Subcontractor services letter for DEP, February 2012

NYC 9/11 Public Portal Document

sCITr►YOFNEWYORKfiSUBc.VN;IIiKV;I.VK9At,twKVVN►~r~~r<i~~ .. .. . ~~~~ FRIMEICONTRAC~T INFORMATION " Agency: DEP Unit/Div: BEDC PIN: PII _._ U FMS Contract No.: 82620060020284 Contract Value: $7,372,760 Registration Date: 01/10/2006 w. Services for Water Tunnel Construction Contract Number! Description: EE-GEO-02 & EE-GEO-03 Geotechnical Engineering a Contract Subject to a Project Labor Agreement (PLA) ❑ _ DEN+TIF GATIIDN PRIME CON,TRACT~OR e, ` ' Name: Jenny/BAC Killam, A Joint Venture Phone: 973-379-6699 Fax: 913-379-6774 City: New York State/Zip: NY 10016 Address: 475 Park Avenue South, 10`" Floor EIN/SSN1._._._._._.P!!_._._._._._ E-Mail: [email protected] itp. ~r~ae.r ., `~ l! SUBCONTRAC,T,OR~INF,C/RMAfIQN:i P j "`

Co. Name: Ian Michael Gowring Co. Representative (Please Print): Faxj. PII Phone: _._._._. ._. ._._._ Ci : Auburn State/Zip: CA / 95603 Address: 8921 Memory Lane EIN/SSN:L. --~_-?!~-------------- E-Mail: [email protected] Other ® (describe below) Subcontract Description: Plumbing ❑ HVAC ❑ Electrical ❑ or participation in the TRC, and providing input Reviewing information, travel to Technical Review Committee (TRC) meeting(s), h- .r to report prepared by others Approx Start Date: 02/01/2012 Approx End Date: 05/31/2012 Agreed-Upon Subcontract Value: $12,000 Project Labor Agreement) Subcontractor Signed Letter of Assent ❑ (if Prime Contract is subject to a O all that apply & note status below) =Q Subcontractor is DSBS-certified as: M/WBE ❑ EBE ❑ or LBE ❑ check W Application Pending ❑ Intends to Apply El NO ❑ r'•g YES El Subcontractor Prevailing Wage or Living Wage Statement (if applicable) ❑ Subcontractor's Experience Modification Rating (EMR): (Letter from insurance carrier to verify rating must be included). information supplied is true and correct. Prime Contractor Certification: I herb ff that the Title Project Ma a er Signature g rime'Contractor / Date 'Z (Z Print Name Thomas P. Kwiatkowski I:t r.a Y

t ' A`GENGARREEIMINARY REVIEW P~~EASE SEE PAGEx2"FOR IN8TRUCTIQNS ' V Date Z ` Agency Preliminary Review Completed By:

4. PLA ❑ 5. Apprenticeship ❑ 6. Licenses El fQ '~ 1. VENDEX ❑ 2. Employment ❑ 3. References ❑

above, I have informed the Subcontractor of all w?U For each of the boxes checked in the agency preliminary response documentation. relevant requirements and provided all requested Date Initials: ra

Final Agency Approval: Granted❑ Denied❑

~w Signature: Date

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NYC-WTC 000159318