8-Responsible Contractor Form Packet.pdf

Responsible Contractor/Subcontractor Certification Cover Sheet

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(s) Provided: __________________________________________________________________

Contractor’s License No.: _____________________________________________

RESPONSIBLE CONTRACTOR STATUS

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):

Explanation:

RESPONSIBLE CONTRACTOR REQUIREMENTS CHECKLIST

Review the attached checklist and return a completed copy, along with any documents requested therein.

A full list of the Responsible Contractor Requirements is linked here, and can also be found on Montgomery County’s website (montgomerycountypa.gov) under Administration County Procurement Policy.

By signing this form, it is assumed that contractors have fully reviewed the Responsible Contractor Requirements.

CERTIFICATION OF RESPONSIBLE CONTRACTOR STATUS

On behalf of the above-named company, the undersigned certifies that the information and responses 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) calendar days upon request.

Signature: _____________________________________

Name and Title (please print): _____________________________

A copy of this form must be signed and provided to the County before any firm, including sub-contractors if requested, may be considered for award of this contract.

https://montgomerycountypa.gov/DocumentCenter/View/2382

Attachment – Responsible Contractor/Subcontractor Certification Checklist

Complete the following and provide the documents highlighted below with your bid. If you answer “no” to any of the below, please provide a detailed explanation on the cover sheet as to why your firm does not meet the requirement.

For all contractors and subcontractors:

Requirement Response

1. My firm and its employees shall have all valid and effective licenses, registrations, or other credentials required by federal, state, county, or local law. I will provide electronic copies of the relevant credentials.

Y: ____

N: ____

2. My firm meets the bonding requirements for the contract, as well as applicable insurance requirements. I will provide electronic copies of these documents, as well as a hard copy of the bond.

3. My firm has not been debarred or suspended by any federal, state, or local government agency or authority within the past three (3) years.

4. My firm has not defaulted on any project within the past three (3) years.

5. My firm has not had any type of license, registration, or other certification revoked or suspended within the past three (3) years.

6. My firm and its principals and owners have not been convicted of any crime relating to their contracting business within the past ten (10) years.

7. My firm has not been found in violation of any law applicable to its contracting business within the past three (3) years.

8. My firm will employ a sufficient number of craft labor personnel or shall use qualified subcontractors to meet the personnel requirement.

9. My firm will pay all craft employees on the project, at a minimum, the applicable wage and fringe benefit rates as established for the classification in which the worker is employed.

10. My firm 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. I will provide electronic copies of the training certification documents.

11. My firm participates in a bona fide apprenticeship program which is registered with and approved by the U.S. Department of Labor or a state apprenticeship agency and has graduated apprentices to journeyperson status for at least three (3) of the past five (5) years. I will provide (1) a list of all trades or classifications of craft employees my firm will employ on the project and (2) documentation verifying that my firm actively participates in a bona fide apprenticeship program, including the name, state, and registration number of the program.

12. My firm shall assign craft labor personnel only to work in the craft or trade in which they are employed.

13. My firm has all other technical qualifications and resources, including equipment, personnel, and financial resources, to successfully perform the contract and shall maintain such capabilities throughout the duration of the project.

14. My firm shall notify the County within seven (7) days of any material changes in its operation related to any matter attested to in this certification.

15. My firm will execute this Contractor Responsibility Certification by a person who has sufficient knowledge to address all matters in this certification.

16. If my firm has ever operated under another name, or currently controls or is controlled by another company, or has controlled or was controlled by another company within the past 5 years, whether as a parent company, subsidiary, or other business relation, I will provide a written statement explaining in detail the nature of any such relationship.

If my firm is the construction manager, general contractor, or other lead or prime contractor on this project:

Requirement Response

1. My firm will ensure that at least seventy (70) percent of all craft labor workers on the project shall be comprised of either journeyperson workers who have successfully completed a bona fide apprenticeship program or apprentices registered in such programs, and that the apprenticeship participation is in the same trade or craft for which the workers are employed on the project. I will identify on payroll documents whether employees are journeyperson workers, apprentices, or neither.

2. My firm will ensure that at least one person on the project will have completed, prior to working on the project, an OSHA 30-hour training course. I will provide an electronic copy of the training certification documents.

If my firm will be subcontracting work to other firms:

Requirement Response

1. My firm will provide a Subcontractor List within seven (7) days of receiving a Notice of Intent to Award Contract which includes the names and business addresses of the subcontractors it intends to use on the project and the scope of the work assigned to each subcontractor.

Y: ____ N: ____

2. My firm will submit Subcontractor Responsibility Certifications and all supporting information for all entities listed on the Subcontractor List. Y: ____ N: ____

3. My firm shall determine whether any firm on its Subcontractor List is organized as a sole proprietorship owned and operated by a single person. For any such entity, my firm will require the subcontractor to supplement its Subcontractor Certification with its Employer Identification Number in addition to the other information required by this certification. Y: ____ N: ____

4. My firm agrees that it shall not be permitted to use a subcontractor on any work performed for the County unless it has identified the subcontractor on its Subcontractor List and has provided a Subcontractor Responsibility Certification.

Y: ____ N: ____