Subcontractor services letter for DEP, February 2012

NYC 9/11 Public Portal Document

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Agency: DEP UniVDiv: BEDC FMS Contract No.: 82620060020284 .PIN:L PH

Contract Value: $7,372,760 Reqistration Date: 01/10/2006 Contract Number / Description: EE-GEO-02 & EE-GEO-03 Geotechnical Engineering Services tor Water Tunnel Construction_______ Contract Subject to a Project Labor Agreement (PLA) □ J 1 Name: Jenny/BAC Killam, A Joint Venture Phone: 973-379-6699 Fax: 913-379-6774

s Address: 475 Park Avenue South, 10'” Floor EIN/SSN: ? PH I City: New York E-Mail: tkwiatkowskiOjennyeng.com I State/Zip: NY 10016

Co. Name: Ronald E. Heuer Co. Representative (Please Print): Phone: (815) 675-2003 Fax: (815) 675-9005________ __________________ City: McHenry | State/Zip: IL / 60051 Address: 3317 West Ringwood Road EIN/SSN: LZZ plZZj E-Mail: [email protected] Subcontract Description: Plumbing □ HVAC □ Electrical □ or Other 13 (describe below) Reviewing information, travel to Technical Review Committee (TRC) meeting(s), participation in the TRC, and providing input to report prepared by others Agreed-Upon Subcontract Value: $10,800 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-certIfled as: M/WBE □ EBE □ or LBE O (check all that apply & note status below) YESQ Application Pending □ Intends to Apply □ 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 Contractor Certification: I hen ifiirm that the information supplied is true and correct.

w Signature of Prime Contractor Print Name Thomas P. Kwiatkowski Title Project Manager Date UZiZ/IZ I^W^^iB^WJ^’AGENCYjRRELlMlNARYyREVIEW^PLEASElSEEiPAGEZ'FbRyNSTRUCTIONS^

si lUK Agency Preliminary Review Completed By: Date

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

^^a^jjS^^WB^^WRRIIVIElCONTRACTORjRESRQNSEjm^»afeW^^r^^ 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

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Final Agency Approval: GrantedC DeniedQ

Signature: Date

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MOCS Subcontractor Approval Form (Sept. 2010)

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