HomeMy WebLinkAboutContract #: 005294 - From: To: - Exception - ExceptionV
School Department Administration Building
North Andover, MA
FORM OF SUB -BID
To All General Bidders Except those Excluded:
C(e-1
Kang Associates, Inc.
January 2, 2014
A. The undersigned proposes to furnish all labor and materials required for completing, in accordance
with the hereinafter described plans, specifications and addenda, all work specified in
fijo-c— 2) ` v. L 3 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:
For Alternate #1:
Deduct $ &" C dollars ($ /Ld C��'i�✓C— ).
For Alternate #2:
Add/
Deduct $ /Ud 0 /iI-N6�12 dollars ($
For Alternate #3:
Deduct $ ZVO dollars ($ A!Y G'rf54yCr� )
For Alternate #4:
Deduct $ ,tea dollars ($
For Alternate #5:
Deduct $ A�� ��'� = dollars ($ Z::!�? G
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 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.)
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 116 years.
2. Ever failed to complete any work awarded? WC�
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
>'i
(a) SG A/00 V Cv/1,7r 1nt- 1X77. 3�
T�
FORM OF SUB -BID - 2
School Department Administration Building Kang Associates, Inc.
North Andover, MA January 2, 2014
fiprn� os� ii i� rT
(b) iG rtor c. S/7�il�A /�iL�N//7-ci 3 �,�Hii i�'yi��Jrzs l�, 02. t
C_LavcES,2
(c) 715
4. Bank reference (, pS /31_QAdLV19y .S/f /e LIJ Mf
7b/-,5-sW1 - 215-20
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.
Date (Name of Sub -Bidder)
SUB -BIDDER'S CHECKLIST:
Addenda Recognized
y Bid Deposit
DCAM Certificate of Eligibility
— Sub -Bidder Update Statement
Certificate of Corporate Bidder
By, *C�11/1r-S1Ar'
Signature and Title of Person Signing Bid
1�1!W C°rt14-1174e 57..
Business Address
City and State
FORM OF SUB -BID - 3
School Department Administration Building
North Andover, MA
CERTIFICATE OF CORPORATE BIDDER
Kang Associates, Inc.
January 2, 2014
certify that I am the
2-'• p C V-.% of the corporation named as Bidder in the
Bid Form, and that J , h� �� -- t '�)Q } 1 U who signed the Bid Form on
behalf of the Bidder was then the ?(,e �5 'I �''e 0 �- 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
Se etary-Clerk
Date
CORPORATE BIDDER - 1
DEVAL L. PATRICK
GOVERNOR
TIMOTHY P. MURRAY
LIEUTENANT GOVERNOR
The Commonwealth of Massachusetts
Executive Officefor Administration and Finance
Division of Capital Asset Management and Maintenance
One Ashburton Place
Boston, Massachusetts 02108
Tel: (617) 727-4050
Fax: (617) 727-5363
Filed Sub -Bid
Certificate of Contractor Eligibility
CONTRACTOR IDENTIFICATION NUMBER: 0481
GLEN SHOR
SECRETARY, ADMINISTRATION &
FINANCE
This Certificate Shall Be Used for Submittin2 Filed Sub -Bids Only
CAROLE CORNELISON
COMMISSIONER
1. CERTIFICATION PERIOD:
This Certificate is valid from 11/5/2013 to 11/5/2014
2. CONTRACTOR'S NAME:
Thomas E. Snowden, Inc.
3. CONTRACTOR'S ADDRESS: 189 Central Street, Saugus, MA 01906
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:
Ft Acoustical Tile
HVAC ❑ Miscellaneous & Ornamental Iron ❑ Terrazzo
1 Electrical Work
❑ Lathing & Plastering 1 Painting Tile
[' Elevators
❑ Marble ❑ Plumbing ❑ Waterproofing, Damp
LJ Fire Protection Sprinkler Systems
1 Masonry Work ❑ Resilient Floors proofing, and Caulking
Glass and Glazing
❑ Metal Windows ❑ Roofing & Flashing
S. EVALUATIONS:
Number of Projects Evaluated: 21
Average Project Evaluation Rating: 93
Number of Projects Below Passing Score: 0
6. SUPPLIER ERSITY OFFICE CERTIFICATION: N/A
10 � t�
ran Gri
y, 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
Document A310 TM -2010
Conforms with The American Institute of Architects AIA Document 310
CONTRACTOR:
SURETY:
(.Name, legal status and address)
(Name, legal ,status and principal place of business)
Thomas E. Snowden, Inc.
Western Surety Company
189 Central Street,
53 State Street
Saugus, MA 01906
Boston, MA 02109
This document has important
legal consequences. Consultation
with an attorney is encouraged
with respect to its completion or
OWNER:
modification.
(Name, legal status and address)
Town of North Andover
Any singular reference to
Contractor, Surety, Owner or
MA
other party shall be considered
plural where applicable.
BOND AMOUNT: $
Five Percent of the Attached bid (5%)
PROJECT:
(Name, location or address, and Project number, t*any) School Department Administration
Building; Div 23
The Contractor and Surety are bound to the Owner in the amount set forth above, for the payment of which the Contractor and Surety bind
themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, as provided herein. The conditions of this
Bond are such that if the Owner accepts the bid of the Contractor within the time specified in die bid documents, or within such time period
as may be agreed to by the Owner and Contractor, and the Contractor either (1) enters into a contract with the Owner in accordance with
the terms of such bid, and gives such bond or bonds as may be specified in the bidding or Contract Documents, with a surety admitted in
the jurisdiction of the Project and otherwise acceptable to the Owner, for the faithful performance of such Contract and for the prompt
payment of labor and material furnished in the prosecution thereof; or (2) pays to the Owner the difference, not to exceed the amount of
this Bond, between the amount specified in said bid and such larger amount for which the Owner 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. The
Surety hereby waives any notice of an agreement between the Owner and Contractor to extend the time in which the Owner may accept the
bid. Waiver of notice by the Surety shall not apply to any extension exceeding sixty (60) days in the aggregate beyond the time for
acceptance of bids specified in the bid documents, and the Owner and Contractor shall obtain the Surety's consent for an extension beyond
sixty (60) days.
]f this Bond is issued in connection with a subcontractor's bid to a Contractor, the term Contractor in this Bond shall be deemed to be
Subcontractor and the term Owner shall be deemed to be Contractor,
When this Bond has been furnished to comply with a statutory or other legal requirement in the location of the Project, any provision in
this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and provisions conforming to such
statutory or other legal requirement shall be deemed incorporated herein. When so furnished, the intent is that this Bond shall be construed
as a statutory bond and not as a common law bond.
Signed and sealed this 21st day of January, 2014
sir
(Witness)
Thomas E. Snowden, Inc.
(Principal) (Seal)
e)
Western Surety Company
(Seat)
ames J. Axo or -in-Fact
Western Surety Company
POWER OF ATTORNEY APPOINTING INDIVIDUAL ATTORNEY-IN-FACT
Know All Men By These Presents, That WESTERN SURETY COMPANY, a South Dakota corporation, is a duly organized and existing corporation
having its principal office in the City of Sioux Falls, and State of South Dakota, and that it does by virtue of the signature and seal herein affixed hereby
make, constitute and appoint
Gregory D Juwa, Richard F Caruso, James J Axon, Michael F Carney, Wilder Parks Jr,
Michael T Gilbert, Adam W De Sanctis, Christine B Gallagher, Bryan F Juwa, Paul
A Patalano, David A Boutiette, Judy Dean, Rebecca Shanley, Individually
of Woburn, MA, its true and lawful Attomey(s)-in-Fact with full power and authority hereby conferred to sign, seal and execute for and on its behalf bonds,
undertakings and other obligatory instruments of similar nature
- In Unlimited Amounts -
and to bind it thereby as fully and to the same extent as if such instruments were signed by a duly authorized officer of the corporation and all the acts of said
Attorney, pursuant to the authority hereby given, are hereby ratified and confirmed.
This Power of Attorney is made and executed pursuant to and by authority of the By -Law printed on the reverse hereof, duly adopted, as indicated, by
the shareholders of the corporation.
In Witness Whereof, WESTERN SURETY COMPANY has caused these presents to be signed by its Vice President and its corporate seal to be
hereto affixed on this 12th day of December, 2013.
s` �REr„y"�,
WESTERN SURETY COMPANY
�We�`pPOAgr�',le:
sr�
ys'•SFAV'�<`
*c,�4jN DPµ a
ZPaul T. Bruflat, Vice President
State of South Dakota I
ss
County of Minnehaha
On this 12th day of December, 2013, before me personally came Paul T. Bruflat, to me known, who, being by me duly sworn, did depose and say: that
he resides in the City of Sioux Falls, State of South Dakota; that he is the Vice President of WESTERN SURETY COMPANY described in and which
executed the above instrument; that he knows the seal of said corporation; that the seal affixed to the said instrument is such corporate seal; that it was so
affixed pursuant to authority given by the Board of Directors of said corporation and that he signed his name thereto pursuant to like authority, and
acknowledges same to be the act and deed of said corporation.
My commission expires f"` "" '°"'"'"""`°" `""""'"'"'°'i
J. MOHR r
June 23, 2015 # seA� NOTARY PUBLIC gEnL r
r SOUTH DAKOTA i
r
4 �,w+aa.w+•.v,4ti�.�.ti..�a.�t,�•s.ti4
J. Mohr, Notary Public
CERTIFICATE
I, L. Nelson, Assistant Secretary of WESTERN SURETY COMPANY do hereby certify that the Power of Attorney hereinabove set forth is still in
force, and further certify that the By -Law of the corporation printed on the reverse her of is still in force. In testimony whereof I have hereunto subscribed
my name and affixed the seal of the said corporation this Z1 S} day of -a)) I .
'
eEry,, WESTERN SURETY COMPANY
CA
27 02�UZ
s a�i„,�up,•'
L. Nelson, Assistant Secretary
Form F4280-7-2012
AuthdriXng By -Law
ADOPTED BY THE SHAREHOLDERS OF WESTERN SURETY COMPANY
This Power of Attorney is made and executed pursuant to and by authority of the following By -Law duly adopted by the shareholders
of the Company.
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, and 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.
EFFECTIVE MARCH 30, 2010
Commonwealth of Massachusetts
Division of Capital Asset Management
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.
2
Bi Da
Project Number (or
_name if no number)
Awarding Authority
Thomas E. Snowden, Inc
Print Name of Sub -bidder or Trade Contractor
189 Central Street, Saugus, MA 01906
Business Address
781-233-8810
Telephone Number
SIGNATURE*
Bi der's Author' ed 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
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D in
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.].
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
❑
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
❑ Z
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 proposals9
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)
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,
❑
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
❑ E
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 Page 9 of 10
Sub -bidder Update Statement Effective March 30, 2010
(781)233-8810
(78 1 ) 233-33.33
' �GTul11TbN
FAX(781)1231-2151
SALES 12OW 189 CENTRAL STREET • SAUGUS, MASSACHUSETTS 01906
DESIGNERS OF AIR-CONDITIONING • HEATING • REFRIGERATION AND SHEET METAL SYSTEMS
July 23, 2013
To Whom It May Concern:
Re: Section I Item OSHA Violation
Project; Carlisle School, Carlisle MA
On May 12, 2011 an informal settlement agreement was executed for a violation
pertaining to an employee not using a suitable cylinder truck, steading device to keep a
compressed gas cylinder from being knocked over. (Please note all of our employees
using cylinders are provided cylinder carts for securing any type of gas cylinder,
employee negligence)
The settlement agreement resulted in a penalty of $2,310.00
Project; Melrose DPW Facility, Melrose MA
On January 27, 2012 an informal settlement agreement was executed for a violation
pertaining to use of a portable ladder with structural defects, ladder not extended properly
above roof and fall arrest systems.
This was an employee's complete negligence the Thomas Snowden Company provides
employee training and certification to all its employees for fall arrest procedures. In
addition our employees have been enrolled in safety classes and meetings provided by
our independent safety consultant and OSHA centers.
The settlement agreement resulted in a penalty of $10,000
ti�` OESIGN7sk
SERVICE
Pg; 2 Section I item OSHA Violation
Please note the Thomas E. Snowden Company takes safety very seriously providing
education and training to all its employees. These citations are a result of employee's
negligence for not following company protocol and job site safety procedures.
Our workman's compensation modifier has and continues to be at a low level which we
attribute to company safety standards, training and education of employees.
The goal and motto of our company is to work safe and smart.
If you have any questions, please do not hesitate to call.
Very Truly Yours
Thomag,E. Snowde Inc.
ear bolla
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
SEE ATTACHED
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
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Resume of Management Personnel
Thomas E. Snowden, Inc.
Richard N. Barbolla, President
Project Management
A.A.S. HVAC Design, B.S.
Mechanical Engineering
10 Hr OSHA Certification, 30 hr. Cert
Unrestricted Master Sheetmetal License
Joe Bureau, PM Sheetmetal Mechanic Foreman
G.E.D. North Shore Community College
Carrier HVAC Design
10 Hr OSHA Certification
Certification Fall Arrest
Unrestricted Master Sheetmetal License
Paul Grove, PM Vice President Pipe Division
Saugus High School, Master Pipefitter
General Electric -All around Machinist
Program & Method Planner
30 Hr OSHA Certification
Unrestricted Master Sheetmetal License
John Mahoney, Sheetmetal Mechanic/Foreman
Dracut High School
Greater Lowell Vocational
10 Hr OSHA Certification and Fall Arrest Certification
Unrestricted Master Sheetmetal License
Mark Rothwell, Pipefitter Foreman
NE Regional Voc. Technical School
I Ohr OSHA Certification
Master Pipefitter & Gasfitter
Mark Crowell, Sheetmetal Mechanic Foreman
Northeast Voc. Technical H.S.
Gould Institute
10 Hr OSHA Certification
Unrestricted Master Sheetmetal License
1985 — Present
1987 — Present
1992 — Present
2002 — Present
2011- Present
2002 — Present
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A
J. Certification (notarization required)
The undersigned, flichard N. Barbolla hereby certifies:
(type name)
That I am an owner or principal of Thomas E• Snowden, Inc,
(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 information submitted is in fact complete, accurate and true, under
oath.
Signed and Sworn under the Pains and Penalties of Perjury.
Dated at 7-24-13
This 24 day of July, 2013.
By (signature):tl
Type name: Richard N. Barbolla
Title or position: President
***************************************************************************
ss. �S C
(county) (state)
Before me,�1 ���� personally appeared and
(notary public)
known to me to be
(name ',��
of officer)
on satisfactory evidence which was his/her driver's license and acknowledged that he/she is
authorized to execute the foregoing and that its execution is his/her free act and deed and the free
act and deed of the firm.
(notary public sign e
(print name)'
commissi n
DANIA DEJES S
Notary Public
_\ Massachusetts
,, Commiaslon Explres Sep 3, 2015
"Upon completion of this Application and the two corresponding Excel spreadsheets, save and
email them to CertificationApp)ication.dcam(a7state.ma.us **
Page 16 of 16
Prime/General Revised March 2011
Computer