Subcontractor services letter for DEP, February 2012

NYC 9/11 Public Portal Document

OF^EW^ORK^SUBCONTRACTOR^ARRROVAEiEQRMimO^^W^^W

i- Agency: DEP FMS Contract No.; 82620060020284 UniVDiv: BEDC PINi. pii

Contract Value: $7,372,760 Registration Date: 01/10/2006

is Contract Number / Description: EE-GEO-02 & EE-GEO-03 Geotechnical Engineering Services tor Water Tunnel Construction_______ Contract Subject to a Project Labor Agreement (PLA) □

Name; Jenny/BAC Killam, A Joint Venture Phone: 973-379-6699__________________ Fax: 913-379-6774 Address: 475 Park Avenue South, 10'*' Floor City: New York I State/Zip: NY 10016 EIN/SSN PII E-Mail; tkwiatkowski Ojennyeng.com SUBCONTRACTOR INFORMATION Co. Name: Richard W. Kimball Co. Representative (Please Print): '■-i Phone: 402-231-4225 Fax: 402-346-8610 Address: 302 South 36'*’ Street, Suite 400 City; Omaha State/Zip: NE/68131 EIN/SSN:! PII E-Mail: [email protected] 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

pl ! Agreed-Upon Subcontract Value: $7,500 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 □ (check all that apply & note status below) YES □ I Application Pending □ I Intends to Apply □ NO □ Subcontractor Prevailing Wage or Living Wage Statement (If applicable) □

fi Subcontractor's Experience Modification Rating (EMR): must be included). (Letter from insurance carrier to verify rating

Prime Contractor Certification: I herebyraffirm that the information supplied is true and correct.

Signature of Prime Contractor Title Project Manager

S Print Name Thomas P. Kwiatkowski

^»O^^^iai^S^GENCY^RRELlMINARY^REVIEWMPtEASgSEE PAiGE>2jF0R INSTRUCTIONS^ Date

IS Agency Preliminary Review Completed By: Date

II tY. vendex'D 2. Employment □ ' '3. References'□ 4. PLA“Q 5; Apprenticeship' □ 6. Licenses □

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.

fe Initials; Date

Final Agency Approval; GrantedD DeniedO

Signature: Date

'IfjSubcohtractedI Amount Has Changedr PJease-^ ' Eritet^Tlie Revised Amount Arid Resubmit:-^^

MOCS Subcontractor Approval Form (Sept. 2010)

NYC-WTC_000159322