Subcontractor services letter for DEP, February 2012

NYC 9/11 Public Portal Document

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Agency: DEP Unit/Div: BEDC FMS Contract No.; 82620060020284 PINl p«

III Contract Value: $7,372,760 Registration Date; 01/10/2006 ^<1 Contract Number / Description: EE-GEO-02 & EE-GEO-03 Geotechnical Engineering Services (or Water Tunnel Construction________ Contract Subject to a' Project Labor Agreement (PLA) □

Ii Name: Jenny/BAC Killam, A Joint Venture Phone: 973-379-6699__________________ Address: 475 Park Avenue South, 10'^ Floor EIN/SSN; Pil Fax: 913-379-6774 City: New York E-Mail: [email protected] State/Zip: NY 10016

mWWl»Wi^S^Wfi^«aCHi!^B!S!asSUBCONTRA<n:ORINFORMATIOWWKW^S^g^We«a»B»m<^ Co. Name: Galyn Rippentrop Co. Representative (Please Print): Phone: (812) 431-8364 Fax: (605) 339-0986 Address: P.O. Box 89321 City; Sioux Falls State/Zip: SD/57109 EIN/SSN: PH ■J- 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

I Agreed-Upon Subcontract Value: $15 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) SubcontractoHs DSBS-certIfled as: M/WBE □ EBE □ or LBE □ (check all that apply & note status below) I Application Pending □ I Intends to Apply □ I NO □ '(ESQ Subcontractor Prevailing Wage or Living Wage Statement (if applicable) □ Subcontractor’s Experience Modification Rating (EMR): (Letter from insurance carrier to verify rating 311 must be included). Prime Contractor Certification: I heretw-a^rm that the information supplied is true and correct.

Signature of Prime Contractor Title Project Manager Print Name Thomas P. Kwiatkowski Date 2.1^/f

Iir^4W^:^^;a»^^WAGENCYcPRELIMINARY.;REVlEW7JPLEASE:SEEPAGE2FORINSTRUCTIONS£ Agency Preliminary Review Completed By; Date III i.VENDEX'C "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. Initials: Date

b Final Agency Approval:

Signature; GrantedD DeniedD

Date

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MOCS Subcontractor Approval Form (Sept. 2010)

NYC-WTC_000159324