15-5.0 UDT RCO ORD NO 3107.pdf

CONTRACTOR RESPONSIBILITY CERTIFICATION FORM

For simplicity, all contractors and subcontractors are designated as contractors herein below:

Contractor Name: ____________________________________ Date: _____________________

Contractor Address: _____________________________________________________________

Contact Name:_________________________________________________________________

Phone No.: ____________________________ Fax No.: ________________________________

Email Address: _________________________________________________________________

Project Name: __________________________________________________________________

Contractor certified by answering each of the questions below:

CHECK ONE FOR EACH QUESTION YES NO

(1) The Firm has all valid, effective licenses, registrations or certificates required by federal, state, county or local law, including by not limited to, licenses, registrations or certificates required to: (a) do business in the designated local; and (b) perform the contract work it seeks to perform. These shall include, but are not limited to, licenses, registrations or certificates for any type of trade work or specialty work which the Firm proposes to self-perform.

(2) The Firm meets the bonding requirements for the contract, as required by applicable law or contract specifications and any insurance requirements, as required by applicable law or contract specifications, including general liability insurance, workers compensation insurance and unemployment insurance requirements.

(3) The Firm has not been debarred by any federal, state or local government agency or authority in the past three (3) years.

(4) The Firm has not defaulted on any project in the past three (3) years.

(5) The Firm has not had any type of business, contracting or trade license, registration, or other certification suspended or revoked in the past three (3) years.

(6) The Firm has not been cited for a willful violation of federal or state safety laws in the past three (3) years.

(7) The Firm and its owners have not been convicted of any crime relating to the contracting business by a final decision of a court or government agency in the past ten years

(8) The Firm has not within the past three years been found in violation of any law applicable to its contracting business, including but not limited to, licensing laws, tax laws, prompt payment laws, wage and hour laws, prevailing wage laws, environmental laws or others, where the result of such violation was the payment of a fine, back pay damages or any other type of penalty in the amount of $1,000 or more.

CHECK ONE FOR EACH QUESTION YES NO

(9) The Firm will pay all craft employees that it employs on the project the current wage rates and benefits as required under applicable federal, state, or local wage laws.

(10) The Firm participates in a Class A Apprenticeship Program for each separate trade or classification in which it employs craft employees and shall continue to participate in such program or programs for the duration of the project.

(11)The Firm has all other technical qualifications and resources, including equipment, personnel, and financial resources, to perform the referenced contract, or will obtain same through the use of qualified, responsible subcontractors.

(12)The Firm will maintain all qualifications, resources and capabilities referenced in this certification throughout the duration of the project.

(13)The Firm shall notify Upper Darby within seven (7) days of any material changes to all matters attested to in this certification.

(14)The Firm understands that the Contractor Responsibility Certification required by this section shall be executed by a person who has sufficient knowledge to address all matters in the certification and shall include an attestation stating, under the penalty of perjury, that the information submitted is true, complete and accurate.

NOTE: As required by the Ordinance, if the bidder receives a Notice of Intent to Award Contract, the bidder shall provide Upper Darby with a final subcontractor list and subcontractor information (including subcontractor certifications), if not previously provided.

VERIFICATION

I certify that the information contained in the Contractor Responsibility Certification is true and correct. I further understand that false statements made in this Certification may be subject to the penalties under the law related to unsworn falsification to authorities, including but not limited to, the penalties set forth in 18 Pa.C.S.A. § 4904.

ATTACH ADDITIONAL SHEETS IF NECESSARY

Signature of Contractor’s Authorized Representative: __________________________________

Title: __________________________________

Date: __________________________________