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REQUEST FOR BID. MASTER SERVICES CONTRACT - ELECTRICAL $10K to $100K University of M assachusetts - Lowell, Massachusetts. UMASS Project #CL16-AJ-0076

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REQUEST FOR BID

MASTER SERVICES CONTRACT

- ELECTRICAL

$10K to $100K

University of M assachusetts - Lowell, Massachusetts

UMASS Project #CL16-AJ-0076

PREPARED FOR University of

Massachusetts - Lowell One University Avenue Lowell,

Massachusetts 01854

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ATTENTION BIDDERS

To ensure that your bids are acceptabl e to the University of Massachusetts - Lowell, and are not rejected due to mistakes, we are providing this Checklist for your convenience.

GENERAL BIDDERS

1. Have you used the appropriate bid form provided for this specific project?

2. Do your bid amounts, as expressed in figures and words, coincide? The amount expressed n words shall

control.

3. Have you added any information not called for, or acknowledged an addendum or alternate that does not exist, which would make your bid conditional or obscure, and lead to a bid protest?

4. Is your Bid Form SIGNED and dated?

5. Bid Deposits

a. Is your bid deposit, if in the form of a bid bond, issued from a bonding company licensed to do

business in the Commonwealth of Massachusetts?

b. Is it signed by you and the bonding c ompany?

c. Is your bid deposit made payable to the University of Massachusetts - Lowell? Bid deposits made payable to the city, town, commonwealth, or architect will cause the bid to be rejected.

d. Is your bid deposit at least five (5%) of the largest possible bid amount, considering all alternates?

PASSBOOKS,LETIERS OF CREDIT, AND DEEDS TO PROPERTY ARE NOT ACCEPTABLE AS A BID DEPOSIT.

7. Have you acknowledged every alternate?

8. If an alternate price is requested and you estimate that there is no change in price, did you indicate by writing "no change", "NIC" or "0"?

LEAVING THIS SPACE BLANK,ON YOUR BID FORM, WHEN ALTERNATES ARE REQUESTED MAY LEAD TO REJECTION OF YOUR BID.

9. Have you acknowledged all addenda issued, and followed the instructions contained therein? 10. Have you provided a completed copy of the following documents?

a) Form for General Bid b) Bid Bond

c) General Contractor Update Statement

d) DCAM Certificate of Eligibility

e) Completed and signed General Contractor Update Statement

f) Signed Certificate of Vote of Authorization g) Signed Statement of State Tax Compliance h) Signed Certificate of Non Collusion

i) Signed Form of Contractor's Equal Employment Certification

j) Bid bond in the amount of 5%

k) Evidence of Insurance at the amounts stated in Article 16 of the General Conditions

I) Copy of the Superintendence License and current OSHA Training Certificate

m) Completed W -9 Form

This checkli st is provided as guidance and assistance to bidders to avoid technical mistakes resulting in rejection of a bid.

This in no way changes, affects, or supersedes the provisions set-forth in M.G.L. c.149 §44A-J or any other sections or provi sions contai ned in the contract documents.

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Master Services Contract – Electrical University of Massachusetts - Lowell

TABLE OF CONTENTS

10/01/2013

Number of Pages

TITLE SHEET FOR PROJECT MANUAL ... 1

TABLE OF CONTENTS... 1

REQUEST FOR BID ... 2

BIDDING DOCUM ENTS INSTRUCTIONS TO BIDDERS ... 3

FORM FOR GENERAL BID... 2

PRIME/GENERAL CONTRACTOR UPDATE STATEMENT(Form CQ3) ... 10

FORM S FORM OF OWNER/CONTRACTOR AGREEMENT ... 1

FORM OF CORPORATE VOTE... 1

FORM OF CONTRACTOR'S EQUAL EMPLOYMENT CERTIFICATION... 1

FORM OF PERFORMANCE BOND... 1

FORM OF PAYMENT BOND... 1

STATEMENT OF STATE TAX COMPLIANCE ... 1

CERTIFICATE OF NON COLLUSION ... 1

W -9 REQUEST FOR TAXPAYER IDENTIFICATION ... 2

CONTRACT DOCUM ENTS GENERAL CONDITIONS OF CONTRACT ... 25

SPECIFIC ATIONS DIVISION 1 - GENERAL REQUIREMENTS SECTION 01010 - SUMMARY OF W ORK ... 1

SECTION 01045 - CUTTING AND PATCHING………...4

SECTION 01050 - CONDUCT OF WORK... 2

SECTION 01100 - LABOR REGULATIONS (41 Pages of W age Rates) ... 1

SECTION 01510 - PROTECTION... 2

SECTION 01520 - CLEANING UP ... 2

SECTION 01700 - PROJECT CLOSEOUT ... 3

END OF T ABLE OF CONTENTS

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Master Services Contract – Electrical University of Massachusetts - Lowell

10/2014

REQUEST FOR BID

Page 1 of 3

REQ UEST FOR BID

The

University of Massachusetts - Lowell

, the Awarding Authority, invites sealed bids from

General Contractors

for the

Master Services Contract – Electrical

for the

University of

Massachusetts

in Lowell, Massachusetts.

The Project consists of, but is not limited to, providing electrical construction services to include

project management, supervision and labor and material for power & lighting. The Electrical

Contractor may be required to coordinate and to work with the Awarding Authority’s other

contractors/vendors selected for a Master Services Contract in other trades. The specific scope of

work will be negotiated by “work order”, and will have a value between $10,000 and $100,000 per

work order.

The work is estimated to cost

$500,000

per year.

General bidders must be Prime/General or Sub-Bidder Contractor certified by the Division of Capital

Asset Management (DCAM) in the following category of work

Electrical

and must submit with its bid

a Certificate of Eligibility and signed Update Statement (Form).

Bids are subject to M.G.L. c.149 §44A-J & to minimum wage rates as required by M.G.L. c.l49

§§26 to 27H inclusive. The Awarding Authority reserves the right to reject any Bid Proposal that is

not in full compliance with the Contract Specifications; to reject any or all bids wholly or in part; to

waive technicalities in accordance with Massachusetts General Law; to make awards in a manner

deemed in the best interest of the Awarding Authority; and to correct any award erroneously made

as a result of a clerical error on the part of the Awarding Authority.

Bids will be received until

11:30 am EST. on May 25, 2016

and publicly opened,forthwith.

All Bids should be delivered to:

University of Massachusetts – Lowell, Purchasing

Department, 600 Suffolk St., Wannalancit Business Center, Suite 415, Lowell, MA 01854

and received no later than the date & time specified above.

Bids shall be accompanied by a bid deposit that is not less than five (5%) of the greatest possible

bid amount (considering all alternates), and made payable to the

University of Massachusetts

Lowell.

The bid deposit shall be in the form of a certified, treasurer’s, cashier check or a bid bond

form a licensed surety in accordance with M.G.L. c.

§

149 44B (2).

Bid Forms and Contract Documents will be available for pick-up at University of Massachusetts

– Lowell, Purchasing Department, 600 Suffolk Street, W annalancit Business Center, Suite 415,

Lowell, MA 01854 or by email via [email protected]

.

There is no requirement for minority and women-owned business participation for this contract.

GENERAL INFORMATION:

1. All terms, conditions, requirements and procedures included in this Request for Bid must be

met for a Bidder to be determined as responsive. If a Bidder fails to meet any material terms,

conditions, requirement or procedure, the Bidders response may be deemed non-responsive

and rejected.

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Master Services Contract – Electrical University of Massachusetts - Lowell

10/2014

REQUEST FOR BID

Page 2 of 3

2. Unless otherwise specified, all communications, responses and documentation must be in

English; all measurements must be in feet, inches and pounds; and all cost proposals or

figures in U.S. currency. All Bids must be submitted in accordance with the specified terms

and no electronic or facsimile copies of will be accepted.

3. Bidders are prohibited from communicating directly with any employee of the Awarding

Authority except as specified in this Request for Bid. The Awarding Authority’s Purchasing

Department is the only authorized party to provide any information in response to any

questions or inquiries concerning this Request for Bid.

4. All Bids and information submitted in response to this Request for Bid are subject to the

Massachusetts Freedom of Information Law, M.G.L., Chapter 66, Section 10 and to Chapter

4, Section 7, Subsection 26, regarding public access to such documents. Any statements

reserving any confidentiality or privacy rights, excepted as permitted in this Request for Bid or

otherwise inconsistent with the statues, will be void and disregarded.

5. The Awarding Authority makes no guarantee that any services or commodities will be

purchased from any contract resulting from this Request for Bid. Any estimates or past

procurement volumes referenced in this Request for Bid are included only for the convenience

of the Bidders, and are not to be relied upon as any indication of the future purchase levels.

6. Unless otherwise stated in this Request for Bid, any reference to a particular trademark, trade

name, patent, design, type, specification, producer or supplier is not intended to restrict this

Request for Bid to any manufacturer or proprietor or to constitute an endorsement of any good

or service, and the Awarding Authority will consider approved equals in accordance with

Article 4.6.3 of the General Conditions.

MINIMUM QUALIFICATIONS:

1. The Bidder must have owned or operated the company under the same name for at least five

(5) years providing services relevant to this Request for Bidding – Electrical.

2. All personnel employed by the Contractor shall be in the steady and continuous employment

of the Contractor. In particular, the designated Project Manager and Foreman must have a

minimum of two (2) years continuous employment with the Contractor.

3.

The awarding party must provide information regarding employee CORI background checks;

to be completed during the hiring process, and annually for all employees working on the

University of Massachusetts Lowell campus throughout the contract. This information must

detail resultant reporting that will be provided to the University.

4. The Bidder must provide a list of all licensed personnel employed by the Contractor, with the

understanding that the University will require copies all licenses at award.

5. Contractors must respond as requested:

Emergency Call – Contractor must respond within one (1) hour of initial call as directed

Service Call – Contractor must respond by phone within one (1) hour and establish a

mutually agreed arrival time at the facility.

6. The Contractor must designate a person that can be reached by phone or beeper at all times

24 hours per day, 7 days per week, and 365 days per year 24 x 7 x365. Contractors must

send a qualified service person to the location and have a vehicle fully equipped with tools and

replacement parts to perform repairs or diagnosis the problem.

7. The Bidder must be DCAM certified in electrical (power & lighting) indicated in this Request for

Bid.

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Master Services Contract – Electrical University of Massachusetts - Lowell

10/2014

REQUEST FOR BID

Page 3 of 3

8. The Bidder must have adequate manpower and equipment to accomplish the work in a timely

fashion in accordance with the General Conditions. In particular, the Bidder must be able to

provide at least three (3) two-man crews on any given day.

9. The Bidder must have access to a Bucket Truck for outdoor lighting, and any other outdoor

electrical needs.

10. The Bidder must have experience in the installation of security and fire alarm systems.

11. The Bidder must provide certificates of insurance in the amounts indicated in Article 16 of the

General Conditions.

12. UML’s Research Reactor is licensed by the U.S. Nuclear Regulatory Commission (NRC). The

license imposes a number of conditions applying to all aspects of the facility, including

security. Due to these conditions the selected Electrical Contractors may be required to

obtain the Transportation Worker Identification Credential (TW IC) issued by the Transportation

Security Administration under the U.S. Department of Homeland Security.

TERM OF CONTRACT AND OPTION TO EXTEND

The term of any contract resulting from this Request for Bid shall be for twelve (12) months.

Based on the Contractor’s performance, the Awarding Authority may elect to extend the contract

for another twelve (12) month period up to a total of three (3) years.

If deemed to be in the best interest of the Awarding Authority, the Awarding Authority may award

up to three (3) separate contracts in rank order and quotes for these services.

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Instructions to Bidders 1 of 3

INSTRUCTIONS TO BIDDERS

Building Projects $10,000 -$100,000

ARTICLE 1 - BIDDER'S REPRESENTATION

1.1 Each General Bidder (hereinafter called the "Bidder") by m aking a bid (hereinafter called

"bid") represents that:

.1 The Bidder has read and understands the Contract Docum ents and the bid is made in accordance therewith.

.2 The Bidder has visited the site and is fam iliar with the local conditions under which the W ork has to be performed.

1.2 Failure to so exam ine the Contract Docum ents and site will not relieve an y Bidder from

any obligation under the bid as subm itted

.

ARTICLE 2 - REQUESTS FOR INTERPRETATION

2.1 Bidders shall prom ptly notif y the Award Authorit y of any am biguity, inconsistency, or

error, which they m ay discover upon examination of the Contract Docum ents, the site, and local conditions.

2.2 Bidders requiring clarification or interpretation of the Contract Docum ents shall m ake a

written request to the Award Authority. The Award Authority will answer such requests if received seven (7) calendar days before the date for receipt of the bids.

2.3 Interpretation, correction, or change in the Contract Docum ents will be m ade by written

Addendum , which will become part of the Contract Docum ents. Award Authority will not be held accountable for any oral interpretations, corrections, or changes.

2.4 Addenda will be m ailed by the Award Authorit y by U.S Postal Service, certificate of

mailing, to ever y individual or firm on record as having taken a set of Contract Docum ents.

2.5 Copies of addenda will be m ade available for inspection at the locations listed in the

Advertisement where Contract Docum ents are on file.

ARTICLE 3 - PREPARATION AND SUBMISSION OF BIDS

3.1 Bids shall be subm itted on the "Form for General Bid" furnished at no cost by UMASS

Lowell. The form s enclosed in the Project Manual shall not be extracted or used. Additional forms are available at the location listed in the Advertisem ent.

3.2 All entries on the bid form shall be m ade by typewriter or in ink.

3.3 W here so indicated on the bid form , sums shall be expressed in both words and figures.

W here there is a discrepancy between the bid sum expressed in words and the bid sum expressed in figures, the words shall control.

3.4 Bid Deposits shall be:

.1 at least five percent (5%) of the greatest possible bid amount, considering all

alternates;

.2 made payable to the University of Massachusetts - Lowell;

.3 conditioned upon faithful performance by the principal of the agreem ents contained in

the bid, and

.4 in the form of:

a. cash,

b. certified check, treasurer’s or cashier’s check issued by a responsible bank or trust com pany, or c. a bid bond issued b y a surety company licensed to do business in the Commonwealth of

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Instructions to Bidders 2 of 3

3.5 Bid deposits of the three (3) lowest responsible and eligible General Bidders shall be

retained until the execution and delivery of the Owner/Contractor Agreem ent.

3.6 The General Bid Form and the bid deposit shall be enclosed in a sealed envelope with

the following plainly m arked on the outside:

General Bid for:

Project Name / Project Number

Bidder's Name, Business Address, and Phone Number

3.7 Date and tim e for receipt of bids is set forth in the Advertisem ent.

3.8 Tim ely delivery of a bid to the location designated shall be the full responsibility of the

Bidder.

ARTICLE 4 - ALTERNATES

4.1 Each General Bidder shall acknowledge Alternates in Section C on the Form for General

Bid by entering the dollar amount of addition or subtraction necessitated by the Alternate.

4.2 In the event an Alternate does not involve a change in the am ount of the base bid, the

Bidder shall so indicate by writing "No Change", or "N/C" or "0" in the space provided

for that Alternate.

4.4 General Bidders shall enter on the Form for General Bid a single am ount for each

Alternate which shall consist of the am ount for work perform ed as a result of the alternate.

4.5 The low Bidder will be determ ined on the basis of the sum of the base bid and the accepted

alternates.

ARTICLE 5 - WITHDRAWAL OF BIDS

5.1 Before Opening of Bids

5.1.1 An y bid m ay be withdrawn prior to the tim e designated for receipt of bids upon written request. W ithdrawal of bids must be confirm ed over the Bidder's signature b y written notice post-marked or sent by facsim ile on or before the date and tim e set for receipt of bids.

5.1.2 W ithdrawn bids m ay be resubm itted up to the time designated for the receipt of bids.

5.2 After Opening of Bids

5.2.1 Bidders m ay withdraw a bid, without penalty, any tim e up to the tim e of Award as defined in paragraph 8.1, and upon demonstrating, to the satisfaction of UMASS Lowell, that a bona fide clerical error was m ade during the preparation of the bid. Failure to conclusively demonstrate a bona fide clerical error m ay result in forfeiture of the bid deposit.

ARTICLE 6 - CONTRACT AWARD

6.1 Award m eans both the determination and selection of the lowest, responsible and eligible bidder, b y University of Massachusetts - Lowell.

6.2 The University of Massachusetts - Lowell will award the contract to the lowest responsible and

eligible bidder within thirty days, Saturdays, Sunda ys, and legal holida ys excluded after the opening of bids in accordance with M.G.L. c.149 §44A.

6.3 The award of this Contract is subject to the approval of the University of Massachusetts -

Lowell. Contracts without approval shall not be considered valid.

6.4 The University of Massachusetts - Lowell reserves the right to waive any informalities in

or to reject any or all Bids if it be in the public interest to do so.

6.5 As used herein, the term "lowest responsible and eligible bidder" shall m ean the General

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Instructions to Bidders 3 of 3

and integrity necessary for the faithful performance of the work, and who m eets the requirements for Bidders set forth in M.G.L. c.l49 §44A-J and is not debarred from bidding under M.G.L. c.l49 §44C; and who shall certif y that they are able to furnish labor that can work in harm ony with all other elem ents of labor em ployed or to be em ployed on the work.

ARTICLE 7 - FORM S REQUIRED FOR CONTRACT APPROVAL

7.1 Upon Award, the General Bidder shall com plete the following forms to ensure prompt

contract validation. These forms will be provided to the selected General Bidder by UMASS - Lowell. Subm it (3) originals of each.

7.2 Owner/Contractor Agreement and Form of Corporate Vote.

7.3 Form of Contractor's Equal Employment Certification in accordance with Article 14 of the General Conditions.

7.4 Form of Performance Bond and Form of Payment Bond m ust be subm itted by the General Contractor on UMASS Lowell's form , in accordance with the General Conditions. The dates on the bonds m ust coincide with the contract date, and a current Power-of-Attorney m ust be attached to each bond.

7.5. Insurance Certificates for the General Contractor are required and m ust be submitted in accordance with the General Conditions.

7.5.1 General Contractors must indicate on special perils insurance or installation floater if stored m aterials are covered.

ARTICLE 8 - CONTRACT VALIDATION

8.1 The Owner-Contractor Agreem ent shall not be valid until signed by the Director of

Purchasing.

8.2 The Notice to Proceed for construction shall not be issued until the Owner/Contractor

Agreem ent has been validated by the Director of Purchasing.

8.3 Incomplete or unacceptable subm issions of forms required by paragraphs 7.2 - 7.5 will

delay the validation of the Owner/Contractor Agreem ent by Purchasing.

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FORM OF GENERAL BID 1 of 2

FORM OF GENERAL BID

TO THE AW ARDING AUTHORITY

A. The undersigned proposes to furnish all labor and materials required for Master Services Contract – for

Electrical the

UNIVERSITY OF MASSACHUSETTS - LOWELL in Lowell, Massachusetts in accordance with Contract Documents prepared by

University of Massachusetts - Lowell

For the contract price specified below, subject additions and deductions according to the terms of the specifications

B. This bid includes addenda number(s)

C. The proposed contract price is: Total of items #1, and #2 below.

Dollars $

Bid Amount in Words Bid Amount in Numbers

Labor and Material Pricing: Prevailing wage rates, insurances, taxes, overhead and profit for the trade

should be considered. The hourly bid rate must not be less than the prevailing wage rate. Include a

price for the Electrician item based on the quantities identified as the base bid hours. The electricians and all other personnel used by the Bidder must be direct employees of the Contractor. The hourly rates indicated will be used for additional work over the quantities in the base bid amount. The rates will be reviewed and adjusted after the first 12 months of the contract.

Item #1: Regular Time – Monday -Friday 7:00 a.m. to 5:00 p.m.

Trade Base Bid Proposed Hourly Rate

Electrician

2500 hours

x

$

/hour

=

$

Item #1 Sub Total

=

$

Item #2: Premium Time – Saturday, Sunday, Holidays, Monday -Friday 5:01 p.m. to 6:59 a.m.

Trade Base Bid Proposed Hourly Rate

Electrician

1000 hours

x

$

/hour

=

$

Item #2 Sub Total

=

$

See below for allowable compensation for sub-trade work and materials.

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FORM OF GENERAL BID 2 of 2

Sub-Trade and Material pricing: 1

The Contractor will be required at the discretion of the University, to obtain a minimum of three proposals for work in each sub-trade unless otherwise directed by the University of Massachusetts - Lowell. The Contractor will submit the three proposals for review and approval. The Contractor will be compensated for the direct costs of the sub-trade work and a 10% mark-up in accordance in Article 8.3.1.g of the General Conditions.

2

The Contractor will be required to submit copies of the m aterial invoices for review by the University of Massachusetts – Lowell. The Contractor will be compensated for the direct costs of the materials and a 15% mark-up and in accordance with Article 8.3.1.f of the General Conditions. The University of Massachusetts – Lowell reserves the right to purchase and supply the materials to the Contractor for the

work order. If the materials are furnished, the Contractor will get no mark-up for the materials.

D. The undersigned agrees that, if selected as general contractor, we will within five days, Saturdays, Sundays, and legal holidays excluded, after presentation thereof by the awarding authority, execute a contract in accordance with the terms of this bid and furnish a performance bond and also a labor and materials or payment bond, each of a surety company qualified to do business under the laws of the Commonwealth and satisfactory to the awarding authority and each in the sum of the contract price, the premiums for which are to be paid by the general contractor and are included in the contract price. The undersigned hereby certifies that he is able to furnish labor that can work in harm ony with all other elem ents of labor employed or to be em ployed on the work; that all em ployees to be em ployed at the work site will have successfully com pleted a course in construction safety and health approved by the United States Occupational Safety and Health Administration that is at least 10 hours in duration at the tim e the employee begins work and who shall furnish documentation of successful com pletion of said course with the first certified payroll report for each em ployee; and that he will

com ply fully with all laws and regulations applicable to awards m ade subject to section 44A. The

Safety Training requirement in this paragraph is effective July 1, 2006.

The undersigned further certifies under the penalties of perjury that this bid is in all respects bona fide, fair and made without collusion or fraud with any other person. As used in this subsection the word "person" shall mean natural person, joint venture, partnership, corporation or other business or legal entity. The undersigned further certifies under penalty of perjury that the said undersigned is not presently debarred from doing public construction work in the Commonwealth under the provisions of section twenty-nine F of chapter twenty-nine, or any other applicable debarment provisions of any other chapter of the General Laws or any rule or regulation promulgated thereunder.

Date:

Signature

BY:

Name of General Bidder

Signature & Title of person signing bid

Business Address (City and State)

Note: If the bidder is a corporation, indicate state of incorporation under signature, and affix corporate seal; if a partnership, give full names and residential addresses of partners if different from business addresses.

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SPECIAL NOTICE TO AWARDING AUTHORITY

BIDDERS’ UPDATE STATEMENTS ARE NOT PUBLIC RECORDS AND

ARE NOT OPEN TO PUBLIC INSPECTION (M.G.L. C.149, §44D)

EFFECTIVE MARCH 30, 2010

Commonwealth of Massachusetts

Division of Capital Asset Management

PRIME/GENERAL CONTRACTOR

UPDATE STATEMENT

TO ALL BIDDERS AND AW ARDING AUTHORITIES

A COMPLETED AND SIGNED PRIME/GENERAL CONTRACTOR UPDATE

STATEMENT MUST BE SUBMITTED WITH EVERY PRIME/GENERAL BID FOR A

CONTRACT PURSUANT TO M.G.L. c.149, §44A AND M.G.L. c. 149A. ANY

PRIME/GENERAL BID

SUBMITTED WITHOUT

AN

APPROPRIATE UPDATE

STATEMENT IS INVALID AND MUST BE REJECTED.

Caution: This form is to be used for submitting Prime/General Contract bids. It is

not to be used for submitting Filed Sub-Bids or Trade Sub-Bids.

AW ARDING AUTHORITIES

If the Awarding Authority determines that the bidder does not demonstrably possess

the skill, ability, and integrity necessary to perform the work on the project, it must

reject the bid.

BIDDE

R’S AFFIDAVIT

I swear under the pains and penalties of perjury that I am duly authorized by the bidder

named below to sign and submit this Prime/General Contractor Update Statement on behalf

of the bidder named below, that I have read this Prime/General Contractor Update Statement,

and that all of the information provided by the bidder in this Prime/General Contractor Update

Statement is true, accurate, and complete as of the bid date.

_

_

_

_

Bid Date

Print Name of Prime/General Contractor

_

_

_

_

Project Number (or

Business Address

name if no number)

_

_

_

_

Awarding Authority

Telephone Number

SIGNATURE



Bidder’s Authorized Representative

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INSTRUCTIONS

INSTRUCTIONS TO BIDDERS

 This form must be completed and submitted by all

Prime/General contractors bidding on projects pursuant to M.G.L. c. 149, §44A and M.G.L. c. 149A.

 You must give complete and accurate answers to all

questions and provide all of the information requested. MAKING A MATERIALLY FALSE STATEMENT IN THIS UPDATE STATEMENT IS GROUNDS FOR

REJECTING YOUR BID AND FOR DEBARRING YOU FROM ALL PUBLIC CONTRACTING.

This Update Statement must include all requested

information that was not previously reported on the Application used for your firm’s most recently issued (not extended or amended) Prime/General Contractor Certificate of Eligibility. The Update Statement must cover the entire period since the date of your Application, NOT since the date of your Certification.

 You must use this official form of Update Statement.

Copies of this form may be obtained from the awarding authority and from the Asset Management W eb Site:

www.mass.gov/dcam .

 If additional space is needed, please copy the

appropriate page of this Update Statement and attach it as an additional sheet.

 See the section entitled “Bidding Limits” in the

Instructions to Awarding Authorities for important information concerning your bidding limits.

INSTRUCTIONS TO AW ARDING AUTHORITIES

Determination of Bidder Qualifications

 It is the awarding authority’s responsibility to determine

who is the lowest eligible and responsible bidder. You must consider all of the information in the low bidder’s Update Statement in making this determination. Remember: this information was not available to the Division of Capital Asset Management at the time of certification.

 The bidder’s performance on the projected listed in Parts

1 and 2 must be part of your review. Contact the project references.

 AW ARDING AUTHORITIES ARE STRONGLY

ENCOURAGED TO REVIEW THE LOW BIDDER’S ENTIRE CERTIFICATION FILE AT THE DIVISION OF

CAPITAL ASSET MANAGEMENT. Telephone (617)

727-9320 for an appointment.

Bidding Limits

Single Project Limit: The total amount of the bid, including all alternates, may not exceed the bidder’s Single Project Limit. Aggregate W ork Limit: The annual value of the work to be performed on the contract for which the bid is submitted,

when added to the annual cost to complete the bidder’s other currently held contracts, may not exceed the bidder’s Aggregate W ork Limit. Use the following procedure to determine whether the low bidder is within its Aggregate Work Limit:

Step 1 Review Update Statement Question #2 to

make sure that all requested information is provided and that the bidder has accurately calculated and totaled the annualized value of all incomplete work on its currently held contracts (column 9).

Step 2 Determine the annual dollar value of the work to be performed on your project. This is done as follows:

(i) If the project is to be completed in less than 12 months, the annual dollar value of the work is equal to the full amount of the bid.

(ii) If the project will take more than 12 months to complete, calculate the number of years given to complete the project by dividing the total number of months in the project schedule by 12 (calculate to 3 decimal places), then divide the amount of the bid by the calculated number of years to find the annual dollar value of the work.

Step 3 Add the annualized value of all of the bidder’s

incomplete contract work (the total of column 9 on page 5) to the annual dollar value of the

work to be performed on your project. The

total may not exceed the bidder’s

Aggregate Work Limit.

Correction of Errors and Omissions in Update Statements

Matters of Form: An awarding authority shall not reject a contractor’s bid because there are mistakes or omissions of form in the Update Statement submitted with the bid, provided the contractor promptly corrects those mistakes or omissions upon request of the awarding authority. [810 CMR 8.05(1)].

Correction of Other Defects: An awarding authority may, in its discretion, give a contractor notice of defects, other than mistakes or omissions of form, in the contractor’s Update Statement, and an opportunity to correct such defects, provided the correction of such defects is not prejudicial to fair competition. An awarding authority may reject a corrected Update Statement if it contains unfavorable information about the contractor that was omitted from the Update Statement filed with the contractor’s bid. [810 CMR 8.05(2)].

(14)

Division of Capital Asset Management

Prime/General Contractor Update Statement Effective March 30, 2010

Page 3 of 10

PART 1 - COMPLETED PROJECTS

LIST ALL PUBLIC AND PRIVATE

BUILDING

PROJECTS YOUR FIRM HAS COMPLETED SINCE THE DATE OF

APPLICATION FOR YOUR MOST RECENTLY ISSUED (NOT EXTENDED OR AMENDED) DCAM CERTIFICATE OF

ELIGIBILITY. YOU MUST REPORT ALL REQUESTED INFORMATION NOT PREVIOUSLY REPORTED ON THAT

DCAM APPLICATION*.

PROJECT TITLE & LOCATION WORK

CATEGORY

CONTRACT PRICE START DATE DATE

COMPLETED

Attach additional sheets if necessary

*

If your firm has been terminated from a project prior to completion of the work or has failed or refused to complete its work under

any contract, full details and an explanation must be provided. See Part 3 of this Update Statement.

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Division of Capital Asset Management

Prime/General Contractor Update Statement Effective March 30, 2010

Page 4 of 10

PROVIDE THE FOLLOW ING REFERENCE INFORMATION FOR EACH COMPLETED PROJECT LISTED ON THE

PREVIOUS PAGE.

PROJECT TITLE

COMPANY NAME

CONTACT PERSON

TELEPHONE

OW NER: DESIGNER: GC: OW NER: DESIGNER: GC: OW NER: DESIGNER: GC: OW NER: DESIGNER: GC: OW NER: DESIGNER: GC: OW NER: DESIGNER: GC:

Is your company or any individual who owns, manages or controls your company affiliated with any owner, designer or general

contractor named above, either through a business or family relationship?

YES

NO

Are any of the contact persons named above affiliated with your company or any individual who owns, manages or control your

company, either through a business or family relationship?

YES

NO

(16)

Division of Capital Asset Management

Prime/General Contractor Update Statement Effective March 30, 2010

Page 5 of 10

PART 2 - CURRENTLY HELD CONTRACTS

LIST ALL PUBLIC AND PRIVATE BUILDING AND NON-BUILDING

CONSTRUCTION

PROJECTS YOUR FIRM HAS UNDER

CONTRACT ON THIS DATE REGARDLESS OF W HEN OR W HETHER THE W ORK COMMENCED.

1

2

3

4

5

6

7

8

9

PROJECT TITLE & LOCATION W ORK CATEGORY START AND END DATES ON SCHEDULE (yes / no) CONTRACT PRICE % NOT COMPLET E $ VALUE OF W ORK NOT COMPLETE (col. 5 X col. 6) NO. OF YEARS REMAINING (see note below) ANNUALIZED VALUE OF INCOMPLETE W ORK (col. 7 ÷ col. 8) (divided by)

ANNUALIZED VALUE OF ALL INCOMPLETE CONTRACT WORK (Total of Column 9)

$_

_

Column 8

If less than one year is left in the project schedule, write 1.

If more than 12 months are left in the project schedule, divide the number of months left
(17)

Division of Capital Asset Management

Prime/General Contractor Update Statement Effective March 30, 2010

Page 6 of 10

PROVIDE THE FOLLOW ING REFERENCE INFORMATION FOR EACH INCOMPLETE PROJECT LISTED ON THE

PREVIOUS PAGE.

PROJECT TITLE

COMPANY NAME

CONTACT PERSON

TELEPHONE

OW NER: DESIGNER: GC: OW NER: DESIGNER: GC: OW NER: DESIGNER: GC: OW NER: DESIGNER: GC: OW NER: DESIGNER: GC: OW NER: DESIGNER: GC:

Is your company or any individual who owns, manages or controls your company affiliated with any owner, designer or general

contractor named above either through a business or family relationship?

YES

NO

Are any of the contact persons named above affiliated with your company or any individual who owns, manages or control your

company, either through a business or family relationship?

YES

NO

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Division of Capital Asset Management

Prime/General Contractor Update Statement Effective March 30, 2010

Page 7 of 10

PART 3 - PROJECT PERFORMANCE

For Parts 3 and 4, if you answer YES to any question, please provide on a separate page a

complete explanation. Information you provide herein must supplement the Application for

your most recently issued (not extended or amended) DCAM Certificate of Eligibility. You must

report all requested information not previously reported on that DCAM Application for

Prime/General Certificate of Eligibility. Include all details [project name(s) and location(s),

names of all parties involved, relevant dates, etc.].

YES

NO

1. Has your firm been terminated on any contract prior to completing a project or has

any officer, partner or principal of your firm been an officer, partner or principal of

another firm that was terminated or failed to complete a project?

2. Has your firm failed or refused either to perform or complete any of its work under

any contract prior to substantial completion?

3. Has your firm failed or refused to complete any punch list work under any contract?

4. Has your firm filed for bankruptcy, or has any officer, principal or individual with a

financial interest in your current firm been an officer, principal or individual with a

financial interest in another firm that filed for bankruptcy?

5. Has your surety taken over or been asked to complete any of your work under any

contract?

6. Has a payment or performance bond been invoked against your current firm, or has

any officer, principal or individual with a financial interest in your current firm

been an officer, principal or individual with a financial interest in another firm that

had a payment or performance bond invoked?

7. Has your surety made payment to a materials supplier or other party under your

payment bond on any contract?

8. Has any subcontractor filed a demand for direct payment with an awarding authority

for a public project on any of your contracts?

9. Have any of your subcontractors or suppliers filed litigation to enforce a mechanic’s

lien against property in connection with work performed or materials supplied

under any of your contracts?

10. Have there been any deaths of an employee or others occurring in connection with

any of your projects?

11. Has any employee or other person suffered an injury in connection with any of

your projects resulting in their inability to return to work for a period in excess of

one year?

(19)

Division of Capital Asset Management

Prime/General Contractor Update Statement Effective March 30, 2010

Page 8 of 10

PART 4 - Legal or Administrative Proceedings; Compliance with Laws

Please answer the following questions. Information must supplement all judicial and

administrative proceedings involving bidder’s firm, which were instituted or concluded

(adversely or otherwise) since your firm’s Application for your most recently issued (not

extended or amended) Certificate of Eligibility. You must report all requested information

not previously reported on that DCAM Application for Prime/General Certificate of

Eligibility.

The term “administrative proceeding” as used in this Prime/General Contractor

Update Statement includes (i) any action taken or proceeding brought by a

governmental agency, department or officer to enforce any law, regulation, code,

legal, or contractual requirement, except for those brought in state or federal courts,

or (ii) any action taken by a governmental agency, department or officer imposing

penalties, fines or other sanctions for failure to comply with any such legal or

contractual requirement.

The term “anyone with a financial interest in your firm” as used in this Section “I”,

shall mean any person and/or entity with a 5% or greater ownership interest in the

applicant’s firm.

If you answer YES to any question, on a separate page provide a complete

explanation of each proceeding or action and any judgment, decision, fine or

other sanction or result. Include all details (name of court or administrative

agency, title of case or proceeding, case number, date action was commenced,

date judgment or decision was entered, fines or penalties imposed, etc.).

YES

NO

1. Have any civil, judicial or administrative proceedings involving your firm or a

principal or officer or anyone with a financial interest in your firm been brought,

concluded, or settled relating to the procurement or performance of any

construction contract, including but not limited to actions to obtain payment

brought by subcontractors, suppliers or others?

2. Have any criminal proceedings involving your firm or a principal or officer or

anyone with a financial interest in your firm been brought, concluded, or settled

relating to the procurement or performance of any construction contract including,

but not limited to, any of the following offenses: fraud, graft, embezzlement,

forgery, bribery, falsification or destruction of records, or receipt of stolen

property?

3. Have any judicial or administrative proceedings involving your firm or a principal

or officer or anyone with a financial interest in your firm been brought, concluded,

or settled relating to a violation of any state’s or federal procurement laws arising

out of the submission of bids or proposals?

4. Have any judicial or administrative proceedings involving your firm or a principal

or officer or anyone with a financial interest in your firm been brought, concluded,

or settled relating to a violation of M.G.L. Chapter 268A, the State Ethics Law?

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Division of Capital Asset Management

Prime/General Contractor Update Statement Effective March 30, 2010

Page 9 of 10

PART 4 - Legal or Administrative Proceedings; Compliance with Laws (continued)

5. Have any judicial or administrative proceedings involving your firm or a principal

or officer or anyone with a financial interest in your firm been brought, concluded,

or settled relating to a violation of any state or federal law regulating hours of labor,

unemployment compensation, minimum wages, prevailing wages, overtime pay,

equal pay, child labor or worker’s compensation?

6. Have any judicial or administrative proceedings involving your firm or a principal

or officer or anyone with a financial interest in your firm been brought, concluded,

or settled relating to a violation of any state or federal law prohibiting

discrimination in employment?

7. Have any judicial or administrative proceedings involving your firm or a principal

or officer or anyone with a financial interest in your firm been brought, concluded,

or settled relating to a claim of repeated or aggravated violation of any state or

federal law regulating labor relations?

8. Have any proceedings by a municipal, state, or federal agency been brought,

concluded, or settled relating to decertification, debarment, or suspension of your

firm or any principal or officer or anyone with a financial interest in your firm from

public contracting?

9. Have any judicial or administrative proceedings involving your firm or a principal

or officer or anyone with a financial interest in your firm been brought, concluded,

or settled relating to a violation of state or federal law regulating the environment?

10. Has your firm been fined by OSHA or any other state or federal agency for

violations of any laws or regulations related to occupational health or safety? Note:

this information may be obtained from OSHA’s Web Site at www.osha.gov

11. Has your firm been sanctioned for failure to achieve DBE/MBE/WBE goals,

workforce goals, or failure to file certified payrolls on any public projects?

12. Other than previously reported in the above paragraphs of this Section I, have any

administrative proceedings or investigations involving your firm or a principal or

officer or anyone with a financial interest in your firm been brought, concluded, or

settled by any local, state or federal agency relating to the procurement or

performance of any construction contract?

13. Are there any other issues that you are aware which may affect your firm’s

responsibility and integrity as a building contractor?

(21)

Division of Capital Asset Management

Prime/General Contractor Update Statement Effective March 30, 2010

Page 10 of 10

PART 5 - SUPERVISORY PERSONNEL

List all supervisory personnel, such as project managers and superintendents, who will be assigned to

the project if your firm is awarded the contract.

Attach the resume of each person listed below

.

NAME

TITLE OR FUNCTION

PART 6 - CHANGES IN BUSINESS ORGANIZATION OR FINANCIAL CONDITION

Have there been any changes in your firm’s business organization, financial condition or bonding

capacity since the date your current Certificate of Eligibility was issued?

Yes

No

If YES, attach a separate page providing complete details.

PART 7 – LIST OF COMPLETED CONSTRUCTION PROJECTS SUBMITTED TO

THE DIVISION OF CAPITAL ASSET MANAGEMENT.

Attach here a copy of the list of completed construction projects which was

submitted with your firm’s DCAM Application for your most recently issued

(not extended or amended) DCAM Certificate of Eligibility. The Attachment

must include a complete copy of the entire Section G – “Completed Projects”

and the final page – “Certification” (Section J) containing the signature and

date that the Completed Projects list (Section G) was submitted to the

Division of Capital Asset Management.

(22)

OWNER-CONTRACTOR AGREEMENT

UNIVERSITY OF MASSACHUSETTS - LOWELL

This agreement made the day of 20 by and between the Univ. of Massachusetts- Lowell hereinafter

called the "Owner", and hereinafter called the "Contractor

CONTR AC TOR’S NAME

Witnesseth, that the Owner and the Contractor, for the consideration hereinunder named, agree as follows

Article 1. Scope of Work: The Contractor shall perform all Work required by the Contract Documents for Master Services Contract – Electrical prepared by University of Massachusetts - Lowell.

Article 2. Time of Completion: The Contractor shall commence work under this Contract on the date specified in the written "Notice to Proceed"

and shall bring the Work to Substantial Completion within per w ork order calendar days of said date. Damages for delays in the performance of the

Work shall be in accordance with Article 9 of the General Conditions of the Contract.

Article 3. Contract Sum: The Owner shall pay the Contractor, in current funds, for the performance of the Work, subject to additions and deductions by Change Order, of the Contract Sum of:

Dollars $

CONTRACT SUM IN WORDS CONTRACT SUM IN NUMBERS

Article 4. The Contract Documents: The following, together with this Agreement, form the Contract and all are as fully a part of the contract as if attached to this Agreement or repeated herein: The Advertisement, Bidding Documents, Contract Forms, Conditions of the Contract, and Specifications as enumerated in the Table of Contents, the drawings as enumerated in the List of Contract Drawings, publication known as the Construction Handbook, and all Modifications issued after execution of the Contract. Terms used in this Agreement which are defined in the Conditions of the Contract shall have the meanings designated in those Conditions.

Article 5. Alternates: The following Alternates have been accepted and their costs are included in the Contract Sum stated in Article 3 of

this Agreement: Alternate No(s): and

Article 6. REAP Certification: Pursuant to M.G.L. c.62(c), sec.49(a), the individual signing this Contract on behalf of the Contractor, hereby certifies, under the penalties of perjury, that to the best of their knowledge and belief the Contractor has complied with all laws of the Commonwealth relating to taxes, reporting of employees and contractors, and withholding and remitting child support.

Article 7. Worker Documentation Certification. In accordance with Executive Order 481 the undersigned further certifies under the penalties of perjury that the Contractor shall not knowingly use undocumented workers in connection with the performance of this contract; that pursuant to federal requirements, the Contractor shall verify the immigration status of all workers assigned to such contract without engaging in unlawful discrimination; and that the it shall not knowingly or recklessly alter, falsify, or accept altered or falsified documents from any such worker(s). The Contractor understands and agrees that breach of any of these terms during the contract period may be regarded as a material breach, subjecting the Contractor to sanctions, including but not limited to mo netary penalties, withholding of payments, contract suspension or termination.

Article 8. Validation: This Contract will not be valid until signed by the Purchasing Department Director.

In Witness Whereof, the Parties Hereto Have Caused This Instrument to be Executed Under Seal. 1

CONTRACTOR

UNIV. OF MASSACHUSETTS - LOWELL

Name of Contractor Printed Name

By:

Address Signature and Seal

Signature and Seal Title

Witness Attest:

1 If a Corporation, attach a notarized copy of the Corporate Vote

authorizing signatory to sign Contract.

(23)

CERTIFICATE OF VOTE OF AUTHORIZATION

200

I hereby certify

that a meeting of the Board of Directors of the:

NAME OF CORPORATION

duly called and held at

on the

day of

200

At which a quorum was present and acting, it was voted that

Name of Corporate Officer

of the

, be and hereby is authorized to execute and deliver for

and on behalf of the Corporation a Contract with

the University of Massachusetts - Lowell for

work to be done at

Project No.

in Lowell, Massachusetts.

And to act as principal to execute bonds in connection therewith, which Contract and Bonds were

presented to and made part of the records of said meeting.

I further certify that

Is duly qualified and acting

Name of Corporate Officer

Title

Repealed, rescinded or amended

A true copy of the record,

of the Corporation and that said vote has not been

ATTEST:

(CORPORATE SEAL)

On this

day of

200

, before me, the undersigned Notary Public, personally

appeared

, duly designated by the board of directors and proved to

me, through satisfactory evidence of identification, which was

, that s/he is

the person whose name is signed on the foregoing documents, and acknowledged to me that s/he

signed it voluntarily for its stated purpose and that it was her/his free act and deed.

Notary Public

My Commission Expires:

UMASS Lowell $25K-$100K CORPORATE VOTE

(24)

FORM OF CONTRACTOR'S EQUAL EMPLOYMENT CERTIFICATION

UNIVERSITY OF MASSACHUSETTS LOW ELL

This form must be completed and submitted by the Contractor prior to the signing of the Owner-Contractor Agreement.

This certifies that:

Contractor

Street Address

City/State/Zip Code

1. Intends to use the following listed construction trades in the work under this contract:

2. Will comply with the minority manpower ratio and specific affirmative action steps contained in

Article 14 of the Conditions of this Contract; and

3. Will obtain similar certifications from each of its subcontractors and submit to the Owner prior

to the award of any subcontract under this contract the subcontractor’s certification.

Signature of Authorized Representative of Contractor

Name and Title

Date

UMASS Lowell $25K-$100K EEO CERTIFICATE

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PERFORMANCE BOND

UNIVERSITY OF MASSACHUSETTS LOWELL

Bond No

KNOW ALL MEN BY THESE PRESENTS:

That we, as Principal,

and as Surety, are held and firmly bound unto

the University of Massachusetts Lowell, as Obligee, in the sum of

dollars $

to be paid to the Obligee, for which payments, well and truly to be made, we bind ourselves, our respective heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents.

WHEREAS, the said Principal has made a contract with the Obligee, bearing the date of 200

for the construction of in Massachusetts

Project Title

NOW

, the condition of this obligation is such that if the Principal and all Subcontractors under said contract shall well and truly

keep and perform all the undertakings, covenants, agreement, terms and conditions of said contract on its part to be kept and performed during the original term of said contract and any extensions thereof that may be granted by the Obligee, with or

without notice to the Surety, and during the life and any guarantee required under the contract, and shall also well and truly

keep and perform all the undertakings, covenants, agreements, terms and conditions of any and all duly authorized

modifications, alterations changes or additions to said contract that may hereafter be made, notice to the Surety of such

modifications, alterations, changes or additions being hereby waived, then this obligation shall become null and void; otherwise, it shall remain in full force and virtue.

IN THE EVENT

, that the contract is abandoned by the Principal, or in the event that the Obligee, under the provisions of

Article 19 of the General Conditions of said contract terminates the employment of the Principal or the authority of the

Principal to continue the work, said Surety hereby further agrees that said Surety shall, if requested in writing by the Obligee, take such action as is necessary to complete said contract.

IN WITNESS WHEREOF, the Principal and Surety have hereunto set their hands and seals this: Day of 200

PRINCIPAL SURETY

BY: BY:

SEAL ATTORNEY-IN FACT

ATTEST: ATTEST

The rate for this bond is % for the first $ and % for the next $

The total premium for this bond is $

UMASS Lowell $25K-$100K PERFORMANCE BOND

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Bond No

PAYMENT BOND

UNIVERSITY OF MASSACHUSETTS - LOWELL

KNOW ALL MEN BY THESE PRESENTS:

That we, as Principal,

and as Surety, are held and firmly bound unto

the University of Massachusetts Lowell, as Obligee, in the sum of

dollars $

to be paid to the Obligee, for which payments, well and truly to be made, we bind ourselves, our respective heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents.

WHEREAS, the said Principal has made a contract with the Obligee, bearing the date of 200

for the construction of in Lowell, Massachusetts

Project Title

NOW the conditions of this obligation are such that if the Principal and all subcontractors under said contract shall pay for all

labor performed or furnished and for all materials used or employed in said contract and in any and all duly authorized modifications, alterations, extensions of time, changes or additions to said contract that may hereafter be made, notice to the

Surety of such modifications, alterations, extensions of time, changes or additions being hereby waived, the foregoing to include any other purposes or items set out in, and to be subject to, provisions of M.G.L. c.30 §39A, and M.G.L. c.149 §29, as amended, then this obligation shall become null and void; otherwise it shall remain in full force and virtue.

IN WITNESS WHEREOF, THE PRINCIPAL AND SURETY HAVE HEREUNTO SET THEIR HANDS AND SEALS THIS:

Day of 200

PRINCIPAL SURETY

BY: BY:

SEAL ATTORNEY-IN FACT

ATTEST: ATTEST

The rate for this bond is % for the first $ and % for the next $

The total premium for this bond is $

UMASS Lowell $25K-$100K PAYMENT BOND

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STATEMENT OF STATE TAX COMPLIANCE

Pursuant to M.G.L. Chapter 62C, §49A as amended by Chapter 233 of the Acts of 1983,

Section 36, I

Name and Title

authorized signatory for

Contracting Party / Company Name

whose principal place of business at

Street Address

City/Town

State

Zip Code

do hereby certify under the pains of penalties of perjury that

Company Name

has complied with all laws of the Commonwealth relating to taxes.

Contracting Party Social Security or Federal I.D. Number

Authorized Signature (must be in ink)

Date

STATEMENT OF STATE TAX COMPLIANCE Page 1 of 1

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CERTIFICATE OF NON COLLUSION

The undersigned certifies under penalties of perjury that this Bid or Proposal has been

made and 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.

Contracting Party / Company Name

Authorized Signature (must be in ink and signed by the person submitting the bid)

Title

Date

UMASS Lowell $25K-$100K CERTIFICATE OF NON COLLUSION 5/2006 Page 1 of 1

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____ ___ ____ ____ ___ ____ ___ ___ P ri nt or t y p e S e e S p ec if ic I n s tru ct io ns o n p ag e 3. Form

UMW-9

University of Massachusetts Substitute W-9 Form (Rev. October 2007)

Request for Taxpayer

Identification Number and Certification

Give form to the requester. Do not

send to the IRS.

Name (as shown on your income tax return):

Business name, if different from above:

Check appropriate box: _ Individual/Sole proprietor _ _ Corporation Partnership Limited liability company. Enter the tax classification:

Other (see instructions)

Exempt Payee

Address (number, street, and apt. or suite no.) Requester’s name and address (optional)

City, state, and ZIP code:

List account number(s) here (optional):

Part I Taxpayer Identification Number (TIN)

Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 4.

Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter.

Vendors:

Dunn and Bradstreet Universal Numbering System (DUNS)

Part II Certification

Under penalties of perjury, I certify that:

Social security number

-or

Employer identification number

-DUNS

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the

Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and

3. I am a U.S. citizen or other U.S. person (defined below).

Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. See the instructions on page 4.

Sign Here

Signature of

U.S. person: Date:

If you have questions on completing this form, please contact Vendor Maintenance at: (978) 934-3461.

Upon completion of this form, please return to: University of Massachusetts Department you are doing business with. (UMLOW)

Part III For University Verification Purposes Only – Do Not Write Below This Line

Business Name Acronym

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University of Massachusetts at Amherst Substitute W-9 Cat. No. 10231X Form UMW-9 (Rev. 10-2007)

General Instructions

Section references are to the Internal Revenue Code unless otherwise noted.

Purpose of Form

A person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W -9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to:

1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued),

2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S.

exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners’ share of effectively connected income.

Note. If a requester gives you a form other than Form W -9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9.

Definition of a U.S. person: For federal tax purposes, you are considered a U.S. person if you are:

• An individual who is a U.S. citizen or U.S. resident alien, • A partnership, corporation, company, or association created or

organized in the United States or under the laws of the United States,

• An estate (other than a foreign estate), or

• A domestic trust (as defined in Regulations section 301.7701-7).

Special rules for partnerships: Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners’ share of income from such business. Further, in certain cases where a Form W-9 has not been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income.

The person who gives Form W -9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its

allocable share of net income from the partnership conducting a trade or business in the United States is in the following cases: • The U.S. owner of a disregarded entity and not the entity, • The U.S. grantor or other owner of a grantor trust and not the

trust, and

• The U.S. trust (other than a grantor trust) and not the beneficiaries of the trust.

Foreign person: If you are a foreign person, do not use Form W-9. Instead, use the appropriate Form W-8 (see Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities).

Nonresident alien who becomes a resident alien: Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a “saving clause.” Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes.

If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items:

1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien.

2. The treaty article addressing the income.

3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions.

4. The type and amount of income that qualifies for the exemption from tax.

5. Sufficient facts to justify the exemption from tax under the terms of the treaty article.

Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States. Under U.S. law, this student will become a resident alien for tax purposes if his or her stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above to support that exemption.

If you are a nonresident alien or a foreign entity not subject to backup withholding, give the requester the appropriate completed Form W-8.

What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS 28% of such payments. This is called “backup withholding.” Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding.

You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return.

Payments you receive will be subject to backup withholding if:

1. You do not furnish your TIN to the requester,

2. You do not certify your TIN when required (see the Part II instructions on page 3 for details),

3. The IRS tells the requester that you furnished an incorrect TIN, 4. The IRS tells you that you are subject to backup withholding

because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or 5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only).

Certain payees and payments are exempt from backup withholding. See the instructions below and the separate Instructions for the Requester of Form W-9.

(31)

Penalties

Failure to furnish TIN: If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect.

Civil penalty for false information with respect to withholding:

If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty.

Criminal penalty for falsifying information: Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment.

Misu

References

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