Attachment F Invest in MA Form~3.pdf
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- Attached to
- Request for Responses - AccRep_OPM - 2024
- Solicitation number
- BD-24-1211-MSBA-MASS-101047
- Issued by
- Suffolk County, Massachusetts
About this file
The document provided is an Invest in Massachusetts Data Form, which is required as part of a contract opportunity from the Massachusetts School Building Authority (MSBA). The form requires respondents to indicate whether at least 50% of the work hours performed under a resulting contract would be performed in Massachusetts, and if so, how many jobs would be created or preserved in the state and where those jobs would be located. Respondents who answer "yes" to the 50% work hours requirement must also certify this commitment, which would be an essential part of any awarded contract.
The related state and local contract opportunity is a Request for Responses for Owner's Project Managers interested in providing management and construction administration services to eligible districts participating in the MSBA's Accelerated Repair Program. The contract opportunity involves work in Suffolk County and the City of Boston. No other details about pricing, set asides, incumbents, funding, or contract term are 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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