Subcontractor services letter for DEP, February 2012

NYC 9/11 Public Portal Document

W^IW*BB^^^^.RRJWE(contragt^nformaw S3 Agency: DEP UniVDiv: BEDC FMS Contract No.: 82620060020284 PIN: t Pll Contract Value: $7,372,760 Registration Date: 01/10/2006 Contract Number / Description: EE-GEO-02 & EE-GEO-03 Geotechnical Engineering Services for Water Tunnel Construction

H gmSgMM^WggjMEtgdMgS^gBSPEW Contract Subject to a Project Labor Agreement (PLA) □

I Name: Jenny/BAC Killam, A Joint Venture Phone: 973-379-6699__________________ Address: 475 Park Avenue South, IO'” Floor EIN/SSNL PH Fax: 913-379-6774 City: New York E-Mail: tkwia([email protected] State/Zip: NY 10016

Co. Name: Ian Michael Gowring Co. Representative (Please Print): Phone: (530) 885-9055____________ Fax: (530) 885-3880________ Address: 8921 Memory Lane City: Auburn IState/Zip: CA / 95603 EIN/SSN:C Pll E-Mail: [email protected] Subcontract Description. Plumbing □ HVAC □ Electrical □ or Other (describe below)

I Reviewing information, travel to Technical Review Committee (TRC) meeting(s), participation in the TRC, and providing input to report prepared by others

IH Agreed-Upon Subcontract Value: $12,000 Approx Start Date: 02/01/2012 Approx End Date: 05/31/2012 Subcontractor Signed Letter of Assent □ (if Prime Contract is subject to a Project Labor Agreement) Subcontractor is DSBS-certified as: M/WBE □ EBE □ or LBE El (check all that apply & note status below) YES □ I Application Pending □ I Intends to Apply □ I NO □ 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). Prime Contjactor Certification: I hei^by-af^m that the information supplied is true and correct.

Signature q^rime'Contractor '*^4 J Title Project Manager Print Name Thomas P. Kwiatkowski Date

I ^^;WM^:^J^5^^St^^ENC^^4RREOMINAR^^REyiEWfPLEASEiSE&pAGEf2XORW Agency Preliminary Review Completed By: Date

1.VENDEX □ 2. Employment □ 3. References □ 4. PLA '5. Apprenticeship □ 6. Licenses □

33^^ I^^:s:^rriivie2Contra^xqr]resrqi^ For each of the boxes checked in the agency preliminary response above, I have informed the Subcontractor of all relevant requirements and provided all requested documentation. Initials: Date

'iSKaas»j^^amii^*A'GENeai5iN»ia.BESROi!isEjsa^j«few«m8am Final Agency Approval: GrantedD DeniedD

II Signature: Date

MOCS Subcontractor Approval Form (Sept. 2010)

I NYC-WTC_000159318