3-Exhibit C - Owners Certification of Responsible Contractor Status.pdf

PDF 202 KB Posted

Attached to
Bid #1 – FY 27 medDispense® C Series EDU Automated Dispensing Cabinet
Solicitation number
Not on record
Issued by
Montgomery County, Pennsylvania

About this file

This is an Owner's Certification of Responsible Contractor Status form issued by Montgomery County Community College for use in contract bidding processes. The form applies to all bids valued at $250,000 or greater and requires contractors to certify their compliance with established responsible contractor criteria. Contractors must indicate whether they meet all responsible contractor requirements, none of the requirements, or only certain requirements, with detailed explanations required for partial compliance. The form requests general company information including name, address, contact details, ownership structure, contractor license number, and a description of services provided. Bidders are required to provide this completed and signed certification before performing work under any contract, and subcontractors must also comply with the requirements.

The responsible contractor requirements mandate that contractors maintain a record of compliance with labor laws including prevailing wage laws and OSHA standards, establish a bona fide apprenticeship program 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 represented in their workforce, and provide comprehensive health and hospitalization benefits for employees and their families. The certification requires that signatories attest under penalty of misrepresentation or falsification that all information provided is true, complete, and accurate, with awareness that intentionally false information may result in disqualification from future contracting opportunities. Contractors must also certify their ability to provide sufficient written proof of compliance with all responsible contractor requirements within five business days upon request by the College.

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Text version

MONTGOMERY COUNTY COMMUNITY COLLEGE

EXHIBIT D- 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 .