Attachment E Investin MA Form~15.pdf
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- Solicitation number
- BD-24-1211-MSBA-MASS-100654
- Issued by
- Suffolk County, Boston City, Massachusetts
About this file
The document is an Invest in Massachusetts Data Form that is part of a Request for Responses (RFR) issued by the Massachusetts School Building Authority (MSBA) for design and construction administration services to replace exterior windows/doors and roofing to increase energy efficiency in educational facilities in Massachusetts. The form requires respondents to indicate whether at least 50% of the work-hours for any resulting contract will be performed in Massachusetts, how many jobs will be created or preserved in Massachusetts, and the specific locations of those jobs. Respondents who answer "Yes" to the first inquiry must certify their commitment to performing 50% or more of the work-hours in Massachusetts.
The related state and local contract opportunity is seeking designers to provide the requested services for eligible districts in Suffolk County, including the city of Boston. Respondents must complete and submit the Invest in Massachusetts Data Form as part of their proposal, which will be an essential part of any contract awarded by the MSBA.
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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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