4-Exhibit D - Owners Certification of Responsible Contractor Status.pdf
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- 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 competitive bidding processes. The form serves as a certification document required from contractors bidding on projects valued at $250,000 or greater. Contractors must complete the form with their company information, ownership structure, license number, and description of services provided. The form requires contractors to certify their compliance status against three specific Responsible Contractor requirements: maintaining a record of compliance with labor laws including prevailing wage laws and OSHA standards, operating 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 providing comprehensive health and hospitalization benefits for employees and their families. Contractors must select one of three options: meeting all requirements, meeting none of the requirements, or meeting certain requirements with written explanation. The certification must be signed by an authorized company representative who attests that the information provided is true, complete, and accurate, and acknowledges that intentionally misrepresented or falsified information may result in disqualification from future contracting opportunities.
The form requires contractors to provide sufficient written proof of compliance with all Responsible Contractor Requirements and those of all subcontractors within five days upon request by the College. A signed copy of the completed form must be provided to Montgomery County Community College before any firm, including subcontractors, may perform work under the contract if requested. This certification document is a mandatory component of the bidding process for qualifying projects and applies across multiple procurement opportunities at the College, including construction services and equipment acquisitions subject to Pennsylvania Prevailing Wage Law.
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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 .