Attachment E Invest in Massachusetts Form~2.pdf
PDF 792 KB Posted
- Solicitation number
- BD-26-1211-MSBA-MASS-132971
- Issued by
- Massachusetts
About this file
This is an Invest in Massachusetts Data Form (Attachment E) required for respondents to a Request for Qualifications issued by the Massachusetts School Building Authority (MSBA) to provide financial advisory services. The form serves as a mandatory submission component that collects respondent information and certifies compliance with Massachusetts job performance requirements. Respondents must complete all sections unless otherwise directed, with completion contingent on their answers to the preliminary inquiries regarding work location.
The form requires respondents to confirm whether at least 50% or more of work-hours will be performed in Massachusetts. If respondents answer affirmatively to this inquiry, they must specify the number of jobs that will be created or preserved in Massachusetts and identify the specific locations within the state where these jobs will be situated. Respondents who commit to performing 50% or more of work-hours in Massachusetts must provide a signed certification from an authorized representative, acknowledging that this commitment will become an essential and binding requirement in any resulting contract. The certification is executed under the pains and penalties of perjury, making it a legally binding attestation of the respondent's Massachusetts job performance obligations.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
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: |
File details come from the government source that posted it. Updated .