Attachment E Invest in Massachusetts Form.pdf

792 KB Posted

Attached to
RFR for Office Signage and Wayfinding
Solicitation number
BD-26-1211-MSBA-MASS-130091
Issued by
Suffolk County, Massachusetts

About this file

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This is an Invest in Massachusetts Data Form attachment for a Request for Response (RFR) for Office Signage and Wayfinding from the Massachusetts School Building Authority (MSBA). The form requires respondents to provide basic business information including company name, full address, contact name, phone number, and email address. The primary purpose of the form is to collect data regarding job creation and preservation within Massachusetts as part of the contract performance requirements.

The form mandates that respondents answer three key inquiries regarding Massachusetts work performance. Respondents must indicate whether at least 50 percent or more of work-hours performed under any resulting contract will be conducted in Massachusetts. If answering affirmatively to this inquiry, respondents must specify the number of jobs that will be created or preserved in Massachusetts and identify the specific locations within the state where those jobs will be situated. Part III of the form requires certification by an authorized representative of the responding firm, signed under penalties of perjury, committing that if awarded the contract, 50 percent or more of work-hours will be performed within the Commonwealth of Massachusetts. This commitment becomes an essential and binding component of any formal agreement executed by the MSBA. Completion of all sections of the form is mandatory unless otherwise directed, with Part III certification required only for respondents answering affirmatively to the initial inquiry regarding Massachusetts work performance.

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Other files

File Type Posted
Office Signage and Wayfinding RFR .pdf PDF
Office Signage Addendum No. 1 QandA.pdf PDF
Attachment F Summary of Signage Needs Preliminary.pdf PDF
Attachment G Example Photos of Signage Locations.pdf PDF
Attachment D Supplier Diversity Program Plan Form~22.pdf PDF
Attachment B Certification of Compliance with Laws.pdf PDF
Attachment C Master Services Agreement~13.pdf PDF
Attachment A Respondent Signature and Acceptance Form~1.pdf PDF
Attachment I 10 post Office Square Insurance Requirements.pdf PDF
Attachment J Creating a Quote in COMMBUYS.pdf PDF
Attachment H Building Rules and Regulations 10 Post Office Square.pdf PDF
Show all 11

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INVEST IN MASSACHUSETTS DATA FORM

Instructions: Completing all parts of this form is mandatory unless directed otherwise.

Part I Respondent Information

Business Name:

Full Address: number, street, and apt. or suite no., city, state, zip

Contact Name: Phone # ( ) - Email address:

Part II Invest in Massachusetts Data (Please respond to the inquiries (1-3) listed below. If you answer "No" to Inquiry #1 of this Part

II, then you are not required to complete Part III of this IMD Form).

1. Will at least 50% or more of the work -hours performed as a result of a contract arising out of this proposal be performed in Massachusetts? Yes No

2. If you responded "Yes" to Inquiry #1, how many of those jobs performed in Massachusetts will be created and/or preserved as a result of a contract arising out of this proposal?

3. If you responded "Yes" to Inquiry #1, where in Massachusetts will those jobs be located?

Part III Certification Based on your responses in Part II of the IMD Form, those Respondents who have answered "Yes" to Inquiry #1 are required to certify the Respondent's commitment that 50% or more of the work-hours performed in connection with any contract arising out of the Respondent's RFR Response will be performed in Massachusetts. This certification must be signed by an individual authorized to bind the Respondent firm. Additionally, this commitment will be an essential part of any contract awarded by the MSBA and will be written into any formal agreement.

I, , hereby certify that the information contained in this IMD Form is true and accurate and I hereby certify on behalf of [Respondent Name] that, if awarded the contract, 50% or more of the work -hours performed in connection with any agreement arising out of the Respondent's RFR Response, will be performed in the Commonwealth of Massachusetts.

Signed under the pains and penalties of perjury.

Print Name Title

Authorized Signature ________________________________ Date

ATTACHMENT E

Invest in Massachusetts ejrobbins D:20110524123954- 04'00' D:20110525082154- 04'00'

INVEST IN MASSACHUSETTS DATA FORM

Instructions: Completing all parts of this form is mandatory unless directed otherwise.

Part I Respondent Information

Business Name:

Full Address: number, street, and apt. or suite no., city, state, zip

Contact Name:

Phone # ( ) -

Email address:

Part II Invest in Massachusetts Data (Please respond to the inquiries (1‐3) listed below. If you answer "No" to Inquiry #1 of this Part II, then you are not required to complete Part III of this IMD Form).

1.

Will at least 50% or more of the work‐hours performed as a result of a contract arising out of this proposal be performed in Massachusetts?

Yes

No 2.

If you responded "Yes" to Inquiry #1, how many of those jobs performed in Massachusetts will be created and/or preserved as a result of a contract arising out of this proposal?

3.

If you responded "Yes" to Inquiry #1, where in Massachusetts will those jobs be located?

Part III

Certification Based on your responses in Part II of the IMD Form, those Respondents who have answered "Yes" to Inquiry #1 are required to certify the Respondent's commitment that 50% or more of the work‐hours performed in connection with any contractarising out of the Respondent's RFR Response will be performed in Massachusetts. This certification must be signed by an individualauthorized to bind the Respondent firm. Additionally, this commitment will be an essential part of any contract awarded by the MSBAand will be written into any formal agreement.

I, , hereby certify that the information contained in this IMD Form is true and accurate and

I hereby certify on behalf of

[Respondent Name] that, if awarded the contract, 50% or more of the work‐hours performed in connection with any agreement arising out of the Respondent's RFR Response, will be performed in theCommonwealth of Massachusetts.

Signed under the pains and penalties of perjury.

Print Name

Title

Authorized Signature ________________________________

Date

Will at least 50% or more of the work-hours performed as a result ofa contract arising outof this proposal be performed in

ATTACHMENT E

Business Name:
ContactName::
Phone # ( ) - x:
Email address::
Will at least 50% or more of the work-hours performed as a result ofa contract arising outof this proposal be performed in:
If you responded "Yes" to Inquiry #1, how many ofthose jobsperformed in Massachusetts will be created and/orpreserved asa:
If you responded "Yes" to Inquiry #1, where in Massachusetts will those jobs be located [1]:
If you responded "Yes" to Inquiry #1, where in Massachusetts will those jobs be located [2]:
If you responded "Yes" to Inquiry #1, where in Massachusetts will those jobs be located [3]:
If you responded "Yes" to Inquiry #1, where in Massachusetts will those jobs be located [4]:
I:
hereby certify that the information contained in this IMD Form is true and accurate and:
Signed under the pains and penalties of perjury:
undefined:
Authorized Signature:
Title:
Address:
PrintButton1:
PrintButton2:

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