{01417166;v1} March 2022

WHITPAIN TOWNSHIP

CONTRACTOR RESPONSIBILITY CERTIFICATION FORM

Contractor Name: _______________________________________ Date: _________________, 20_____

Contractor Address: ____________________________________________________________________

____________________________________________, ________________ Zip Code________________

Contact Name: _________________________________________E-mail__________________________

Contact Direct Phone No.: _______________________________ Fax No.: _______________________

Project Name: _________________________________________________________________________

To be certified, Contractor is required to check all the following boxes:

Yes No

1. Does the Contractor and its employees have all valid, effective licenses, registrations or certificates required by federal, state, county, or local law, including, but not limited to, licenses, registrations or certificates required to: (a) do business in the designated locale; 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 construction or maintenance trade work or specialty work which the firm proposes to self-perform.

2. Does the Contractor meet 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?

3. Has the Contractor been debarred by any federal, state or local government agency or authority in the past three (3) years?

4. Has the Contractor defaulted on any project in the past three (3) years?

5. Has the Contractor had any type of business, contracting or trade license, registration, or other certification revoked or suspended by any government agency or authority in the past three (3) years?

6. Has the Contractor or its principals/owners been convicted of any crime relating to the contracting business in the past ten (10) years?

7. Has the Contractor within the past three (3) 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 $5,000 or more?

8. The Contractor will employ a sufficient number of craft labor personnel required to successfully perform any project work it self-performs or shall use qualified subcontractors to meet this requirement.

9. The Contractor will ensure that all craft labor it employs on the project will have completed, prior to working on the project, the OSHA 10 hour training course for safety established by the U.S. Department of Labor.

10. The construction manager, general contractor or other lead or prime contractor responsible for the project shall ensure that at least 70 percent of the craft labor workforce employed on the project shall be comprised of either journeypersons, workers who have successfully completed an apprenticeship training program registered with and approved by the U.S. Department of Labor or a state apprenticeship agency, or registered apprentices enrolled in such programs.

A. These craft labor requirements ensure that the great majority of the craft labor personnel employed on the project have the requisite skills and qualifications to perform the project work as they will be participants in or graduates of bona fide apprenticeship training programs in each trade or craft in which their services are utilized.

B. For purposes of this subsection, apprenticeship training programs may include those which are subject to the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1001 et seq. (“ERISA”), or non-ERISA programs.

C. To demonstrate compliance with this section 10, the Contractor shall provide, with this certification, a list of all trades or classifications of craft employees it will employ on the project and the names and addresses of all applicable apprenticeship programs relating to craft personnel utilized on the project.

11. The Contractor shall assign workers to perform only work in their respective craft or trade for which they have sufficient skills and training, or shall use qualified subcontractors to meet this requirement.

12. The Contractor has all other technical qualifications and resources, including equipment, personnel and financial resources, to successfully perform the referenced contract, and shall maintain such capabilities throughout the duration of the project, or will obtain same through the use of qualified, responsible subcontractors or vendors.

13. The Contractor shall notify the Township within seven days of any material changes in its operation that relates to any matter attested to in this certification.

14. The Contractor understands that this Contractor Responsibility Certification shall be executed by a person who has sufficient knowledge to address all matters in the Certification and said signature shall constitute an attestation, under the penalty of perjury, that the information submitted is true, complete and accurate.

Upon receipt of a Notice of Intent to Award Contract, the Contractor will provide the Township with a subcontractor list and subcontractor information and certifications as specified in the Responsible Contractor Ordinance.

ATTACH ADDITIONAL SHEETS IF NECESSARY.

Signature of Bidder’s Authorized Representative: ______________________________________

Title: ______________________________________

Date: ______________________________________