CM-09.pdf

CONTRACTOR CERTIFICATION

Published May 2025

CM-09

INSTRUCTIONS

This statement must bear the signature of the contractor. If the Contractor is:

• a partnership this statement must be signed by a general partner designated as such;

• a corporation, joint venture, or trust this statement must be signed by a duly authorized officer or agent of such corporation, trust or joint venture; or

• an individual doing business under a name other than his own name this statement must so state, giving the address of the individual.

REQUIRED CERTIFICATION

To the Official, acting in the name and on behalf of the City of Boston. The undersigned agrees to furnish all labor and materials and to perform all work required for

Description of Service in accordance with the terms of the accompanying contract documents.

LEGAL FORM OF BUSINESS ENTITY

The Contractor is a/an

Individual

Partnership

Limited Liability Partnership (LLP)

Corporation

Limited Liability Company (LLC)

Joint Venture

Trust

Other (written description):

Legal Form of Business Entity

If the Contractor is a Partnership, state name and address of all partners:

Names and Addresses of all Partners

CONTRACTOR CERTIFICATION

CM-09

If the Contractor is a Corporation, state the following:

Corporation is incorporated in the State of

State of Incorporation President is

Name of President

Treasurer is

Name of Treasurer Place of business is

Business Address (Street, City, State, & Zip Code)

If the Contractor is a Joint Venture, state the name and business address of each person, firm or company that is party to the joint venture:

of all Parties to the Joint Venture

A copy of the joint venture agreement is on file at

Location of Joint Venture Agreement and will be delivered to the Official on request.

If Contractor is a Trust, state the name and address of all Trustees:

of all Trustees

The trust document(s) are on file at

Location of Trust Documents and will be delivered to the Official on request.

If the business is conducted under any title other than the real name of the owner, state the time when, and place where, the certificate required by General Laws, c.110, §5, was filed:

State, time, and place where certificate filed

CONTRACTOR CERTIFICATION CM-09

The Taxpayer Identification Number* of the contractor (the number used on the Employer’s Quarterly Federal Tax Return, U.S. Treasury Department Form 941) Is: Contractor Taxpayer

Identification Number *If individual, use Social Security Number Contractor Individual

Social Security Number

City of Boston Ordinance, Chapter IV, § 4-8 requires City Contractors to safeguard unprotected pedestrians, cyclists, and motorcyclists by installing side under-ride guards, convex blind spot mirrors, cross-over mirrors, and appropriate warning signage on all large vehicles used within the City of Boston in connection with a City Contract. Large vehicles are those with a gross weight exceeding 10,000 lbs., a trailer with an unladen mass exceeding 10,000 lbs., or a semi-trailer with a gross weight exceeding 26,000 lbs.

Contractors are required to have such large vehicles inspected by the City prior to starting work on a City of Boston Contract. Additional details may be found at boston.gov/procurement.

The undersigned certifies under penalties of perjury that this bid or proposal has been made an submitted in good faith and without collusion or fraud with any other person.

As used in this certification, the word “person” shall mean any natural person, business, partnership, corporation, union, committee, club, or other organization, entity or group of individuals.

Contractor

Signature

Title

Business Address (Street)

Business Address (City, State, Zip Code)

APPROVED AS TO FORM BY CORPORATION COUNSEL APRIL, 2025

THIS FORM IS VOID AND WITHOUT LEGAL EFFECT IF ALTERED IN ANY WAY

boston.gov/procurement