the
appropriate page of this Sub -bidder Update Statement
and attach it as an additional sheet.
Division of Capital Asset Management
Ciih-hirlrlar I Inrlata gtntzmant Gffantiva RA—k )n onin
INSTRUCTIONS TO AWARDING AUTHORITIES
Determination of Sub -Bidder Qualirications
It is the awarding authority's responsibility to determine
each responsible bidder. You must consider all of the
information in the bidder's Sub -bidder 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 sub -bidder's performance on the projects listed in
Parts 1 and 2 must be part of your review. Contact the
project references.
AWARDING AUTHORITIES ARE STRONGLY
ENCOURAGED TO REVIEW THE SUB -BIDDER'S
ENTIRE CERTIFICATION FILE AT THE DIVISION OF
CAPITAL ASSET MANAGEMENT. Telephone (617)
727-9320 for an appointment.
Correction of Errors and Omissions in Sub -bidder
Update Statements
Matters of Form: An awarding authority shall not reject a
sub -bidder's bid because there are mistakes or omissions of
form in the Sub -bidder Update Statement submitted with the
bid pursuant to M.G.L. c.149, §44D, provided the sub -bidder
promptly corrects those mistakes or omissions upon request
of the awarding authority. [810 CMR 8.13(1)].
Correction of Other Defects: An awarding authority may, in
its discretion, give a sub -bidder notice of minor defects and
omissions as to form in the Sub -bidder's Update Statement
and provide an opportunity to correct its Sub -bidder Update
Statement. However, the sub -bidder shall not be allowed to
make corrections to a Sub -bidder Update Statement if
material information about the sub -bidder was omitted from
the Sub -bidder Update Statement filed with the sub -bidde'r's
bid. The Awarding Authority shall advise DCAM of any
material omissions in a Sub -bidder's Update Statement..
[810 CMR 8.13(2)].
Page 2 of 10
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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.].
1. Has your firm been terminated on any contract prior to completing a project or has YES
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 ro'ect?
2. Has your firm failed or refused either to perform or complete any of its work under
any contract rior to substantial com letion?
3. Has Your firm failed or refused to complete anpunch 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 Elcontract?
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 E1
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 proiects?
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
Division of Capital Asset Management Page 7 of 10
Sub -bidder 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.).
I. Have any civil, judicial or administrative proceedings involving your firm or a
or
.X1Ga AU
-
principal officer or anyone with a financial interest in your firm been brought,
j
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
El
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
Sub -bidder Update Statement Effective March 30, 2010
PART 4 - Legal or Administrative Proceedings; Compliance with Laws (continued)
5. Have any judicial or administrative proceedings involvingpal
or ofor anyone with financial
YES
❑
a interest in your firm been brought, c nrcluded,
or settled relating to a violation of any state or federal law
regulating hours of labor,
unemployment compensation, minimum wages, prevailing wages, overtime pay,
Le ual a ,child labor or worker's
compensation?
6. Have any judicial or administrative proceedings involving your firm or a princi al
or officer or anyone with financial
❑
a 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
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
nuhlic (;nntrarrt;n-9 in your firm from
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 EeLlating the environment?
10. Has your firm 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. ov
11. Has your firm been sanctioned for failure to achieve DBE/MBE/WBE goals,
workforce goals, or failure to file certified Payrolls on any publicprojects?
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?
13. Are there any other issues that you are aware which may affect your firm's
responsibility and integrity as a building contractor?
Division of Capital Asset Management
Sub -bidder Update Statement Effective March 30, 2010 Page 9 of 10
PART 5 - SUPERVISORY PERSONNEL
List all supervisory personnel who will be assigned to the project if your firm is awarded the con
Attach the resume of each person listed below. tract.
NAME
e
S
doss S,i
PART 6 - CHANGES IN BUSINESS
TITLE OR FUNCTION
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 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
Sub -bidder Update Statement Effective March 30, 2010 Page 10 of 10
ROV H. Dobbelaar, General Manager
Licenses and Education
-Construction Supervisor License Number CS 84173
•Journeyman Sprinkler Filter License Number 3927
-Certified Blazemaster CPVC Technician
*Member National Fire Protection Association
,Member American Fire Sprinkler Association
'.City of Boston Licensed F.R. Contractor
*Salem Fire Rescue, Certificate of Fitness
*Syracuse University 1968-1971 Engineering and Architecture
•BA, Wass-Boston, Public and Community Service
•MA, Umass-Boston, Critical and Creative Thinking
Experience--36 Years General Contracting/Fire Protection
•Owner, Renaissance Builders, 1971-1985 Experience
Owner, Fyre Technologies, 1985-1994
•Xcel Fire Protection, Inc. 1994 - present
Present Directly responsible for all day to day operations including sales, contract
engineering, purchasing, hiring, project managing and contract closeout negotiations,
Management Personnel
Marc Richardson Chief Desi ner
Education, Licenses and Certificati
•Nicet Level II Certification ons
• Contractor's Sprinkler License No. SC -129284
• Victaulic Design Seminar
• TycoiSprinkCad Design Seminar
• Train Technical Electriacl School
• National Fire Sprinkler Association Member
• Society for Fire Protection Engineers
Experience —20 Years of Automatic Fire
•BKN Design, Boscawen, NH Protec tion Design Experience
•DiFava Fire Protection, Derry, NH
*RD Sprinkler, Auburn, NH
*Tri-State Sprinkler, Auburn, NH
•XcPI Fire Protection, Inc., Salern, NH
2013 to Present: Marc Richardson is Xcel Fire Protection
all aspects of the design process, including value engineering, calculations, stocklisting, and coordination 's Head Engineer. His duties include
liason between the architect, owner, and/or g ng, water flow tests, hydraulic
with other trades. He also serves as Xcel's head
general contractor in terms of design issues.
Management Personnel
Curtis McGadden Senior Pro 'ect Mana er
Education, Certifications, Associations
*BA, Rhode Island School of Design
• Journeyman Sprinkler License No. SJ -116407
• Certified Blazemaster/Lubrizol CPVC Technician
• Salem Fitness Certification
*Member National Fire Protection Association
*Member American Fire Sprinkler Association's Yankee Chapter
Experience — 26 Years of Automatic Fire Protection Experience
*Tyco Sprinkler Systems, Inc.
*Xcel Fire Protection, Inc.
1992 to Present: Curtis McGadden is Xcel Fire Protection's Senior Project
include project managing, field coordination/material purchasing, liason between co His duties
and Xcel management, organizing manpower and operations, and contract close-out.
Management Personnel
Jason Rod ers Pro'ect Manager
Education, Certifications, Associations
*Northern Essex Community College
*North East Regional Vocational
*Journeyman Sprinkler License No. SJ -112891
MBA, Management Boston University
'Certified Blazemaster/Lubrizol CPVC Technician
*Member National Fire Protection Association
•Mem ber American Fire Sprinkler Association's Yankee Cha
Experience — 15 Years ofAutomatic Fire Protection *Larkin Sprinkler Ater
n Experience
•Xcel Fire Protection, Inc.
2000 to Present: Jason Rodgers is Xcel Fire Protection's Pro'
project managing, field coordination/material purchasing, liasone
management, organizing manpower and operatio sect Manager. His duties include
ns, and contra between ose out ntractors and XCeI
k
Management Personnel
Ross Sabin Senior Pro'ect Foreman
Education, Certifications, Associations
• Journeyman Sprinkler License No. SJ -106855
• Certified Blazemaster/Lubrizol CPVC Technician
•Natinal Fire Protection Installation Certification
OSHA 10 Hour Safety
*Renovator Certification pursuant to CFR Part 745.225
Experience — 15 Years ofAutomatic Fire Protection *Larkin Sprinkler on Experience
•Xcel Fire Protection, Inc.
2001 to Present: Ross Sabin is Xcel Fire Protection's
Senior leading project crew from mobilization to certification of sprinkler systems.
His duties include
hand with designer, purchaser, and clien, in project coordination a
crew in installation matters. Ross is well versed in run systems. He works hand in
swell as directing all field
projects for XFP. Additionally, he is responsible for all safety aspectme s
projects.
critical deadline
p on projects.
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J. Certification (notarization required)
The undersigned, Cathleen Tsetsilas hereby certifies:
(type name) les.
That I am an owner or principal ofXcel Fire Protection Jn
(compan . c'
y name)
and that all answers and all statements contained in the attache
and G) for certificate of eligibility are complete true
information certificate
failure to provide all required i d application (including Sections F
and correct. Providing false or misleading
decertification and/or debarment. I attest to the accuracy of
q information will be considered grounds for denial,
application and verify that the information submitted is in fact lcomplete, accurate and true
under
Signed and Sworn under the Pains and Penalties of Perjury.
Dated at 7/18/13 y
This 18th day of July, 2013
By (signature):
Type name: Cathleen Tsetsilas
Title or position: President
ss.
(coup )
(state)
Before me,
(not public) , personally appeared and
known to me to be
,-'
-(name of officer) based
on satisfactory evidence which was his/her driver's license and acknowledged that
authorized to execute the foregoing and that its execution is his/her free act an
act and deed ofti�i g he/she is
hmi• d deed and the free
CHERYL T. TSETSILAS
My commission expires: NOTARY Ha LIC
fic signature) State of New Hampshire
p M---- rT ��Wsion Expires
April 27, 2016
"Upon completion of this Application and the two corresponding Excels re
email them to CerhfieationA lication.dca� castatc.ru�a;udsheets, save and
Prime/General Revised March 2011 Page 16 of 16
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