Fillable Amendment Request Form 0 (Commonwealth of Massachusetts)

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Amendment Request Form 0 (Commonwealth of Massachusetts)

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U.S.A. forms for Commonwealth of Massachusetts

BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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One Ashburton Place, 15
th
Floor, Boston MA 02108 617.727.4050 Page | 1
REQUEST TO AMEND DCAMM CONTRACTOR’S CERTIFICATE OF
ELIGIBILITY
Date:
Division of Capital Asset Management and Maintenance
One Ashburton Place - 15th Floor
Boston, MA 02108
Attn: Contractor Certification Office
Contractor Name:
Contractor ID Number:
Contractor’s Address:
TYPE OF AMENDMENT:
☐
Add the Following Category(s) of Work:
[Please attach ALL of the Evaluations in support of each Category to be added
☐
Increase Single Project Limit:
[Please attach ALL of the Evaluations in support of an Increase in the Single Project Limit; if
applicable, also attach revised, current Bonding Letter]
☐
Increase Aggregate Work Limit:
[Please attach revised, current Bonding Letter or CPA Letter in support of an Increase in Aggregate
Work Limit]
☐
Supplier Diversity Office Status:
[Please attach current Supplier Diversity Office Certification]
☐
Change Contractor’s Legal Name to:
[Please attach Secretary of State Corporations Division Legal Name Change Amendment plus a current
DUA Certificate of Good Standing indicating new name]
☐
Change Mailing Address to:
The undersigned certifies, under pains and penalties of perjury, that there have been no (i) adverse changes in
bonding limits and/or financial condition or (ii) legal or administrative penalties, violations or judgments against
the Contractor since the date of the most recent Application for Certification.
Granting Amendments is discretionary. Contractor must satisfy all requirements in order for an Amendment to
be approved and granted.
*An authorized signatory is an individual who is authorized to sign and bind the company.
*Authorized signatory
Print Name:
Title:
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Amendment Request Form 0 (Commonwealth of Massachusetts)

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Completed 26 July 2020

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