Subcontractor services letter for DEP, February 2012

NYC 9/11 Public Portal Document

; i CITY40F NEWBYORK SUBCONTRACTOR APP..ROVALEFORWNMAW `MM PRIMECONTRACTINF,ORMATION? '` ' (a. Agency: DEP Unit/Div: BEDC FMS Contract No.: 82620060020284 PIN:,_._._._._._._._. Pi% WF Contract Value: $7,372,760 Registration Date: 01/10/2006 TQ Contract Number / Description: EE-GEO-02 & EE-GEO-03 Geotechnical Engineering Services for Water Tunnel Construction Contract Subject to a Project Labor Agreement (PLA) ❑ " 'k `; FRIMEtCONTRA'CTORIDENTIFICATION' ```. :,. . .. ,E Name: Jenny/BAC Killam, A Joint Venture Fc~ Phone: 973-379-6699 Fax: 913-379-6774 Address: 47.5 Park Avenue South, 10`h Floor City: New York I State/Zip: NY 10016 ,4. EIN/SSN: ' Pll E-Mail: [email protected] .k€ .'• SUBCONTRACTOR,INFORMATION! ~:,' i! aii t~ a ' Co. Name: Ronald E. Heuer Co. Representative (Please Print): Phone: (815) 675-2003 Fax: (815) 675-9005 Address: 3317 West Ringwood Road City: McHenry State/Zip: IL / 60051 ys EIN/SSN: ._._._._._.P!!._._._._._. E Mail: ronheuer®mc.net Subcontract Description: Plumbing ❑ HVAC ❑ Electrical ❑ or Other ® (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 I Approx End Date: 05/31/2012 j Z Subcontractor Signed Letter of Assent ❑ (if Prime Contract is subject to a Project Labor Agreement) U Subcontractor Is DSBS-certified as: M/WBE ❑ EBE ❑ or LBE ❑ (check all that apply & note status below) YES ❑ Application Pending ❑ Intends to Apply ❑ NO ❑ az 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 her of 'rm that the information supplied is true and correct.

Signature of Prime Contractor Title Project Manager Print Name Thomas P. Kwiatkowski Date Z 2/I z

' ~ - 41 'AGENCY~PREL•'IMINARY,~REVIEW PLEASE?SEE,PAGE`,2',FOR`s!NSTRUCTIONS'

yZ! " Agency Preliminary Review Completed By: Date

F-_ 1.. VENDEX ❑r 2. Employment ❑ 3. References ❑ 4. PLA ❑ 5. Apprenticeship ❑ 6. Licenses ❑

`?RRIME=NTRACTOR!RESRQNSE !' 'oc s 0 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 {

a= , `'r crAGENCYx`FINAL'RESPgONSE'~ ,':~s. '" ,~.H< Final Agency Approval: Granted❑ Denied❑

"rW Signature: Date 1 -Q ."J' z7'Y •. +t..,,Ey, i - .7- .&. ~ ,s. :.i { ." j .3• fii '~F'i ~,„'~V

rlf Subcontracted Amount Has Changed, P~leasew 1;6EiiiirThe.4i~fi~dAmo'6nt,-A6d; Resubmit:.,r; 4; MOCS Subcontractor Approval Form (Sept. 2010)

NYC-WTC 000159320