Attachment E Investin MA Form~11.pdf
PDF 792 KB Posted
- Attached to
- 2024 Technical Review Services
- Solicitation number
- BD-24-1211-MSBA-MASS-95097
- Issued by
- Suffolk County, Massachusetts
About this file
The document provided is the "Invest in Massachusetts Data Form" for a contract opportunity from the Massachusetts School Building Authority (MSBA). The form requires respondents to indicate whether at least 50% of the work hours for the resulting contract will be performed in Massachusetts, how many jobs will be created or preserved in the state, and where those jobs will be located. Respondents answering "Yes" to the first inquiry must also certify that 50% or more of the work hours will be performed in Massachusetts if awarded the contract.
The related state and local contract opportunity is for "2024 Technical Review Services" where the MSBA is seeking architectural and/or engineering firms or individuals to provide technical services assistance for MSBA-funded public K-12 school construction projects or to otherwise assist the MSBA with services associated with the delivery and implementation of its grant program. No additional details about the pricing terms, set asides, incumbents, funding requirements, or other salient information were provided.
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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: |
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