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HomeMy WebLinkAboutContract #: 005159 - From: To: - Exception - ExceptionSchool 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 accordance with the hereinafter described plans, specifications and addenda, all work specified in r of the specifications and in any plans specified in such section epared by Kang Associates, Inc. for the School Department Administration Building,North Andover, MA for the contract sum of: dollars ($ O• ). For Iternate #1: Deduct $ dollars For Alternate #2: Add/ Deduct $ dollars ($ N ). For Alternate #3: Deduct $ dollars ($ ). For Alternate #4: Deduct $ dollars ($ ). For Alternate #5: Deduct $ /+J dollars ($ ). B. This sub -bid includes addenda numbered —Z 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 Kang Associates, Inc. North Andover, MA 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? _ .& 0 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 (a) FORM OF SUB -BID - 2 School Department Administration Building North Andover, MA (b) (c) Kang Associates, Inc. January 2, 2014 4. Bank reference 4�(.&4-�_ - ��T 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. Dat (Name of Sub -Bidder) ;) By: Signa re and Title QWerson Signing Bid 'Y Z� ,, .v— Business Address SUB -BIDDER'S CHECKLIST: y Addenda Recognized Bid Deposit /bCAM Certificate of Eligibility ub-Bidder Update Statement Certificate of Corporate Bidder A g,/r - '!ear, D/6 d 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. Signature ?Ile -4110 hxz ( -"L rint Name & Title Date c�? el Z���i�.�� /!�- Company 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 ` Print Name & Title ^� Date Company game CERTIFICATE OF TAX COMPLIANCE uant to Chapter 62 the Massachusetts General Laws, Section (b), I authorized signatory for ame 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 North Andover, MA f�iI1T11"IA � Kang Associates, Inc. January 2, 2014 certify that I am the --r?k� of the corporation named as Bidder in the Bid Form, and that who signed the Bid Form on behalf of the Bidder was then the _�&v4z !����? 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. -1 Corporate Seal k,,;t LcA /i Secretary- Jerk CORPORATE BIDDER - 1 The Commonwealth of Massachusetts Executive Office for Administration and Finance Division of Capital Asset Management and Maintenance One Ashburton Place DEVAL L PATRICK Boston, Massachusetts 02108 GLEN SHOR GOVERNOR Tel. (617) 727-4050 SECRETARY. ADMINISTRATION & FINANCE Fax. (617) 727-5363 TIMOTHY P. MURRAY CAROLE CORNELISON LIEUTENANT GOVERNOR COMMISSIONER Filed Sub -Bid Certificate of Contractor Eligibility CONTRACTOR IDENTIFICATION NUMBER: 0872 This Certificate Shall Be Used for Submitting Filed Sub -Bids Only 1. CERTIFICATION PERIOD: This Certificate is valid from 4/13/2013 to 4/13/2014 2. CONTRACTOR'S NAME: Lapan Mechanical Contractors, Inc. 3. CONTRACTOR'S ADDRESS: 3 Bethany Street, Worcester, MA 01604 4. WORK CATEGORIES: This Contractor is certified to file bids under Massachusetts General Laws Chapter 149, 5. EVALUATIONS: Number of Projects Evaluated: 16 Average Project Evaluation Rating: 94 Number of Projects Below Passing Score: 0 6. SUPPLIER DIVERSITY O TION: �;?_ � 0 '� , S-7-- eya S. Bernstein, DeputyGeneral Counsel, Approval Date for Carole J. Cornelison, Commissioner NOTE TO CONTRACTORS: Complete Applications for Renewal of Contractor Eligibility are due no later than three months PRIOR to the Expiration Date of the Certification Period shown above. Failure to submit Completed Applications timely may result in a gap in Certification or a lapse in Certification altogether for your company. S Reviewer's Initials _ Chapter 149A and Chapter 25A in the following checked Categories of Work: ❑ Acoustical Tile dj HVAC ❑ Miscellaneous & Ornamental Iron n Terrazzo ❑ Electrical Work ❑ Lathing & Plastering ❑ Painting ❑ Tile 71 Elevators ❑ Marble W Plumbing ❑ Waterproofing, Damp [i Fire Protection Sprinkler Systems ❑ Masonry Work [] ResiIient Floors proofing, and Caulking M Glass and Glazing ❑ Metal Windows ❑ Roofing & Flashing 5. EVALUATIONS: Number of Projects Evaluated: 16 Average Project Evaluation Rating: 94 Number of Projects Below Passing Score: 0 6. SUPPLIER DIVERSITY O TION: �;?_ � 0 '� , S-7-- eya S. Bernstein, DeputyGeneral Counsel, Approval Date for Carole J. Cornelison, Commissioner NOTE TO CONTRACTORS: Complete Applications for Renewal of Contractor Eligibility are due no later than three months PRIOR to the Expiration Date of the Certification Period shown above. Failure to submit Completed Applications timely may result in a gap in Certification or a lapse in Certification altogether for your company. S Reviewer's Initials _ Colonial Surety Company Administrative Office 50 Chestnut Ridge Road Montvale, NJ 07645 201-573-8788 BID BOND KNOW ALL PERSONS BY THESE PRESENTS, that we, LaPan Mechanical Contractors, Inc., Worcester, MA as Principal, and the COLONIAL SURETY COMPANY, a corporation under the laws of the Commonwealth of Pennsylvania, as Surety, are held and firmly bound unto town of north andover, North Andover, MA as Obligee, in the sum of 5% of amount bid not to exceed $3300 for the payment, whereof in lawful money of the United States, we bind ourselves, our heirs, administrators, executors or successors, jointly and severally, firmly by these presents. WHEREAS, the Principal has submitted the accompanying bid for new plumbing for administration building NOW, THEREFORE, if the said contract be awarded to the Principal and the Principal shall, within such time as may be specified, enter into the contract in writing, then this obligation shall be void: otherwise to remain in full force and effect. Provided, however, that if said contract is not awarded within 60 days of the date of bid opening, this bond shall be void and of no force and effect. Signed and sealed this 21st day of January 2014. LaPan Mechanical Contractors, Inc. Witness: Richard LaPan Jr. (Frincipai/Titie) (Seal) COLONIAL SURETY COMPANY (Attorney-in-fact) (Seal) / Witness: Richard LaPan Jr. Anthony J. Cimasko COLONIAL SURETY COMPANY Duncannon, Pennsylvania Administrative Office: 50 Chestnut Ridge Road, Montvale, New Jersey 07645 GENERAL POWER OF ATTORNEY Know all Men by These Presents, That COLONIAL SURETY COMPANY, a corporation duly organized and existing under the laws of the Commonwealth of Pennsylvania and having an administrative office in Montvale, Bergen County, NJ does by these presents make, constitute and appoint Anthony J. Cimasko Worcester MA Wayne Nunziata or Anthony J. Cimasko or Audie B. Murphy of Montvale and the State of New Jersey its true and lawful Attorneys) -in -Fact, with full power and authority hereby conferred in its name, place and stead, to execute, acknowledge and deliver. Any and All Bonds and to bind the Company thereby as fully and to the same extent as if such bonds were signed by the President, sealed with the cor- porate seal of the Company and duly attested by its Secretary, hereby ratifying and confirming all that the said Attorney(s)-in-Fact may do in the premises. Said appointment is made under and by authority of the following resolution adopted by the Board of Directors of the Colonial Surety Company at a meeting held on the 25th day of July, 1950. "Be it Resolved, that the President, any Vice -President, any Secretary or any Assistant Secretary shall be and is hereby vested with full power and authority to appoint any one or more suitable persons as Attorney(s)-in-Fact to represent and act for and on behalf of the Company subject to the following provisions: "Section L Attorney -in -Fact. Attorney -in -Fact may be given full power and authority for and in the name of and on behalf of the Company, to execute, acknowledge and deliver, any and all bonds, recognizances, contracts, agreements of indemnity and other conditional or obligatory undertakings and any and all notices and documents canceling or terminating the Company's liability thereunder, and any such instruments so executed by any such Attorney -in -Fact shall be binding upon the Company as if signed by the President and sealed and attested by the Corporate Secretary." "in Witness Whereof, Colonial Surety Company has caused these presents to be signed by its President and its corporate seal to be hereto affixed the 27th day of April . A.D., 2011. ,,or, c \ 'Oa °� c State of New Jersey p Incorporated SS.: U — • — `< County of Bergen 1930 r en17SyI J COLONIAL SURETY COMPANY By Wayne Nunziata, President On this 27th day of April , in the year 2011, before me Theresa Spinelli , a notary public, personally appeared Wayne Nunziata , personalty known to me to be the person who executed the within instrument as President , on behalf of the corporation therein named and acknowledged to me that the corporation executed it. e`esa S/)/ THERESA SPINELLI / Notary A Notary Public of New Jersey Public My Commission Expires September 9, 2015 4 UILdc, �eW Je� Theresa Spinelli Notary Public I, the undersigned Secretary of Colonial Surety Company, hereby certify that the above and foregoing is a full, true and correct copy of the Original Power of Attorney issued by said Company, and do hereby further certify that the said Power of Attorney is still in force and effect. And I do hereby further certify that the Certification of 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 the Colonial Surety Company at a meeting duly called and held on the 30th of January 1968, and that said resolution has not been amended or repealed: RESOLVED, that the signature of the Secretary or any Assistant Secretary of this Corporation, and the seal of Corporation, may be affixed or printed by facsimile to any certificate to a Power of Attorney of this Corporation, and that such printed facsimile sig- nature and seal shall be valid and binding upon this Corporation." GIVEN under my hand and the seal of said Company, at Montvale, New Jersey this 21st day of January 20 14 Original printed with Blue and Black ink. For verification of the authenticity of this Power of Attorney you may call (201) 573.8788 and ask for the Power of Attorney clerk. Please refer to the above named individual(s) and details of the bond to which the power is attached. Audie B. urph Secretary Form S-100-101 (Rev 1/11) COLONIAL SURETY COMPANY Duncannon, Pennsylvania - Inc 1930 -- FINANCIAL STATEMENT—DECEMBER 31, 2012 ASSETS `Stocks and Bonds ....................$ Cash in Office & Banks .................. Accrued Interest & Dividends .............. Premiums & Agents Balances Receivable .... Other Assets .......................... ................... I................ Total Admitted Assets ............... LIABILITIES & SURPLUS 34,760,501 Reserve for Unearned Premiums. .......... $ 6,180,207 4,147,334 Claim Reserves .......................... 11,432,780 287,491 Other Liabilities ......................... 1,189,463 766,069 Collateral Held .......................... 1,001,897 3,450,098 Capital Stock ........................... 3,000,000 Surplus ................................ 20,607,146 43,411,493 Total Liabilities & Surplus .............. 43,411,493 'Bonds and stocks are valued on basis approved by National Association of Insurance Commissioners, STATE OF NEW JERSEY ss.: COUNTY OF BERGEN I, Wayne Nunziata, President of COLONIAL SURETY COMPANY, do hereby certify that the foregoing is a full, true and correct copy of the Financial Statement of said Company, as of December 31, 2012. IN WITNESS WHEREOF, I have signed this statement at Montvale, New Jersey, this 2nd day of May, 2013. /�\gurety c° /a � O lacorporated * ` 1930 1 * @nnSYti�a1 Theresa Spinelli A Notary Public of New Jersey My Commission Expires September 9, 2015 Wayne Nunziata President t � Theresa Spinelli Notary Public EFFECTIVE MARCH 30, 2010 Commonwealth of Massachusetts Division of Capital Asset ManaAem( SUB -BIDDER UPDATE STATEMENT TO ALL SUB -BIDDERS, TRADE CONTRACTORS AND AWARDING AUTHORITIES 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 PrimelGeneral 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. LaPan Mechanical Contractors Inc. AdDa Print Name of Sub -bidder or Trade Contractor a:4" 3 Bethany St. Worcester Ma. 01505 Project Number or/� Business Address tn�aame if no//nn�uumber) /�,,6'f/V 1x� 508-793-2164 Awarding Authority Telephone Number SIGNATURE* Bidde 's Autrued Representative Division of Capital Asset Management Page 1 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/deam. 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 Sub -bidder Update Statement Effective March 30, 2010 INSTRUCTIONS TO AWARDING AUTHORITIES Determination of Sub -Bidder Qua/cations 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 -bidder'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 o 10 W U Z , Um �D W Q WW J Q aZ W 0� UQ CO =0 W LL Z W =X �W F- ~ Q Z Ww W w OW 2U) 0� oZ 0 W oU CN W EA w 0 CO) U� W ooO qo— LL .O.I Z W OW 0. 0 0UW Q Q. Q Q LL m LL F- aOw WV <ow f- W � J L N W cr)— N � N M N LL1 W F-. O N O N O O p -j 0. 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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.]. VF.0 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 aproject'? 2. Has your firm failed or refused either to perform or complete any of its work under El Z any contract prior to substantial completion? 3. Has your firm failed or refused to complete any punch list work under any contract? 4. Has your firm filed for bankruptcy, or has any officer, principal or individual with a 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 contract? 6. Has a payment or performance bond been invoked against your current firm, or has any officer, principal or individual with a financial interest in your current firm been an officer, principal or individual with a financial interest in another firm that had a payment or performance bond invoked? 7. Has your surety made payment to a materials supplier or other party under your El payment bond on any contract? 8. 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 Q any of yourprojects? 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 ear? 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.). YES NO 1. Have any civil, judicial or administrative proceedings involving your firm or a [] principal or officer or anyone with a financial interest in your f rni 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 Q 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) v kq NO 5. Have any judicial or administrative proceedings involving your firm or a principal or officer or anyone with a financial interest in your firm been brought, concluded, or settled relating to a violation of any state or federal law regulating hours of labor, unemployment compensation, minimum wages, prevailing wages, overtime pay, equal pay, child labor or worker's com nsation? 6. Have any judicial or administrative proceedings involving your firm or a principal Q or officer or anyone with a financial interest in your firm been brought, concluded, or settled relating to a violation of any state or federal law prohibiting discrimination in employment? 7. Have any judicial or administrative proceedings involving your firm or a principal ❑ or officer or anyone with a financial interest in your firm been brought, concluded, or settled relating to a claim of repeated or aggravated violation of any state or federal law regulating labor relations? 8. Have any proceedings by a municipal, state, or federal agency been brought, 1 Iz concluded, or settled relating to decertification, debarment, or suspension of your firm or any principal or officer or anyone with a financial interest in your firm from public contracting? 9. Have any judicial or administrative proceedings involving your firm or a principal or officer or anyone with a financial interest in your firm been brought, concluded, or settled relating to a violation of state or federal law regulating the environment? 10. Has your firm been fined by OSHA or any other state or federal agency for Q ®>; violations of any laws or regulations related to occupational health or safety? Note: this information ma 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, Q workforce goals, or failure to file certified payrolls on any public.projects? 12. Other than previously reported in the above paragraphs of this Section I, have any Q 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 Q responsibility and integrity as a building contractor? Division of Capital Asset Management Page 9 of 10 Sub -bidder 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 FUNCTI©N< Richard LaPan Jr President project Management Keith LaPan Vice President Project Management PART 6 - CHANGES IN BUSINESS ORGANIZATION OR FINANCIAL CONDITION Have there been any changes in your firm's business organization, financial condition or bonding capacity since the date your current Certificate of Eligibility was issued? ❑ Yes ® No If YES, attach a separate page providing complete details. PART 7 - LIST OF COMPLETED CONSTRUCTION PROJECTS SUBMITTED TO THE DIVISION OF CAPITAL ASSET MANAGEMENT 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 10 of 10 Sub -bidder Update Statement Effective March 30, 2010 - 17_`�.n.OtPAM, 7 OF-CllASUOYEP. PROYEC270-' STATE r—i�,,.r~iJs, a�LI E 01?F JF s e YC `��,�.tJ�°''•j_i�I'Zig'.:_��-;lY"fi.��?�i(�i��r�..�_ _.:.-�iyF?�..'�si:�bti� �:.��... • r. e a -7 ns r—i�,,.r~iJs, a�LI E 01?F JF s e YC `��,�.tJ�°''•j_i�I'Zig'.:_��-;lY"fi.��?�i(�i��r�..�_ _.:.-�iyF?�..'�si:�bti� �:.��... I Certification (notarization required) The undersigned, Richard LaPan Jr hereby certifies: (type name) That I am an owner or principal of President, (company name) and that all answers and all statements contained in the attached application (including Sections F and G) for certificate of eligibility are complete, true and correct. Providing false or misleading information or failure to provide all required information will be considered grounds for denial, decertification and/or debarment. I attest to the accuracy of all information contained in this application and verify that the informatioA submitted is in fact complete, accurate and true, under oath. Signed and Sworn under the Pains and Penalties of Perjury. Dated at 10128113 This 28th day of October, 2013. By (signature): Type name: Richard LaPan, Jr. Title or position: President ss. (county) Before me, known to it (state) Speared and 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 deed of the firm. Q,6 b. & 9- 1 r)PrIA- Wh - 1 0 —.� . . . 9a eq L7an �(no pub csignature) , ":A btary PubOMMONWc%,'H OF MAMy Commissior• lf iceJanuary -1 _',1 (prurt name) **Upon completion of this Application and the two corresponding.Egcel spreadsheets, save and email them to ���• _r;., ,4 �n.t= =r r .>...�; Prime/General Revised March'201.1 `, -s�' k'1� Page 16 of lb Computer