Agenda

CONSTRUCTION CONTRACTOR’S
QUALIFICATION STATEMENT

On Schedule A, attached, list major engineered construction projects completed by this
organization in the past five (5) years. (If joint venture, list each participant’s projects separately).

On Schedule B, attached, list current projects under construction by this organization, (If joint
venture, list each participant’s projects separately).

Name of Surety Company and name, address, and phone number of agent.

LIST OF SUBCONTRACTORS
(to be submitted after bid opening)

LIST OF SUBCONTRACTORS
(to be submitted with bid)

The name and address of each subcontractor who will be paid at least five percent (5%) of the prime
contractor's total bid shall be listed below. To be deemed a responsive bid, this form must be submitted
even if no subcontractors are required to be listed. In that case, the bidder should state “None” (or similar

language stating that no subcontractors need to be listed) in the space below. (Refer to General Condition
6.09.H)

By:

(Signature of joint ventured partner -- attach evidence of authority to sign)

Name (typed or printed):

Title:

Business Address:

Phone No.: Fax No.:

Address for receipt of official communications:

(Each joint ventured must sign. The manner of signing for each individual, partnership and
corporation that is a party to the joint venture should be in the manner indicated above).

BF 6 of 8
Bid Form

A Corporation

Corporation Name: _ Not Applicable (SEAL)

Date and State of Incorporation:

List of Executive Officers
Name Title

Type (General Business, Professional, Service, Limited Liability):
By:

(Signature -- attach evidence of authority to sign)

Name (typed or printed):
Title: (Corporate Seal)
Attest:

(Signature of Corporate Secretary)

Business Address:

Phone No.: Fax No.:

Date of Qualification to do business is

A Joint Venture

Bid Form

MA SOC Filing Number: 201400734740 Date: 10/29/2014 12:37:00 PM

THE COMMONWEALTH OF MASSACHUSETTS

I hereby certify that, upon examination of this document, duly submitted to me, it appears
that the provisions of the General Laws relative to corporations have been complied with,
and I hereby approve said articles; and the filing fee having been paid, said articles are

deemed to have been filed with me on:

October 29, 2014 12:37 PM

WILLIAM FRANCIS GALVIN

Secretary of the Commonwealth

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(7) The name and business address, if different from office location, of each person in addition to manager(s) auchorized to
exeeure documents filed with the Corporations Division, and at least onc person shall be named if there are no managers:

NAME ADDRESS
Robert L. Delhome

Luigi M. Schena, Jr.

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D The Commonwealth of Massachusetts
William Francis Galvin
Secretary of the Commonwealth
One Ashburton Place, Room 1717, Boston, Massachusetts 02108-1512

Limited Liability Company
Certificate of Organization
(General Laws Chapter 156C, Section 12)

Federal Identification No.; Applied for.

(1) The exact name of the limited liabilicy company:

Charter Contracting Company, LLC

(2) The streer address of the office in the commonwealth ac which its records will be maintained:

SUBMITTED on January 20th 20.19
If BIDDER is:

An Individual

Name (typed or printed): Not Applicable

By: (SEAL)
(Individual's Signature)
Doing business as:

Business address:

Phone No.: Fax No.:
A Partnership
Partnership Name: _Charter Contracting Company, LLC (SEAL)

Bid Form

Date and State of Organization
October 29, 2014 - Commonwealth of Massachusetts

Names of Current General Partners

7,02 BIDDER accepts the provisions of the Agreement as to liquidated damages in the event of failure
to complete the Work within the times specified in the Agreement.

8.01 The following documents are attached to and made a condition of this Bid:

A.

B.

D.

Bid Form; Attached

Bid Bond; Attached

A tabulation of Subcontractors, Suppliers and other individuals and entities required to be
identified in this Bid; and = attached

Construction Contractor's Qualification Statement. Attached