3-Exhibit C - Owners Certification of Responsible Contractor Status.pdf
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- Solicitation number
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- Montgomery County, Pennsylvania
About this file
This document is an Owner's Certification of Responsible Contractor Status form from Montgomery County Community College. The form requires potential contractors to certify their eligibility for contract opportunities by demonstrating compliance with three key requirements: a record of compliance with labor laws, a bona fide apprenticeship program approved by the U.S. Department of Labor or Commonwealth of Pennsylvania, and comprehensive health and hospitalization benefits for employees and their families. The form applies specifically to bids of $250,000 or greater and requires contractors to indicate whether they meet all, none, or some of the responsible contractor requirements.
The document stipulates that contractors must be prepared to provide written proof of compliance within five days if requested, and that any intentional misrepresentation may result in disqualification from future contracting opportunities. Contractors must sign the form, and a copy must be provided to the college before any firm, including subcontractors, can perform work under the contract. The form includes sections for general company information, ownership structure, contractor's license number, and space for explaining partial compliance with the responsible contractor requirements.
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Text version
MONTGOMERY COUNTY COMMUNITY COLLEGE
EXHIBIT C - OWNER’S CERTIFICATION OF RESPONSIBLE CONTRACTOR STATUS
GENERAL INFORMATION
Company Name:
Address:
City:
Telephone Number ( ) Fax Number ( )
Ownership Structure (Please check one) ☐Sole Proprietorship ☐Partnership ☐Corporation ☐Joint Venture ☐Other Description of Services Provided
Contractor’s License #
RESPONSIBLE CONTRACTOR STATUS – ALL CRITERIA MUST BE MET FOR BIDS OF $250,000 or greater
Please check one of the following boxes:
1. Meets all Responsible Contractor requirements (see below)
2. Meets none of the Responsible Contractor requirements
3. Meets certain of the Responsible Contractor requirements (provide explanation below)
If you have checked box 3 above, please provide an explanation below (attach additional pages if necessary):
RESPONSIBLE CONTRACTOR REQUIREMENTS
(1) a record of compliance with labor laws, including prevailing wage laws, OSHA, etc.;
(2) a bona fide apprenticeship program (a program that is approved and registered with the United States Department of Labor’s Bureau of Apprenticeship and Training or the Commonwealth of Pennsylvania for each apprenticeable trade or occupation represented in their workforce); and
(3) comprehensive health and hospitalization benefits for employees and their families.
OWNER’S CERTIFICATION OF RESPONSIBLE CONTRACTOR STATUS
On behalf of the above-named company, the undersigned certifies that the information and
MONTGOMERY COUNTY COMMUNITY COLLEGE
response provided herein are true, complete and accurate as of this date, and he/she is aware that any intentionally misrepresented or falsified information may result in disqualification from future contracting opportunities. Further, the above- named company certifies it can provide sufficient written proof that it and all subcontractors comply with the Responsible Contractor Requirements above within five (5) days upon request.
Signature
Printed Name
Before any firm, including sub-contractors, may perform work under this contract, a copy of this form must be signed and provided to the College if requested.
File details come from the government source that posted it. Updated .