Subcontractor services letter for DEP, February 2012

NYC 9/11 Public Portal Document

ate; __ k=" - ` ~t -CIT,Y~'0F~NEW-,Y0RKiSUBC0NTRAGT0R~AP.P,R0VAL,&tF0.RMV. ,~ RM. , ~ ~" a'.'. ~ r 2 _:~~~~~,. ev , Agency: DEP Unit/Div: BEDC ,f FMS Contract No.: 82620060020284 PIN.._._._.-.-.--.-.-.- 1 PII.-.-.-.-.-.-.-.-.--~

W ' Contract Value: $7,372,760 Registration Date: 01/10/2006 tZ Contract Number / Description: EE-GEO-02 & EE-GEO-03 Geotechnical Engineering Services for Water Tunnel Construction Contract Subjecttoa Project Labor Agreement (PLA) ❑ s.PRIME`CONTRACTOR:IDENTIFICATION i ~~

ur- Name: Jenny/BAC Killam, A Joint Venture 21 Phone: 973-379-6699 Fax: 913-379-6774 fa• IState/Zip: NY 10016 Address: 475 Park Avenue South, 10th Floor City: New York EIN/SSN: PII - - E-Mail: [email protected] ; ;;Ott - `p':Ottt: SUBCONTRACTOR~INFORMAT1ONi "~ .`1 A*r ± ~$ = Co. Name: Richard W. Kimball Co. Representative (Please Print): Phone: 402-231-4225 Fax: 402-346-8610 Address: 302 South 36`h Street, Suite 400 City: Omaha State/Zip: NE / 68131 EIN/SSN:i:_:_ jj_: - E-Mail: rick.kimball © kiewit.com Subcontract Description: Plumbing ❑ HVAC ❑ Electrical ❑ or Other Z (describe below) Reviewing information, travel to Technical Review Committee (TRC) meeting(s), participation in the TRC, and providing input V. to report prepared by others ' Agreed-Upon Subcontract Value: $7,500 Approx Start Date: 02/01/2012 I Approx End Date: 05/31/2012 Z Subcontractor Signed Letter of Assent ❑ (if Prime Contract is subject to a Project Labor Agreement) UW - Subcontractor is DSBS-certified as: M/WBE ❑ EBE ❑ or LBE ❑ (check all that apply & note status below) Intends to Apply ❑ NO ❑ YES ❑ Application Pending ❑ a# 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).

jj Prime Contractor Certification: I h reby ffirm that the information supplied is true and correct.

Signature of Prime Contractor Title Proiect Manager Print Name Thomas P. Kwiatkowski Date - i Z

, " ~ ' AGENCY~P:RELIMINARY_;REVIEW OL^ ASE SEE PAGE~2?FOR_INSTRUCTIONS v Zq Agency Preliminary Review Completed By: Date ~W 1. VENDEX'❑ 2: Employment ❑ "3. References ❑ 4. PLA"❑ ' ' 5-Apprenticeship ❑ 6. Licenses ❑ R

s a~ ~ ' P..RIMECONTRACTORiRESPON$Eet~ '# '` "~ 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. R, o Initials: Date

_ s + k ` ' `",r 'f ~ AGENCYFINALRESPONSE ~ W ~ ±~

Final Agency Approval: Granted❑ Denied❑

"Z W Signature: Date

`If,Subcontracted Amount Has Changed, Please, ~Z ~Enter.The Reviled:Amount And Resubmit ,

M0CS Subcontractor Approval Form (Sept. 2010)

NYC-WTC 000159322