Fillable DCAMM - Application for DCAMM Sub-Bidder Joint Venture Certificate of Eligibility

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DCAMM - Application for DCAMM Sub-Bidder Joint Venture Certificate of Eligibility

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The DCAMM - Application for DCAMM Sub-Bidder Joint Venture Certificate of Eligibility form is 3 pages long and contains:

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  • 51 other fields

Country of origin: US
File type: PDF

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 Page 1 of 3
Contractor Certification Office 617.727.4050 February 25, 2016
Division of Capital Asset Management and Maintenance
One Ashburton Place - 15th Floor
Boston, MA 02108
Attn: Contractor Certification Office
Re: Application for Joint Venture Certificate of Eligibility (all fields are required)
Joint Venture Name/Contact Information:
Joint Venture Name:
Managing Partner:
Contact Person:
Telephone Number:
J.V. Address:
Project Information:
Project Name:
Project Location:
Public Awarding Authority:
Estimated Contract Amount:
Bid Date:
Category(ies) of Work:
Date
:
Application for DCAMM Sub-Bidder
Joint Venture Certificate of Eligibility
One Ashburton Place, 15
th
Floor, Boston MA 02108 Page 2 of 3
Contractor Certification Office 617.727.4050 February 25, 2016
Contractor #1 Information:
Name:
Address:
Contractor ID Number:
Certificate Expiration Date:
Current Categories of Work:
Percentage Interest in J.V.
Noted in J.V. Agreement at Section/Paragraph:
Contractor #2 Information:
Name:
Address:
Contractor ID Number:
Certificate Expiration Date:
Current Categories of Work:
Percentage Interest in J.V.
Noted in J.V. Agreement at Section/Paragraph:
Joint and Several Liability:
Joint and Several Liability Language Noted in J.V. Agreement at Section/Paragraph:
Required Documentation:
The following documents must be attached in order for the Application to be deemed complete:
1. Current Certificates of Eligibility for each participant
2. Updates Statements for each participant
3. Joint Venture Agreement
One Ashburton Place, 15
th
Floor, Boston MA 02108 Page 3 of 3
Contractor Certification Office 617.727.4050 February 25, 2016
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 its most recent Application for Certification.
Contractor #1 Name:
Contractor #2 Name:
by: by:
Authorized Signatory Signature* Authorized Signatory Signature*
Print Name:
Print Name:
Title: Title:
* An Authorized Signatory is an individual who has the authority to sign documents and bind the company.
Commonwealth/State of
County of
On this
day of
, before me, the undersigned notary public,
personally appeared
(name of document signer),
in behalf of
(company),
proved to me through satisfactory evidence of identification, which was
, to be the
person who signed the preceding document in my presence, and who swore or affirmed to me that the contents
of the documents are truthful and accurate to the best of (his) (her) knowledge and belief.
(seal)
Notary Public Signature
My commission expires:
Commonwealth/State of
County of
On this
day of
, before me, the undersigned notary public,
personally appeared
(name of document signer),
in behalf of
(company),
proved to me through satisfactory evidence of identification, which was
, to be the
person who signed the preceding document in my presence, and who swore or affirmed to me that the contents
of the documents are truthful and accurate to the best of (his) (her) knowledge and belief.
Notary Public Signature
My commission expires:
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DCAMM - Application for DCAMM Sub-Bidder Joint Venture Certificate of Eligibility

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Completed 15 May 2020

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