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HomeMy WebLinkAboutContract #: 005184 - From: To: - Exception - Exception�.� mss School Department Administration Building Kang Associates, Inc. North Andover, MA January 2, 2014 FORM OF SUB -BID To All General Bidders Except those Excluded: A. The undersigned proposes to furnish all labor and materials required for completing, in accordance with the hereinafter described plans, specifications and addenda, all work specified in Seck��n 27�c�Oc� I Plumbing 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: K1063 Four-�-hou5a - fhree hundit(se d f ars+ qy) 3X18.0 0 For Alternate #1: Deduct $ NO 1 Ch(A e dollars ($ No �m e). For Alternate #2: Deduct $ No Ghana P dollars ($ vv Ch ). For Alternate #3: Deduct $ W dollars ($ N o Mang P ), For Alternate #4: Deduct $ N� `���qP dollars ($ Mo C—hwqc ). For Alternate #5: Deduct $ 1 vv (-�' ,Q dollars ($ N0 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 h'I 'NO •:uL •..• (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 2` -'( years. 2. Ever failed to complete any work awarded? N 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. nn Building Architect . General Contractor Amount of Contract (a)1 �25'1�1 Senl� fKXl�l I �a�e� Ka Cons+.` FORM OF SUB -BID - 2 School Department Administration Building Kang Associates, Inc. North Andover, MA January 2, 2014 (b) L ° d hoEd kt Arck P •LLv*i ��67 (c) fbmp Environ. Barus X25 n lesert �7�, (1L�.Ua 4. Bank reference owmen Nu -N Cast o Saving3 fSQnK (5a)am-000 I 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. _ 20 141 1Y &22b. f ffealia, Date (Name of Sub -Bidder) 'J By: //% &P14-4 Mi�s Je4 Signature and Title of Person Signing Bid SUB -BIDDER'S CHECKLIST: Addenda Recognized Bid Deposit DCAM Certificate of Eligibility Sub -Bidder Update Statement V Certificate of Corporate Bidder J ll N eve( 5)+. SOI4e 10 r7 Business Address 46�&-Jom�) n;z�t)� City and State FORM OF SUB -BID - 3 School Department Administration Building Kang Associates, Inc. North Andover, MA January 2, 2014 CERTIFICATE OF CORPORATE BIDDER Nlacc KvlmI certify that I am the C& of the corporation named as Bidder in the Bid Form, and that MaCC who signed the Bid Form on behalf of the Bidder was then the 6M I 1 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. C10M&s Plum bmg A &_q i1c Corporate Seal )?� At'ell- Secretary-Clerk /12d/ZD /y Date CORPORATE BIDDER -1 tea, 1 DEVAL L. PATRICK GOVERNOR TIMOTHY P. MURRAY LIEUTENANT GOVERNOR The Commonwealth of Massachusetts Executive Office for Administration and Finance Division of Capital Asset Management and Maintenance One Ashburton Place Boston, Massachusetts 02108 Tek (617) 727-4050 Fax: (617) 727-5363 Filed Sub -Bid Certificate of Contractor Eligibility CONTRACTOR IDENTIFICATION NUMBER: 2218 GLEN SHOR SECRETARY, ADMINISTRATION & FINANCE CAROLE CORNELISON COMMISSIONER This Certificate Shall Be Used for Submitting Filed Sub -Bids Only I. CERTIFICATION PERIOD: This Certificate is valid from 2/11/2013 to 2/11/2014 2. CONTRACTOR'S NAME: Compass Plumbing & Heating, Inc. 3. CONTRACTOR'S ADDRESS: 50 Oliver Street, Suite 107, North Easton; MA 02356 4. WORK CATEGORIES: This Contractor is certified to file bids under Massachusetts General Laws Chapter 149, Chapter 149A and Chapter 25A in the following checked Categories of Work: ❑ Acoustical Tile C HVAC El Electrical Work 1:1 Miscellaneous &Ornamental Iron [] Lathing & Plastering ❑ Painting [� Elevators ❑ Marble 1 Fire Protection Sprinkler Systems Masonry Work EV] Plumbing [] ❑ Resilient Floors ❑ Glass and Glazing ❑ Metal Windows � J Roofing & Flashing 5. EVALUATIONS: Number of Projects Evaluated: 9 Average Project Evaluation Rating: 97 Number of Projects Below Passing Score: 0 6. SUPPP"IVERSITY OFFICE CERTIFJC;�70N: N/A Freya S. Bernstein, Deputy General Counsel, for Carole J. Cornelison, Commissioner ❑ Terrazzo [.� Tile Waterproofing, Damp proofing, and Caulking Approval Date 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 /a se in C' P —Pe- altogether for your company. J Reviewer's Initials 1� S '20 r -Air AIA DocumentA310TIV -1970 KNOW ALL MEN BY THESE PRESENTS, that we Compass Plumbing & Heating, Inc. of 50 Oliver Street, (Here insert full name and address or legal title of Contractor) Suite 107, North Easton, MA 02356 as Principal, hereinafter called the Principal, and Endurance American Insurance Company of 333 (Here insert full name and address or legal title of Surety) Westchester Avenue, White Plains, NY 10604 a corporation duly organized under the laws of the State of Delaware as Surety, hereinafter called the Surety, are held and firmly bound unto Town of North Andover of 120 Main (Here insert full name and address or legal title of'Owner) Street, North Andover, MA 01845 as Obligee, hereinafter called the Obligee, in the sum of FIVE PERCENT OF AMOUNT BID Dollars ($ 5% OF BID ), 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 Demo. of the old Police Station (Here insert full name, address and description of project) 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 Obligce 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 21St day of January, 2014 &7;W (Witness) Compass Plumbing & Heating, Inc. (Principal) (Seal) Ad _ITitle) .r(es)c1hizi� — Endurance Americ9A Insurance Company (Surety) jitle) Mark D. eskanic (Seal) Attorney -in -Fact AIA Document A310Tw —1970. Copyright © 1963 and 1970 by The American Institute of Architects. ENDURANCE AMER11CAN INSURANCE±CCPANY FEWER OF ATTORNEY iI.'f IPII W104--ft-99 — - Ntsnber 14 KiYOW alfMen by t%tese Presents, that ENDURANCE AMERICAN INSURANCE COMPANY, a Delaware corporation (the "Corporation"), with offices at 750 Third Avenue, New York, New York 10017, has made, constituted and appointed and by these presents, does make, constitute and appoint - MARK D. LESKANIC, OSCAR B. JOHNSON NE GN-SWOHffSC its=true and lawfuhAttoi Rtt, at WALTHAM in the State of MA and leach of them° nto have full power W10twithout th�he�r-to make, execute, seal ark dInd-0n its behalf bondsZindetakittgs or=obligatians in surety or cosurety with, others, also to execute and deliver on its behalfIenewalr_eA7Msior�agWments, waivers, consents-astip�atrons relating to such aforesaid bonds, undertakings or obligations provided, however, that no single bond or undertaking so made, executed and delivered shall obligate the Corporation for any portion of the penal sum thereof in excess of the sum of SEVEN MILLION FIVE HUNDRED THOUSAND Dollars ($7,500,000.00). Such bonds and undertakings for said purposes, when duly executed by said attomey(s)-in-fact, shall be binding upon the Corporation as fully and to the same extent as if signed by the President of the Corporation under ft c ora#e seal attested by its Corporate cratar 7411j - _ — This appointment is made underand by authority of cer arit as�ationMa opted by�tre Board of Directors of the Clorporation'i unammouS written consent on th which appears below underJhe ate heading entitled "Certificate �- — - - This Power of Attorney is signed and sealed by facsimile under and by authority of the following resolution adopted by the Board of Directors of the Corporation by unanimous written consent on the 21day of July, 2011 and said resolution has not since been revoked, amended or repealed: RESQLV tenting powers of attorney, pursuant to certain resb'Ititions adopted by the-Board-pf Directors of�te ion by unanimous writteriongenton _ the signature of such directors hand officers$nd the seal of the Cori maffe aihxedtte_a e ower of attorney ser t> g thereto by facsimile, and any such powers o Ilsitomey or certificate bear ig such acsimrle srgr�atuF.eal shall be valid and'bindin 1 edd-r$o'rafn the tuiure.with resplect to anyband or u dertaking to which it is attached:— - h7 1 a This POWerOf Attome7y shalll Expire and'allauthority hereunder shall terminate without notice at 12:01 a.m. (Standard Timer where said attorneys) -in -fact is authorized to act.) NOVEMBER 24TH, 2014,-%,- r) • 3 IN WITNESS UVHFFiEE ifrioratron has causedes beulyrgnednd its corporate se to be hereuitito affixed atfd attested this 25TH dap Nom--'OtRewrk, END — _ — 1# NCE AMERICAN INSURANCE COMPANY - ) (Corporate Seal = _ — = — UR ATTEST ...................sIXN.... ....... Ali Wrighi �/ie resident STATE {3FNEW YDRKM ss: WHITE PLAINS ill III COUNT' OF=NEW=YO By ............................................ 4. ?l..:"^.......................................................... — Ronald_Diggs, Vice P_psident On the 25TH day of NOVEMBER, 2013 before me personally came RONALD DIGGS to me known, who being by me duly swom, did depose and say that (s)he resides in HELLERTOWN, PENNSYLVANIA that (s)he is a VICE PRESIDENT of ENDURANCE AMERICAN INSURANCE COMPANY, the corporation described in and which executed the above instrument; that (s)he knows the seal of said corporation that the seal affixed to said instrument is such corporate seal; that it was so affixed by order of the Board of Directors of said corporation, and that (s)he signed his (her) name thereto by like order. (Notarial Seal) — �- ............. m ................ - _.... - ry s. DNoi 2015 CERTIFICATE STATE OF CALIFORNIA -1 ' ss: WHITE PLAINS COUNTY OF LOS ANGELES - - _ _ - NCE AMR - I,�fose h C-0 DonnelFA.-MECIJTIVE VICE PRESIDENT of ENDURANCE ICAN INSURANCE C PA Y��_Dela rare dna (the "Corporation), her r#ifya R 1. Tnatahe ongTinat power of altomey of which the foregoing is a cope was duly executed on behalf of the Compoona ion -m -Ms nio since been revoked, amended or tbodififfi-tis-ta the undersigned has compared the foregoing copy thereof with the original power of attorney, and that the same is a true and correct copy of the original power of attorney and of the whole thereof; 2. The following are resolutions which were adopted by the Board of Directors of the Corporation by unanimous written consent on the 21 st day of July, 2011 and said resolutions have not since been revoked, amended or modified "RESOLVED, that each of #*individuals named belowds an d twHnakt execute eat and deliver for and on behalf f the Corporation any and all bonds, ur de or gat nsAp striaty or co -surety with others and tom_ xecute and deliver for and_nU� h f WK- o oratro� enewals, extensions, a6lreements!l waivers, consents or stipulations relatmftsuch resA tas,� undertakings or obligations. ALFRED N. WRIGHT, RONALD DIGGS And ;wiM1:,msun RESOLVED FURTHWhaf8aO of the individuals named above is authorized to appoint attomeys-in-fact for the purpose of making -executing, sealing and delivering bonds undertakings or blig oations iw ori s�t�� and on behalf of the Corporation. _ Y/ - — 3. Thendetsigne�furires thatthe above resolutions ail true and,Conrect copies of the resolutions assn recorded and n—ee thereof. _,•— —= -,t f j j� IN WITNESS WHEREOF F,have hereunto'set my hand and affixed the corporate seal this 2 S7 day of �[ 20 �`T . �✓ — _ Jos ` J � ._ Co rate Seal �-.-.: �: '� -� �' Joseph C. O'Donnell Executive Vice President. '_Tfiry mei pndted on W16red bonded safety paper. A4reproductions are void. W, f;m2li2; )\ , �;(@/!«( #0 f®!% ! `§ °)/ ,a}!q r 0) 0 q� }��� � >�}`\\§\ (AX �� . ........ k� ®®®�j\ri r! ' 'n 00 \, ƒ}J%§E\% 40 . ;o5c30 0 )0 . , #�, 7o , f\\(f ( Ems§ u� ! �(\2�lb ,� 7!;To 2 }§fit) ) ' ƒ§E5§ ' E�� _ &, . Eco ! i , W, f;m2li2; )\ , �;(@/!«( #0 f®!% ! `§ °)/ ,a}!q r 0) 0 q� }��� � n} ,�a-E ° |-4 E3330 2/ . 23«aƒE3� � 0= , k 11 o o k 0M k ( (0 ��-- - -— �-- 2 W, f;m2li2; )\ , �;(@/!«( #0 f®!% ! `§ °)/ ,a}!q r 0) 0 q� }��� � EFFECTIVE MARCH 30, 2010 Commonwealth of Massachusetts Division of Capital Asset Management Q 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 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. 1/21/2014 Compass Plumbinq & Heating, Inc Bid Date Print Name of Sub -bidder or Trade Contractor Demo. old Police Station 50 Oliver St. #107 N.Easton, MA 02356 Project Number (or Business Address name if no number) Town of North Andover 508-238-3479 Awarding Authority Telephone Number SIGNATURE* A4�__ &W�. Bidder's Authorized 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/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 Sub -bidder Update Statement Effective March 30, 2010 INSTRUCTIONS TO AWARDING AUTHORITIES Determination of Sub -Bidder Qualifications 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 of 10 W U Z, �m 0 D w F- p W W J 0 aZ � 02 UQ U� =0 �W LL Irw DX 0W F— ~ Q0 �Z W 0 OfW 2U) 0-1 O z oV 0 � W U- 0 0 0 H� U� Wim* 00 aim wLL fl1 Q Z J > 0 W LL aQ0 �UW QaA Ua- J Q � LL aOw Lu U QQpW 0 (n _ J �— m L WM N M N � W W o N 0 N 0 N 0 N 0 0 Qa w IN O 00 cfl O M o M U o E U N o v� ~Q _ N r N_ r N_ p O N L O O N O N O N N N � � o � Q ti ca 0) o r - 3 ° W O O �- U C O CD U) N 0- O O O E� F - C) 0 0 0 0 0 0 0 0 0 o 0 o U � N E o Z 604 � M E m 0 OL Q. 02 m (D c cd > co N O C U E ccc rnw c c c c ma) co Y� 0 m - m m 0 m 0 - a) ccca O m4 L "' "�ca OW E E E E E E H > > > 7 7 7 Q « c4 a a a a a. 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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.]. YES NO 1. Has your firm been terminated on any contract prior to completing a project or has ❑ any officer, partner or principal of your firm been an officer, partner or principal of another firm that was terminated or failed to complete aproject? 2. Has your firm failed or refused either to perform or complete any of its work under ❑ 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 El N contract? 6. Has a payment or performance bond been invoked against your current firm, or has ❑ any officer, principal or individual with a financial interest in your current firm been an officer, principal or individual with a financial interest in another firm that had a payment or performance bond invoked? 7. Has your surety made payment to a materials supplier or other party under your payment bond on any contract? 8. Has any subcontractor filed a demand for direct payment with an awarding authority ❑ fora public project on any of your contracts? 9. Have any of your subcontractors or suppliers filed litigation to enforce a mechanic's ❑ lien against property in connection with work performed or materials supplied under any of your contracts? 10. Have there been any deaths of an employee or others occurring in connection with any of 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 firm been brought, concluded, or settled relating to the procurement or performance of any construction contract, including but not limited to actions to obtain payment brought by subcontractors, suppliers or others? 2. Have any criminal proceedings involving your firm or a principal or officer or ❑ anyone with a financial interest in your firm been brought, concluded, or settled relating to the procurement or performance of any construction contract including, but not limited to, any of the following offenses: fraud, graft, embezzlement, forgery, bribery, falsification or destruction of records, or receipt of stolen property? 3. Have any judicial or administrative proceedings involving your firm or a principal ❑ or officer or anyone with a financial interest in your firm been brought, concluded, or settled relating to a violation of any state's or federal procurement laws arising out of the submission of bids or proposals? 4. Have any judicial or administrative proceedings involving your firm or a principal ❑ or officer or anyone with a financial interest in your firm been brought, concluded, or settled relating to a violation of M.G.L. Chapter 268A, the State Ethics Law? Division of Capital Asset Management Page 8 of t0 Sub -bidder Update Statement Effective March 30, 2010 PART 4 - Legal or Administrative Proceedings; Compliance with Laws (continued) YES NO 5. Have any judicial or administrative proceedings involving your firm or a principal ❑ or officer or anyone with a financial interest in your firm been brought, concluded, or settled relating to a violation of any state or federal law regulating hours of labor, unemployment compensation, minimum wages, prevailing wages, overtime pay, equal pay, child labor or worker's compensation? 6. Have any judicial or administrative proceedings involving your firm or a principal ❑ or officer or anyone with a financial interest in your firm been brought, concluded, or settled relating to a violation of any state or federal law prohibiting discrimination in employment? 7. Have any judicial or administrative proceedings involving your firm or a principal ❑ or officer or anyone with a financial interest in your firm been brought, concluded, or settled relating to a claim of repeated or aggravated violation of any state or federal law regulating labor relations? 8. Have any proceedings by a municipal, state, or federal agency been brought, ❑ concluded, or settled relating to decertification, debarment, or suspension of your firm or any principal or officer or anyone with a financial interest in your firm from public contracting? 9. Have any judicial or administrative proceedings involving your firm or a principal or ❑ officer or anyone with a financial interest in your firm been brought, concluded, or settled relating to a violation of state or federal law regulating the environment? 10. Has your 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.gov 11. Has your firm been sanctioned for failure to achieve DBE/MBE/WBE goals, N 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 ❑ N 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 ❑ N 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 FUNCTION Marc Nios Preident John Ierardi Foreman Thomas Simmons Plumber 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