CBP_for_Motor_Pool__8.2015.pdf

Feb 2015 JFsc

CONSTRUCTION BID PACKAGE (CBP)

“THIS IS A SUBCONTRACTING OPPORTUNITY”

INVITATION TO BIDDER

Project Title: Motor Pool Metal Siding & Installation (Deficiency #104637)

NAICS Code: 238170 Siding Contractors: http://www.census.gov/cgi-bin/sssd/naics/naicsrch

Date: January 7, 2016

Project Location: Earle C Clements Job Corps 2302 U S Hwy 60 E Morganfield, KY 42437

Owner: U.S. DEPARTMENT OF LABOR (DOL)

Center Operator: Management & Training Corporation (MTC) 500 N Marketplace Dr., P.O. Box 10, Centerville, Utah 84014

Pre-bid Conference: Earle C Clements Job Corps, Friday, January 15, 2016 @ 12:00 (noon) CST Note: Any questions must be submitted to the buyer by January 20, 2016 at 3pm CST.

Bids are due: Friday, January 29, 2016 by 5:00 PM CST

Submit bid to: Earle C Clements Job Corps, Attn: Meg Bealmear, Procurement Supervisor;

Earle C Clements Job Corps, 2302 US Hwy 60 E Morganfield, KY 42437.

Note: The Buyer is designated as MTC’s representative for this procurement

Contract type: Fixed price, single lump sum contract

Estimated Price Range: $25,000 to $100,000

Contract Documents: This Construction Bid Package (CBP) contains Section 1, Contractual

Requirements and Section 2, Statement of Work (SOW), and may also include drawings and/or specifications describing the work.

http://www.census.gov/cgi-bin/sssd/naics/naicsrch

INSTRUCTIONS TO BIDDER

1. Bid: Bid shall be submitted on MTC Bid Form and must be signed by an authorized official of the company making offer.

In addition, responsive bids shall include all of the following items with the bid form:

a. Three references for projects of comparable scope. The references shall include the company name, phone number, contact person, address, description and size of the project and date the work was performed.

b. Provide a listing of DBA Worker Classifications and rates associated with this project. This information will be verified against certified payroll reports.

c. A breakdown of the major components of the work if the bid is greater than $25,000

d. W-9 Form

e. MTC Vendor Self-Certification Form

f. Bid Guaranty, when applicable (see item #3 below & bid form)

g. Surety Company Name, when applicable (see Item #4 below & bid form)

h. Proof of insurance

2. Bid Submission: Deliver bid to Buyer, prior to the time stated in the Invitation to Bid. Bids maybe delivered by hand, Fed Ex, Express Mail, UPS, Fax, Email, and USPS.

3. Bid Guaranty: Each bidder shall provide bid guaranty in the amount of 20% of base bid when the bid is greater than

$25K. Bid guarantee is not required for bids under $25,000. Bid guaranty shall be in the form of a bid bond (SF24 or AIA A310, or similar), cashier’s check or money order made payable to Management & Training Corporation/Center Name. Submit the bid guaranty with the bid. Bid guaranty will be returned to bidders when the contract is awarded or solicitation cancelled.

4. Performance and Payment Bonds: If the base bid is greater than $25K Performance and Payment Bonds are required. Surety Company shall have an A- rating. Upon receipt of the “Intent to Award” letter the bidder shall deliver bonds within ten (10) business days.

5. Center Visit/Facility Inspection: Required prior to submitting a bid. A “virtual” facility inspection is not acceptable.

6. Davis Bacon Act (Reference Section B) & Wage Comparability (Reference Section C): The contractor agrees to pay at least the applicable prevailing Federal Contractor Minimum Wage as required by Executive Order 13658.Comply with the attached Davis Bacon Wage Determination. Weekly ccertified payroll report(s) are required.

7. Acceptance of Bid: Bids shall be evaluated and awarded to the most responsive bidder. MTC shall be the sole judge as to the most responsive bid. MTC reserves the right to waive any irregularity or technicality in bids received. The Buyer shall send Intent to Award letter to the successful bidder. The formal agreement shall be executed on an MTC purchase order form.

8. First-Tier Subcontractor Information (FFATA): Reference Section E. Upon receipt of the “Intent to Award” letter the bidder shall deliver this form as required.

9. SF1413 – Statement and Acknowlegement form: Reference Section G. Upon receipt of the “Intent to Award” letter the bidder shall deliver this form(s) as required.

BID FOR LUMP SUM CONTRACT

Proposal of (Contractor Name): Date:

To: Earle C Clements Job Corps, 2302 US Hwy 60 E Morganfield, KY 42437

In compliance with and by signature below acknowledges and agrees to the Bid Provision, this Statement of Work (SOW), dated (August 19, 2015), MTC Terms and Conditions, and all other information contained in this CBP, the undersigned hereby proposes to provide all labor (in compliance with the attached Davis-Bacon Act Wage/Wage Comparability) materials, supervision, tools, equipment, and transportation and to perform all work for the complete project.

Motor Pool Metal Siding & Installation (Deficiency #104637)

Base Bid: For the following sums: (show amounts in both written form and figures. Completion of the Project as Specified

______________________________________________________ Dollars ($______________________)

The undersigned acknowledge receipt of Addenda (Indicate Addendum Number(s) received) ___ ___ ___ ___ ___ ___ ___ ___

The bid guaranty attached in the sum of Dollars ($ ) being at least 20% of the base bid when the bid is greater than $25K, shall be forfeited to you in the event we fail to execute the contract after receipt of the Intent to Award letter from MTC/Earle C Clements Job Corps.

The undersigned shall honor our bid for one hundred and twenty days (120) after the bid date. Upon written notice of bid acceptance we will enter into formal agreement with MTC/Earle C Clements Job Corps.

If the base bid is greater than $25K the undersigned is prepared to furnish Performance and Payment Bonds in the required amount with (indicate name of surety company) ________________________________ as surety, subject to your approval.

The undersigned, if awarded a contract for all or part of the work, agrees to place orders promptly for all materials required; to prosecute the work diligently to the full extent allowed by conditions within our control; and to complete the work of the contract within

90 days (ninety days) consecutive calendar days after written Notice to Proceed. The undersigned further agrees to pay MTC/Earle C Clements Job

Corps, not as a penalty, but as liquidated damages for breach of contract, the sum of $5,000.00 (five thousand dollars) per consecutive calendar day thereafter that the work remains incomplete or unsatisfactory.

Print Name: Witness

(Seal if Corporation)

Sign: __________________________________________________

Title _____________________________________

DUNs#:

Tax ID#:

Business Address _______________________________________________________________

Phone#: ____________________ Fax#: ____________________ Email: ______________________________

CONSTRUCTION STATEMENT OF WORK (SOW)

SECTION 1: Contractual Requirements

A. Codes and Standards

1. The contractor shall in accomplishing the project, defined in this statement of work, comply with applicable building codes, ordinances, and regulations which are enforced by City, County, State or Federal agencies.

B. Davis-Bacon Act (DBA)

1. This project is subject to the provisions of the Davis-Bacon Act for construction work on a federal facility. Accordingly, the contractor and subcontractors shall be required to comply with the attached DBA Wage Determination for the type of work being performed. The DBA provides that all workers employed by contractor and subcontractors in any construction, alteration or repair, including painting and decorating, buildings, and works which are federally funded, shall be paid prevailing wages and receive fringe benefits at rates not less than those on similar construction in accordance with the Wage Determination. A copy of the Wage Determination is attached.

2. The contractor must provide a listing of those DBA Worker Classifications and rates associated with this project.

3. The Contractor shall display in a prominent and accessible place the “Employee Rights under the Davis Bacon Act” poster

(bilingual) and Wage Determination informing all workers of their rights under DBA.

4. The contractor shall provide proof of their compliance with the Wage Determination and any subcontractor’s compliance of the

Wage Determination via weekly certified payroll report(s) which shall be submitted to the Buyer. A properly filled-out Certified Payroll is required prior to processing payments.

C. Wage Comparability

1. The contractor agrees: (1) to pay at least the prevailing applicable Federal Contractor Minimum Wage as required by Executive

Order 13658. (Refer to Section 6(a) (1) of the Fair Labor Standards Act of 1938, as amended.

D. MTC Terms and Conditions

1. Contractor agrees to Management & Training Corporation’s Terms and Conditions which can be found at www.mtctrains.com. It is the Contractor’s responsibility to understand MTC’s current Terms and Conditions at the time services and/or goods are provided.

E. FFATA Sub-award Reporting System (FSRS.gov)

1. When applicable, construction contracts with a value of $25,000 or more, including any subsequent contract modifications are subject to the provisions of FFATA (Federal Funding Accountability and Transparency Act of 2006), per FAR 52.204-10 Reporting Executive Compensation and First-Tier Subcontract Awards. Reported information will be made public via the FFATA Sub-award Reporting System (FSRS.gov).

2. Upon receipt of the “Intent to Award” letter the bidder shall deliver this form as required.

F. Required Insurance

1. Contractor shall provide and maintain and cause its subcontractors to provide and maintain the insurance coverage identified herein until obligations are satisfied.

2. Prior to the effective date of the contract, the Contractor shall provide the Buyer with proof of insurance via certificate of insurance (ACORD 25-S) and deliver same to Management & Training Corporation (MTC), operator of the Earle C Clements Job Corps. Such certificate shall identify the contract between MTC and the Contractor and contain provisions that insurance coverage afforded under the policy shall not be canceled, terminated or materially altered until at least thirty (30) days prior written notice has been given to MTC.

3. Without limiting any liability or any other obligations of the Contractor, the Contractor shall provide and maintain and cause its subcontractors to provide and maintain insurance coverage with forms and insurers acceptable to MTC, until all obligations under the contract are satisfied, as follows:

4. Workers’ Compensation insurance to cover obligations imposed by Federal and State statutes having jurisdiction of its employees engaged in the performance of this contract, and Employers’ Liability insurance with a minimum limit of five hundred thousand dollars ($500,000). Evidence of qualified self-insured status shall also suffice for this section.

5. Commercial General Liability insurance with a minimum combined single limit of one million dollars ($1,000,000) each occurrence and an aggregate of three million dollars ($3,000,000). The policy shall include coverage for bodily injury, personal injury, broad form property damage, blanket contractual, contractor’s protective, products and complete operations.

6. Comprehensive Automobile Liability insurance with a minimum combined single limit of one million dollars ($1,000,000) for each occurrence; and an aggregate of one million dollars (1,000,000), coverage applying to “Any Auto”. Contractors who are unable http://www.mtctrains.com/ to meet this requirement should provide a detailed statement as to their current coverage for further consideration.

7. The policies required shall name MTC/Earle C Clements Job Name, its agents, officials and employees as additional insured and shall specify that the insurance afforded the Contractor shall be primary insurance and that any insurance coverage carried by MTC or its employees shall be excess coverage except as provided by state law, and not contributory insurance to that provided by the Contractor.

8. Failure on the part of the Contractor to provide and maintain the required liability insurance and provide proof thereof to MTC within thirty (30) days following commencement of a new policy period, shall constitute a material breach of the contract upon which MTC may immediately terminate this contract.

9. Upon receipt of the “Intent to Award” letter the bidder shall deliver a fully executed Certificate of Liability insurance, as required.

G. SF1413 – Statement and Acknowledgement Form

1. The requirement for completing and submitting the SF 1413 is stipulated by Federal Acquisition Regulation (FAR) 52.222-

11. The clause states that contractors and subcontractors (all tiers) performing on a Federal contract involving construction are required to submit a fully executed SF 1413 Statement and Acknowledgement form. A fillable form may be found at http://www.gsa.gov/portal/getFormFormatPortalData.action?mediaId=82661.

2. Upon receipt of the “Intent to Award” letter the bidder shall deliver this form(s) as required.

H. Resolution of Disputes

1. In the event either party commences legal action to enforce any term of this Agreement, the prevailing party in such action will be entitled to recover its costs and attorney’s fees incurred in such action from the other party. Default any payments due under this agreement will incur interest, 18% per annum.

I. Performance and Payment Bonds

1. The contractor shall provide bonds covering performance of the contract and payment of obligations arising hereunder if the base bid is greater than $25,000. The bonds must be obtained through an A- rated Surety Company (Subject to MTC/ Earle C Clements Job Corps 0 approval) and authorized to do business in the state where the work of this contract is performed. The A-rating can be obtained through the A.M. Best website (www.ambest.com)

2. The performance and payment bonds shall each be in an amount equal to 100 percent of the contract price. Bonds shall be executed on AIA A-311, AIA A-312 respectively or federal standard forms SF25 and SF25A, respectively or similar. The cost of the bond shall be included in the contract sum. Increases to the original contract sum (change orders) shall include a revised performance and payment bonds for the associated additional costs.

3. Upon receipt of the “Intent to Award” letter the bidder shall deliver this form(s), if required.

J. Center Visit/Facility Inspection

1. Prior to submitting the bid, it is required that bidders examine the CBP and visit the center to make field measurements, evaluations, etc. to become familiar with existing conditions under which the work will be performed. Virtual inspection via internet is not acceptable.

2. Additional time or payments will not be approved for conditions arising during construction that were apparent prior to submission of the bid. Unforeseen conditions arising during construction that were not apparent prior to the bid submission shall be brought to the immediate attention of the Buyer.

3. Contractors unable to attend the pre-bid conference may contact the Buyer to schedule an alternate time to visit the center and inspect the facility.

K. Drawings and Specifications

1. The SOW may contain material specifications and/or drawings relevant to the work. MTC makes no assurance to the

Contractor as to the accuracy of any drawings or completeness of the specifications.

2. For clarification of any part of the SOW, address questions to the Buyer. The Contractor shall be responsible for all incidental work not specified but required by building codes or professional practice for the complete and correct installation of the work. No allowance will be made for failure of the Contractor or subcontractors to correctly interpret and clearly understand the intent of the SOW and their responsibility to perform the work in full.

3. The contractor shall not acquire building permits.

http://www.gsa.gov/portal/getFormFormatPortalData.action?mediaId=82661 http://www.ambest.com/

L. Center Operating Hours

1. The Center shall remain in operation throughout the construction. Any anticipated disruption to center operation shall have prior approval from the Buyer. Contractor access to the construction site shall be limited to the following 8am to 5pm CST.

Access to the center will not be permitted on weekends without prior approval of the Buyer.

M. Supervision

1. The Contractor shall provide a qualified job superintendent, job foreman, or lead man who is authorized to act for the contractor and will be at the construction site daily to oversee and direct the work. The contractor and its employees shall conduct themselves in an professional manner and abide by the following center rules and regulations:

a. Contractor employees are required to sign-in and sign-out individually at security location

b. Observe facility and security regulations

c. Shall not use the food services facilities unless authorized

d. Shall not fraternize with students or staff

e. Shall not consume or transport alcohol, drugs or firearms onto the center

f. Shall not smoke unless in designated areas

2. MTC/Earle C Clements Job Corps reserves the right to direct the removal from the premises any contractors’ employee or sub-contractor for conduct in violation of facility regulations.

3. Contractors/subcontractors must show valid driver’s license and proof of auto insurance at the security location before their vehicles will be permitted on the center.

N. Notice to Proceed

1. Upon receipt of written “Notice to Proceed” (NTP) from the Buyer, the contractor shall begin the work within fourteen (14) days from date of notice.

2. A pre-construction meeting shall be scheduled prior to commencing the work.

O. Construction Schedule & Schedule of Values

1. For projects where progress payments will be made the contractor shall submit a detailed schedule of the work to be performed and the schedule of values to the Buyer at the pre-construction meeting.

P. Protection and Safety

1. The contractor shall maintain a clean and safe work area.

2. The contractor shall, prior to digging or trenching, identify all underground utilities. Existing site utility drawings are

Not available. Contractor shall contact the local utilities and/or utility locator service.

3. The contractor shall cordon off the construction site with fencing, caution tape, etc. that is appropriate to secure the work area from unauthorized or accidental entry.

4. The contractor shall provide required personal protective equipment (PPE) for construction workers, students and MTC staff entering the construction site. The contractor shall protect existing facilities and finishes from damage and promptly repair damages at no additional cost to the contract.

5. The contractor shall be responsible for all equipment and materials brought onto the center. MTC/Earle C Clements Job Corps is not responsible for damage or loss of contractor’s equipment and materials.

6. The contractor shall submit to the Buyer, Material Safety Data Sheets (MSDS) for all construction materials of a hazardous nature.

Q. Temporary Facilities and Staging Area

1. Temporary construction office/storage facilities shall be the responsibility of the contractor. Coordinate with the center for location of a staging area and vehicle parking. Electricity will be made available by the center. Connection to existing power shall be by the contractor.

R. Collection and Disposal of Waste

1. The contractor shall, at the end of the work day, properly store and secure hazardous and other materials. Construction debris shall be collected daily by the contractor. Disposal shall be off the center, in accordance with applicable law. The contractor shall be responsible for all fees, permits, etc., required for construction waste management and disposal. Copies of Certificates of Disposal of hazardous materials must be submitted to the Buyer.

S. Project Coordination/Progress Meeting

1. The Buyer, Contractor and designated staff shall hold weekly or bi-weekly meetings for the purpose of coordinating project activities such as administrative issues, submittals, Change Order (CO) requests, proposals, resolve conflicts, update schedules, review progress and payment applications.

T. Changes in the Work

1. When a question arises during the work, the Contractor shall submit in writing a Request for Information (RFI) to the Buyer.

The answer or solution to the RFI will be discussed in the Progress Meeting.

2. Minor changes in the work, recommended by the Buyer or Contractor that do not involve a change to the Contract Sum or the Performance time shall be made after written instruction from the Buyer authorizing the Contractor to proceed with the agreed upon changes.

3. When changes in the work involve adjustment to the Contract Sum or the Performance time, or both, the Contractor shall submit to the Buyer in writing a Request for Change (RFC) with the following:

a. The RFC shall include a statement outlining the reason for the change, i.e. unforeseen conditions, product substitution, value engineering, etc. and a complete description of the change.

b. Include a list of quantities of products to be purchased and unit costs. Indicate the amount of trade discounts, if any.

c. Show equipment rental costs, delivery charges, applicable taxes, other fees.

d. If product or system substitution is being requested provide complete supporting data from both specified product/system and proposed substitute product/system.

e. Include a statement indicating the effect the proposed change will have on the Contract performance time and construction schedule.

f. Show the total cost of the proposed change. In such change order proposals that increase the contract sum, profit and overhead shall be computed as follows:

1) The Contractor’s combined profit and overhead on work performed by his own crews shall not exceed

20% of the total direct costs.

2) The Contractor’s commission (mark-up) on work performed by his subcontractors shall not exceed 10% of the direct total costs.

3) Subcontractor profit and overhead shall not exceed 20% of total direct costs

g. When the Buyer and the Contractor agree to the change request as proposed or as modified, the Contractor will submit a contract modification/change order (CO) for the Contractor’s signature, the Center Director’s signature, or Sr. Vice President. Contract modifications shall be executed as a CO on AIA Document G 701 or equivalent.

h. The Contractor is responsible to keep the work progressing on schedule. Requests for changes in the work shall not be considered as instruction to delay or stop work. Work on the requested change shall not be performed until after the Change Order (CO) has executed.

U. Progress Payments

1. Submit applications to the Buyer monthly as the work proceeds or at intervals of percentage completion.

2. Use American Institute of Architects (AIA) form or similar form for payment application. Equivalent forms include

Government form SF1443 and continuation sheets.

3. Schedule of Values

a. Prior to the first application for payment, the Contractor shall submit the Schedule of Values as a basis for the Buyer to compute the value of the work completed to date for approval of the progress payment.

b. The Schedule shall list the installed value of the component parts of the construction work in sufficient detail for the Buyer to accurately verify the value of work in place.

c. For payment requests that include stored materials, breakdown the value: (1) the cost of the materials, delivered and off loaded, with taxes paid (if any) and (2) the total installed value. To receive payment for stored materials, materials must be stored in a bonded warehouse. Contractor shall provide purchase orders and bonded storage documentation with payment request.

d. Break down the value of major component parts into sub-values for each major product or construction trade operation.

e. For the various components listed on the Schedule, the value of each shall include a directly proportional amount of the Contractor’s overhead and profit.

4. Retainage, when applicable

a. The Buyer shall retain ten percent (10%) of the requested progress payment amount until substantial completion and acceptance of the installed work.

b. When the work is substantially completed, the Buyer shall retain only an amount considered adequate to complete or correct any unfinished and/or unacceptable items noted on the final punch list.

V. Substantial Completion

1. When the work is substantially complete, the Contractor shall notify the Buyer in writing requesting inspection of the work.

A substantial completion inspection shall be conducted by designated center staff and the Contractor to develop a punch list consisting of items that are incomplete, that do not meet the specifications, or are not of acceptable workmanship.

When the center accepts the project as substantially complete, the center will take occupancy and the Contractor will issue the Substantial Completion Certificate. The date of substantial completion stops the performance time clock and establishes the date of commencement of Contractor’s and manufacturer’s warranties and guarantees. The Contractor shall submit their written Guarantee of Workmanship for the period of one (1) year, unless otherwise specified.

2. The contractor shall provide the Buyer at the substantial completion, two complete operation and maintenance manuals (O&M) including manufacturer’s product data sheets for all equipment supplied, detailed parts lists and equipment maintenance requirements. In addition, submit certificates of manufacturer’s warranties and guarantees for equipment and materials installed as part of the project.

3. The Contractor shall provide a Substantial Completion Pay Request. The pay request will include the remaining dollar value of the contract, plus retainage, less liquidated damages if accessed, and less the amount agreed upon for correcting the punch list items.

W. Final Inspection and Acceptance – Contract Closeout

1. When the Contractor has completed all of the work on the punch list, they shall notify the Buyer for a final inspection. If the work is accepted, the Contractor shall submit to the Buyer:

a. Contractor’s “Notice of Final Completion”

b. Contractor’s Final Pay Request

c. Davis Bacon Weekly Certified Payroll Report (final certified payroll reports submitted with final pay request)

d. Surety Company’s “Consent of Surety to Final Payment (only applies when payment and performance bonds are part of the contract)

e. Contractor’s “Certificate of Release of Liens”

f. Contractor’s “Certificate of Payment of Debts and Claims”

g. Contractor’s 1-year Guarantee of Workmanship

h. 2-complete sets of O&M manuals for installed equipment and product data sheets

X. Additional Federal Acquisition Regulations (FAR)

1. The contractor shall be required to adhere to the FAR Clause(s) applicable to this project identified in the attached Terms and

Conditions. Additional applicable clauses are listed below.

a. All Construction Contracts:

52.222-4 Contract Work Hours and Safety Standards Act 52.222-6 Davis-Bacon Act 52.222-7 Withholding of Funds 52.222-8 Payrolls and Basic Records

52.222-9 Apprentices and Trainees 52.222-10 Compliance with Copeland Act Requirements 52.222-11 Subcontracts (Labor Standards)

52.222-12 Contract Termination-Debarment 52.222-13 Compliance with Davis-Bacon and Related Act Requirements

52.222-14 Disputes Concerning Labor Standards 52.222-15 Certification of Eligibility

CONSTRUCTION STATEMENT OF WORK (SOW)

SECTION II: Technical Requirements

The Contractor shall provide the following:

1. Provide 24 gauge metal siding over 2x4 furring laid flat running horizontally at 24” O.C.

2. The siding color is sandstone

3. Provide for minimal repair of existing original 1 x 6 wood siding

4. Repair the existing building wrap as necessary for a weatherproof building wall system.

5. Infill two existing windows with wood framing and plywood. Provide building wrap.

6. Provide all necessary J-channel, coil stock, trims matching the new metal siding for a complete installation.

7. Provide flashing at the brick wainscot and gable end (see proposed gable end rake flashing detail)

8. At recessed wall area between two existing roll doors build out with framing approximately 9” and cover with OSB and building wrap.

9. Follow metal siding manufacturers standard details for each condition e.g. bottom angle, top channel, head and jamb, corners, etc.

Please see attached are the SOW drawings

FAR 52.204-10 First-Tier Subcontractor Information

Information required if award is $25,000 and over This form implements section 2 of the Federal Funding Accountability and Transparency Act of 2006 (Pub. L. 109-282), as amended by section 6202 of the Government Funding Transparency Act of 2008 (Pub. L. 110-252), which requires contractors to report subcontract award data and the total compensation of the five most highly compensated executives of the contractor and subcontractor. The public may view first-tier subcontract award data at http://usaspending.gov.

Buyer's responsibility:

Prime Contract number:

NAICS Code Description of Award Sub award Number Amount of Sub award

Sub award Date

6-digit North American Industry Classification System (NAICS) found in contract

A description of the products or services (including construction) being provided under the subcontract, including the overall purpose and expected outcomes or results of the subcontract.

Prime contractor's identifying number (PO number)

Anticipated total over the life of award

Date award signed.

Format: MM/DD/YYYY

Subcontractor's Information

DUNS Number Name of Subcontractor DUNS Number of Parent Company Name of Parent Company

Subcontractor's Data Universal Number System

Name of company Parent Company's Data Universal

Number System Name of subcontractor's parent company

Subcontractor's Physical Address Street Address 2 City State Zip Code + 4

Congressional District Country

Street address Additional line for street address City

2-digit code

Zip code plus 4 (no dashes) 2-digit code 2-digit code

Subcontractor's Place of Performance Street Address 2 City State Zip Code + 4

Congressional District Country

Street address Additional line for street address City

2-digit code

Zip code plus 4 (no dashes) 2-digit code 2-digit code

Subcontractor's Indication of Reporting Applicability "Yes" or "No"

If a subcontractor in the previous tax year had gross income from all sources under $300,000, enter "No" because the Contractor does not need to report awards to that subcontractor. If over $300,000, enter "Yes" because the Contractor does need to report awards to that subcontractor.

Subcontractor's Indication of Reporting Highly Compensated Officers (Public will not have access to this information) Officer's Name

Officer's Compensation

If in the preceding fiscal year, received 80%+ and $25M annual gross revenue from federal contracts, "Yes" and give names & compensation for the five most highly compensated individuals for the calendar year; if not, "No"

#1

#2

#3

#4

"Yes" or "No" #5

I certify that I have checked the appropriate categories for myself or my company.

Signature of authorized company representative Date

Printed Name

Title