HomeMy WebLinkAboutContract #: 005545 - From: To: - Exception - ExceptionSchool Department Administration Building
North Andover, MA
FORM OF SUB -BID
To All General Bidders Except those Excluded:
A.
C)m /-1 t_/ecA/',('C_
Kang Associates, Inc.
January 2, 2014
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
Division 26 - Electrical 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:
Two Hundred TweM Seven Thousand Dollars dollars ($ 227,000.00 ),
For Alternate #1:
Deduct $
For Alternate #2:
dollars ($ N/A ),
Add/
Deduct $ N/A dollars ($ N/A )
For Alternate #3:
Deduct $ N/A dollars ($ N/A
For Alternate #4:
Deduct $ Fight hundred seventy five dollars dollars ($ -$875.00 ),
For Alternate #5:
Deduct $ Sixteen thousand dollars dollars ($ -16,000.00 ),
This sub -bid includes addenda numbered I
C. This sub -bid
❑ may be used by any general bidder except:
❑ may only be used by the following general bidders:
(To exclude general bidders, insert an "X" in one box only and fill in blank following that box. Do not
answer C if no general bidders are excluded.)
FORM OF SUB -BID -1
School Department Administration Building
North Andover, MA
Kang Associates, Inc.
January 2, 2014
D. The undersigned agrees that, if he is selected as sub -bidder, he will within five days, Saturdays,
Sundays, and legal holidays excluded, after presentation of a subcontract by the general bidder
selected as the general contractor, execute with such general bidder a subcontract in accordance
with the terms of this sub -bid, and contingent upon the execution of the general contract, and, if
requested so to do in the general bid by such general bidder, who shall pay the premiums therefor,
or if pre -qualification is required pursuant to section 44D 3/4, furnish a performance and payment
bond of a surety company qualified to do business under the laws of the Commonwealth and
satisfactory to the awarding authority in full sum of the subcontract price.
E. The names of all persons, firms and corporations furnishing to the undersigned labor or labor and
materials for the class or classes or part thereof work for which the provisions of the section of the
specifications for this sub -trade requires a listing in this paragraph, including the undersigned if
customarily furnished by persons on his own payroll and in the absence of a contrary provisions in
the specifications, the name of each such class of work or part thereto and the Bid price for such
class of work or part thereof are:
Name
Class of Work
Bid Price
(Do not give bid price for any class or part thereof furnished by undersigned.)
F. The undersigned agrees that the above list of bids to the undersigned represents bona fide bids
based on the hereinbefore described plans, specifications and addenda and that, if the undersigned
is awarded the contract, they will be used for the work indicated at the same amounts stated, if
satisfactory to the awarding authority.
G. The undersigned further agrees to be bound to the general contractor by the terms of the
hereinbefore described plans, specifications, including all general conditions stated therein, and
addenda, and to assume toward him all the obligations and responsibilities that he, by those
documents, assumes toward the owner.
H. The undersigned offers the following information as evidence of his qualifications to perform the
work as bid upon according to all the requirements of the plans and specifications:
1. Have been in business under present business name 21 years.
2. Ever failed to complete any work awarded? No
3. List one or more recent buildings with names of the general contractor and architect on which
you served as a subcontractor for work of similar character as required for the above named
buildings.
Building Architect . General Contractor Amount of Contract
(a) Walmart-Derrv. NH Walmart Bast Hatfield $755.119.00
FORM OF SUB -BID - 2
School Department Administration Building
North Andover, MA
Kang Associates, Inc.
January 2, 2014
(c) VA Medical Center Health Care Architects Legion Construction $562,000.00
4. Bank reference Clinton Savings Bank, 200 Church St., Clinton, MA 01510 978-365-3700
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.
01/21/2014 D.M.H. Electric, Inc.
Date (Name of Sub -Bidder)
By:. / �6,v/ /it'�S/
Signar and Title of Person Signing Bid
SUB -BIDDER'S CHECKLIST:
Addenda Recognized
Bid Deposit
DCAM Certificate of Eligibility
Sub -Bidder Update Statement
Certificate of Corporate Bidder
29 Legate Hill Road
Business Address
Sterling, MA 01564
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
1, David Hinckley certify that I am the
Clerk of the corporation named as Bidder in the
Bid Form, and that Timothy QToole who signed the Bid Form on
behalf of the Bidder was then the President 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.
1/21/2014
Date
CORPORATE BIDDER - 1
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.
F I llll PW11116w M 1 IUM
Date 1/21/2014
D.M.H. Electric Inc.
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.
Date 1/21/2014
D.M.H. Electric, Inc.
Company Name
CERTIFICATE OF TAX COMPLIANCE
Pursuant to Chapter 62C of the Massachusetts General Laws, Section 49A (b), I
David Hinckley , authorized signatory for D.M.H. Electric, Inc.
Name of individual Name of contractor
do hereby certify under the pains and penalties of perjury that said contractor has complied with
all laws of the Commonwealth of Massachusetts, and the Town of North Andover, relating to
taxes, permit or other fees, reporting of employees and contractors, and withholding and
remitting child support.
Date
1/21/2014
CERTIFICATE OF VOTE
At a duly authorized meeting the Board of Directors of the D.M.H. Electric, Inc,
held on 1/21/2014 it was
VOTED, THAT
_Timothy O'Toole President
(Name) (Officer)
Of D.M.H. Electric, Inc. be and hereby is authorized to execute contracts and bonds in
the name and on behalf of said D.M.H. Electric, Inc. , and affix its corporate seal hereto;
and such execution of any contract or obligation in the name of D.M.H. Electric, Inc. on
its behalf by such officer under seal of Timot y O'Toole , shall be valid and binding
upon D.M.H. Electric, Inc.
I hereby certify that I am the clerk of the above named D_M_H_ Electric, Inc. and
that Timothy O'Toole is the duly elected officer as above of said
D.M.H. Electric. Inc. , and that the above vote has not been amended or rescinded and
remainc in full fnrre and effect ac the date of thic enntrart
1/21/2014
(Date)
Certification of the Corporate Clerk
School Department Administration Building
North Andover, MA
FOREIGN CORPORATIONS CERTIFICATION
AFFIDAVIT OF COMPLIANCE
Form AF -4A 1/78
EXECUTIVE OFFICE FOR
ADMINISTRATION AND FINANCE
The Commonwealth of Massachusetts
X Massachusetts Business Corporation
Non-profit Corporation
Foreign (non -Massachusetts) Corporation
I, David Hinckley
President X Clerk of 1)_M_H_ Electric,, Inc_
. (Name of Corporation)
Kang Associates, Inc.
January 2, 2014
whose principal office is located 29 Legate Hill Road, Sterline, MA 01564
do hereby certify that the above named Corporation has filed with the State Secretary all certificates and
annual reports required by Chapter 1566, Section 109 (Business Corporation), by Chapter 181, Section 4
(Foreign Corporation), or by Chapter 180, Section 26A (non-profit Corporation) of the Massachusetts
General Laws.
SIGNED UNDER THE PENALTIES OF PERJI
Signature of responsible Corporate Officer
FOREIGN CORP - 1
The Commonwealth of Massachusetts
Executive Office for Administration and Finance
Division of Capital Asset Management and Maintenance
One Ashburton Place
Boston, Massachusetts 02108
2. CONTRACTOR'S NAME:
DEVAL L. PATRICK
GLEN SHOR
GOVERNOR Tel: (617) 727-4050
SECRETARY, ADMINISTRATION &
Fax: (617) 727-5363
FINANCE
TIMOTHY P. MURRAY
CAROLE CORNELISON
LIEUTENANT GOVERNOR
COMMISSIONER
Filed Sub -Bid
!I Elevators
Certificate of Contractor Eligibility
_-1 Fire Protection Sprinkler Systems
CONTRACTOR IDENTIFICATION NUMBER: 0903
Jl Glass and Glazing
This Certificate Shall Be Used for Submitting Filed Sub -Bids Only
1. CERTIFICATION PERIOD: This Certificate is valid from 4/12/2013 to 4/12/2014
2. CONTRACTOR'S NAME:
DMH Electric, Inc.
3. CONTRACTOR'S ADDRESS:
29 Legate Hill Road, Suite A, Sterling, MA 01564
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:
r Acoustical Tile,_
HVACJ Miscellaneous &Ornamental Iron ❑Terrazzo
Electrical Work
Lathing & Plastering C Painting ❑ Tile
!I Elevators
❑ Marble Ll Plumbing D Waterproofing, Damp
_-1 Fire Protection Sprinkler Systems
! I Masonry Work ] Resilient Floors proofing, and Caulking
Jl Glass and Glazing
01 Metal Windows __] Roofing & Flashing
S. EVALUATIONS:
Number of Projects Evaluated: 22
Average Project Evaluation Rating: 91
Number of Projects Below Passing Score: 0
6. SUPPLIEDIVERSITY OFFICE CERTIFICATION: N/A
Taran Gr
shy, General Counsel, Approval Date
for Carol
3. Cornelison, Commissioner
NOTE TO CONTRACTORS: Complete Applications for Renewal of Contractor Eligibility are due no later than three months
PR/OR 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. VS
Reviewer's Initials
E
THE MAIN STREET AMERICA GROUP
NGM Insurance Company • Old Dominion Insurance Company
Main Street America Assurance Company • MSA Insurance Company
Information Systems and Services Corporation
Bid Bond
06-0273295
KNOW ALL MEN BY THESE PRESENTS, that we (Here insert full name and address or legal title of Contractor)
DMH Electric, Inc.
29 Legate Hill Road, Sterling, MA 01564
as Principal, hereinafter called the Principal, and (Here insert full name and address or legal title of Surety)
NGM Insurance Company
55 West Street
Keene, NH 03431
a corporation duly organized under the laws of the State of Florida
as Surety, hereinafter called the Surety, are held and firmly bound unto (Here insert full name and address or legal title of Owner)
Town of North Andover, MA
120 Main Street, North Andover, MA 01845
as Obligee, hereinafter called the Obligee, in the sum of 5% (Five Percent) of Attached Bid Dollars ($ ),
for the payment of which sum well and truly to be made, the said Principal and the said Surety, bind ourselves, our heirs,
executors, administrators, successors and assigns, jointly and severally, firmly by these presents.
WHEREAS, the Principal has submitted a bid for (Here insert full name; address and description of project)
School Administration Office Building
New construction of admin building
120 Main Street, North Andover, MA
NOW, THEREFORE, if the Obligee shall accept the bid of the Principal and the Principal shall enter into a Contract with
the Obligee in accordance with the terms of such bid, and give such bond or bonds as may be specified in the bidding or
Contract Documents with good and sufficient surety for the faithful performance of such Contract and for the prompt
payment of labor and material furnished in the prosecution thereof, or in the event of the failure of the Principal to enter
such Contract and give such bond or bonds, if the Principal shall pay to the Obligee the difference not to exceed the
penalty hereof between the amount specified in said bid and such larger amount for which the Obligee may in good faith
contract with another party to perform the Work covered by said bid, then this obligation shall be null and void,- otherwise
to remain in full force and effect.
Signed and sealed this 21st day of January, 2014
(Witness)
(Witnes
DMH Elec
(Principal)
(Title)
NGM Insurance
(Surety) /
(Title) Attorney-in-fact ` Richard C Traina
(Seal)
Printed in cooperation with the American Institute of Architects (AIA) by the NGM Insurance Company of
4601 Touchton Road East, Suite 3400, Jacksonville, FL 32256 904-739-0873. The language in this document conforms exactly to the
language used in AIA Document A310, February, 1970 edition.
68-5302(11/00)
WARNING: Any unauthorized reproduction or alteratipn of this document is prohibited.
TO CONFIRM VALIDITY of the attached bond please call -5646.:
TO SUBMIT A CLAIM: Send all correspondence to 55 West Street, Keene, NH 03431 Attn: Bond Claims.
SENSITIVE
O
OFs�' NEAT OPSOJ�
Commonwealth of Massachusetts
Division of Capital Asset Management
PRIME/GENERAL CONTRACTOR
UPDATE STATEMENT
TO ALL BIDDERS AND AWARDING AUTHORITIES
A COMPLETED AND SIGNED PRIME/GENERAL CONTRACTOR UPDATE
STATEMENT MUST BE SUBMITTED WITH EVERY PRIME/GENERAL BID FOR A
CONTRACT PURSUANT TO M.G.L. c.149, §44A AND M.G.L. c. 149A. ANY
PRIME/GENERAL BID SUBMITTED WITHOUT AN APPROPRIATE UPDATE
STATEMENT IS INVALID AND MUST BE REJECTED.
Caution: This form is to be used for submitting Prime/General Contract bids. It is
not to be used for submitting Filed Sub -Bids or Trade Sub -Bids.
AWARDING AUTHORITIES
If the Awarding Authority determines that the bidder does not demonstrably possess
the skill, ability, and integrity necessary to perform the work on the project, it must
reject the bid.
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 Prime/General Contractor Update Statement on behalf
of the bidder named below, that I have read this Prime/General Contractor Update Statement,
and that all of the information provided by the bidder in this Prime/General Contractor Update
Statement is true, accurate, and complete as of the bid date.
01/21/2014 D.M.H. Electric, Inc.
Bid Date Print Name of Prime/General Contractor
Schopl Ad�nini traton Building 29 Legate Hill Road -Unit A
Project NL '
er�or Business Address qt-arl i nn mn ni qFa
name if no number)
North Andover School Department
Awarding Authority
SIGNATURE*
978-422-0400
Telephone
Bidder's A
Division of Capital Asset Management Page t of 10
INSTRUCTIONS
INSTRUCTIONS TO BIDDERS
• This form must be completed and submitted by all
Prime/General contractors bidding on projects pursuant
to M.G.L. c. 149, §44A and M.G.L. c. 149A.
• You must give complete and accurate answers to all
questions and provide all of the information requested.
MAKING A MATERIALLY FALSE STATEMENT IN THIS
UPDATE STATEMENT IS GROUNDS FOR
REJECTING YOUR BID AND FOR DEBARRING YOU
FROM ALL PUBLIC CONTRACTING.
• This Update Statement must include all requested
Information that was not previously reported on the
Application used for your firm's most recently
issued (not extended or amended) Prime/General
Contractor Certificate of Eligibility. The Update
Statement must cover the entire period since the
date of your Application, NOT since the date of your
Certification.
You must use this official form of Update Statement.
Copies of this form may be obtained from the awarding
authority and from the Asset Management Web Site:
www.mass.00v/dcam
If additional space is needed, please copy the
appropriate page of this Update Statement and attach it
as an additional sheet.
See the section entitled "Bidding Limits" in the
Instructions to Awarding Authorities for important
information concerning your bidding limits.
INSTRUCTIONS TO AWARDING AUTHORITIES
Determination of Bidder Qualifications
• It is the awarding authority's responsibility to determine
who is the lowest eligible and responsible bidder. You
must consider all of the information in the low bidders
Update Statement in making this determination.
Remember: this information was not available to the
Division of Capital Asset Management at the time of
certification.
• The bidder's performance on the projected listed in Parts
1 and 2 must be part of your review. Contact the project
references.
• AWARDING AUTHORITIES ARE STRONGLY
ENCOURAGED TO REVIEW THE LOW BIDDER'S
ENTIRE CERTIFICATION FILE AT THE DIVISION OF
CAPITAL ASSET MANAGEMENT. Telephone (617)
727-9320 for an appointment.
Bidding Limits
Sinole Proiect Limit: The total amount of the bid, including all
alternates, may not exceed the bidders Single Project Limit.
Aggregate Work Limit: The annual value of the work to be
performed on the contract for which the bid is submitted,
when added to the annual cost to complete the bidder's other
currently held contracts, may not exceed the bidders
Aggregate Work Limit. Use the following procedure to
determine whether the low bidder is within its Aggregate
Work Limit:
Step 1 Review Update Statement Question #2 to
make sure that all requested information is
provided and that the bidder has accurately
calculated and totaled the annualized value of
all incomplete work on its currently held
contracts (column 9).
Step 2 Determine the annual dollar value of the work
to be performed on your project. This is done
as follows:
(i) If the project is to be completed in less
than 12 months, the annual dollar value of
the work is equal to the full amount of the
bid.
(ii) If the project will take more than 12 months
to complete, calculate the number of years
given to complete the project by dividing
the total number of months in the project
schedule by 12 (calculate to 3 decimal
places), then divide the amount of the bid
by the calculated number of years to find
the annual dollar value of the work.
SteD 3 Add the annualized value of all of the bidders
incomplete contract work (the total of column
on page 5) to the annual dollar value of the
work to be performed on your project. The
total may not exceed the bidder's
Aggregate Work Limit.
Correction of Errors and Omissions in Update
Statements
Matters of Form: An awarding authority shall not reject a
contractors bid because there are mistakes or omissions of
form in the Update Statement submitted with the bid,
provided the contractor promptly corrects those mistakes or
omissions upon request of the awarding authority. [810 CMR
8.05(1)].
Correction of Other Defects: An awarding authority may, in
its discretion, give a contractor notice of defects, other than
mistakes or omissions of form, in the contractors Update
Statement, and an opportunity to correct such defects,
provided the correction of such defects is not prejudicial to
fair competition. An awarding authority may reject a corrected
Update Statement if it contains unfavorable information about
the contractor that was omitted from the Update Statement
filed with the contractors bid. [810 CMR 8.05(2)].
Division of Capital Asset Management Page 2 of 10
Prime/General Contractor Update Statement Effective March 30, 2010
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PART 3 - PROJECT PERFORMANCE
For Parts 3 and 4, if you answer YES to any question, please provide on a separate page a
complete explanation. Information you provide herein must supplement the Application for
your most recently issued (not extended or amended) DCAM Certificate of Eligibility. You must
report all requested information not previously reported on that DCAM Application for
Prime/General Certificate of Eligibility. 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?
❑x
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
❑ x
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
hada 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
❑ x❑
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
❑ 0
any of your projects9
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
Prime/General Contractor Update Statement Effective March 30, 2010
PART 4 - Legal or Administrative Proceedings; Compliance with Laws
Please answer the following questions. Information must supplement all judicial and
administrative proceedings involving bidder's firm, which were instituted or concluded
(adversely or otherwise) since your firm's Application for your most recently issued (not
extended or amended) Certificate of Eligibility. You must report all requested information
not previously reported on that DCAM Application for Prime/General Certificate of
Eligibility.
The term "administrative proceeding" as used in this Prime/General Contractor
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
❑ X❑
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
❑ X❑
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
Prime/General Contractor Update Statement Effective March 30, 2010
PART 4 - Legal or Administrative Proceedings; Compliance with Laws (continued)
"=1011
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
❑ KI
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
❑ Q
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,
❑FXI
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
❑ x❑
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
Prime/General Contractor Update Statement Effective March 30, 2010
PART 5 - SUPERVISORY PERSONNEL
List all supervisory personnel, such as project managers and superintendents, 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
Timothy J. O'Toole
President
David M. Hinckley
Clerk
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 ❑x 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.
Attach here a copy of the list of completed construction projects which was
submitted with your firm's DCAM Application for your most recently issued
(not extended or amended) DCAM Certificate of Eligibility. The Attachment
must include a complete copy of the entire Section G — "Completed Projects"
and the final page — "Certification" (Section J) containing the signature and
date that the Completed Projects list (Section G) was submitted to the
Division of Capital Asset Management.
Division of Capital Asset Management Page 10 of 10
Prime/General Contractor Update Statement Effective March 30, 2010
David M. Hinckley
1 Kathleen Lane
Sterling, MA 01564
978-422-7369
Employment History 1991 — Present Secretary, Clerk and Director -
DMH Electric, Inc.
1988 — 1991 Apprentice Electrician — P.F. Industries
1985 — 1988 Apprentice Electrician - Krouse Enterprises
Education Massachusetts Master Electrician License
Massachusetts Journeyman's License
Massachusetts Construction License
New Hampshire Master Electrician License
Graduate Assabet Valley Regional Vocational
Professional
Memberships MECA — Massachusetts Electrical Contractors Association
ASM — America Sub -Contractors of Massachusetts
ABC- Associated Business Contractors of Massachusetts
North Central Mass Chamber of Commerce
Wachusett Chamber of Commerce
MASSACHUSETTS
DRIVER`S I
LICENSE iMA `
SIA9a W 4d 11MMS
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NONE .S17380614
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15 05;.27-1971
t 15 sec M 10
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s 1 KATHLEEN LN l
STERLING, MA 01564.2241 I
5 DO 05-27.2010 Rev 07.15-2009
COMMONWEALTH OF MASSACHUSETTS
M=Ij Cap
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BOARD OF
ELECTRICIANS.
ISSUES THE FOLLOWING LICENSE AS A
REGISTERED MASTER ELECTRICIAN 7
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DMH ELECTRIC CO "r I
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DAVID M HINCKLEYi "Y1W
1 KATHLEEN LANE }``. �` L
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STERLING MA 01564-2241
16114 A 07/31/16 36704
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BOARD OF !
ELECTRICIANS
ISSUES THE FOLLOWING°LICENSE
AS A REG JOURNEYMAN ELECTRICIAN
DAVID M HINCKLEY
29 LEGATE HILL RD Z
UNIT A '
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STERLING MA 01564-2369
35964 E 07/31/16 36707
a y • a �_
Massachusetts - Department of Public Safety r
LV}' Board of Building Regulations and
Standards
t'unstrvction Supenisor
M1
License: CS -066079.
DAVID M HINCKLEY. -.-'
1 KATHLEEN LN
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STERLING MA 0156
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Expiration
Commissioner
05/27/2015 '
a
Timothy J. O'Toole
13 Rogers Field Way, Clinton, Massachusetts 01510 978-368-8319
Employment History 1991 - Present President, Treasurer, CEO, CFO and
Director - DMH Electric, Inc.
1982 - 1991 W.J. Donovan, Inc. Electronics & Trade Shows
1978 -1982 Commonwealth of Massachusetts
1970 - 1978 Apprentice Electrician - O'Toole & Son
Education Massachusetts Journeyman's License
1970 - 1974 Clinton High School
1974 - 1976 Worcester Industrial Tech Institute
1976 - 1978 Mount Wachusett Community College
Professional
Memberships MECA - Massachusetts Electrical Contractors Association
ASM - America Sub -Contractors of Massachusetts Assn.
ABC - Associated Builders & Contractors
North Central Mass Chamber of Commerce
Wachusett Chamber of Commerce
OSHA 000107678
01 IPA <1I Sd,,; ., Mi Hnitth Adm:n,s 1t"xn
has succa;st141y c ompMed a 10-ticxa 0cxxgmt!cm5t Safety a. ct tieaTh
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CAFistn�ction,Wety & Health
COMMERCIAL
DRIVER'S LICENSE
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9a END 4d NUMBER
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t Commonwealth of Massachusetts
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stingy Enninccr Department of Public Safety
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License: ^HE -089158 License: SSCO-001557
7
TIMOTHY J OTOOLE.'--_ TIMOTHY J OTOOLE___
29 LEGATE HILL RD } '_• 29 LEGATE HjLL RD
STERLING MR 0864 . STERLING NrA Oti64.
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Expiration: ii J,-/7lrll 1511,
Commissioner 06/24/2014 f CommissionerT" Expiration
i
v COMMONWEALTH OF MASSACHUSETTS
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.Q
TIMOTHY J OTOOLE
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13 ROGERSFIELD WAY
CLINTON MA 01510-1804
37312 E 07/31/16 42379
STATE OF NEW HAMPSHIRE
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