PHILIPPINE CONTRACTORS ACCREDITATION BOARDNEW CONTRACTOR’S LICENSE APPLICATION F O R M PCAB PCAB-PAD-NEW-F01 Revision 03 Eff. Date 6/22/2011 1 of 24 Page REQUIRED ITEMS The following pertinent documents and information shall be submitted in support to PCAB license application.(Applicant may Initially fill out the check boxes subject for final validation by PCAB/DTI-ROG pre-screener) Complied A. LEGAL Yes No NA 1. Affidavit of Attestation and General Information (Page 3 of 24 and Page 4 of 24) 1.1 For Sole Proprietorship: Certified true copy of Business Name Registration Certificate [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] 1.2 For Partnership or Corporation: Certified true copy of SEC Certificate of Registration and Articles of Partnership/Incorporation and By-Laws with construction contracting as one of the purposes and subsequent amendments thereto, if any; 1.3 For Cooperative: Certified copy of CDA Certificate of Registration from Cooperative Development Authority , Articles of Cooperation and By-Laws with construction contracting as one of the purposes and subsequent amendments thereto, if any; 2. Authorized Managing Officer (AMO) Nomination: 2.1 AMO Affidavit ( Page 5 of 24 ) with a passport size picture of AMO; • For Corporations only: Original Corp. Secretary's certificate as to the nomination of the AMO ( Page 6 of 24 ); 2.2 Original NBI clearance of Filipino AMO; (valid as of the date of filing) 2.3 If AMO is Non-Filipino (in addition to 2.1): 2.3.1 Working Visa 2.3.2 Alien Certificate of Registration; 2.3.3 NBI clearance if AMO has resided in the Philippines for six (6) months or longer if not, equivalent clearance from AMO's home country duly authenticated by the Philippine Embassy. For Corporations or Associations with foreign shareholders, the following documents shall be submitted: 1. Corporate Secretary’s Certification as follows: a. List of stockholders showing their nationalities and shareholdings; and b. List of Board of Directors showing their names and nationality. 2. Copy of latest General Information Sheet duly filed with SEC showing the names of stockholders and directors, nationality and shareholdings. • The percentage control of the number of seats occupied by foreigners in the Board of Directors shall not exceed 40%. B. FINANCIAL 3. Complete Financial Statements with accompanying Auditor’s notes dated within the last six (6) months immediately preceding the filing of application (duly audited and signed on every page by an Independent CPA with valid PRC-BOA accreditation) and a CD-R (compact disc recordable) containing the firm’s Audited Balance Sheet & Income Statement in the prescribed template to be uploaded by the CIAP-RID in CIAP database. The PCAB Financial Statement Forms A & B can be downloaded from the DTI website www.dti.gov.ph. 3.1 For old companies, audited financial statements for the immediately preceding taxable year and copy of the Quarterly or Annual Income Tax Return certified by the BIR 3.2 Cash: Original copy of Bank Certification/Bank statement of account certified by Bank Manager of cash deposits as of the Balance Sheet date;Note: (Amount in excess of ½ of 1% of the minimum networth required for category applied for or P 50,000.00 whichever is higher, reflected as “Cash” or “Cash on Hand” shall be deducted from the networth, If unsupported.) 3.2.1. Authorization to Depository Bank (Page 7 of 24 ); 3.3 List of Land and Building/Industrial Plants owned by the applicant and registered in its name (Page 10 of 24) 3.3.1. Certified Copy of Transfer of Certificate of Title (TCT) including back page 3.3.2. Deed of Sale or Certified Copy of Tax Declaration of Land / Bldg., owned by the applicant. 3.4 List of Construction and/or Transportation/Delivery Vehicles/Equipment/Machineries/Plants owned by the applicant and registered in its name (Page 11 of 24 ) 3.4.1 Certified Copy by Land Transportation Office (LTO) of Certificate of Registration and Current Official Receipt of Registration of Construction and/or Transportation/Delivery Vehicles/Equipment reported; 3.4.2. Certified Copy of Deed of Sale or sales invoices/official receipts of other construction equipment/machineries; 3.5 Documents to be submitted if the values of the applicant's Receivables and Inventories Accounts exceed more than 50% & 20%,respectively, of the contractor’s networth, otherwise, the amount in excess of said account shall be deducted for categorization purposes. 3.5.1 Schedule of Receivables duly signed by AMO and Certified by the firm’s PRC BOA accredited CPA (Page 13 of 24 ) 3.5.2 Schedule of Inventories duly signed by AMO and Certified by the firm’s PRC BOA accredited CPA (Page 13 of 24 ) [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] F O R M PCAB PCAB-PAD-NEW-F01 Revision 03 Eff. Date 6/22/2011 2 of 24 Page 4. Authorization to verify documents from BIR & other agencies and/or quarterly income tax return to cover income reported on interim financial statements.(Page 8 of 24 and Page 9 of 24) C. TECHNICAL 5. List of Sustaining Technical Employee/s - STE (Page 12 of 24) supported by the following documents for each STE: 5.1. STE Affidavit/s ( Page 14 of 24) with recent passport size picture/s. 5.2 Certified Copy by the Professional Regulation Commission of its valid PRC ID or Certification of Good Standing from PRC in the absence valid PRC ID; 5.3 Original NBI Clearance/s of nominated STE/s; 5.4. STE Affidavit/s of Construction Experience (Page 16 of 24) 5.5. Personal Appearance Form duly accomplished and signed by the STE/s appearing before the designated officer of the PCAB or the nearest DTI regional/provincial office (Page 17 of 24) 5.6. Affidavit of No Construction Activity (Page 18 of 24) D. OTHERS D.1. Original Signature of AMO on each and every page of the application forms including supporting documents. D.2 The Board may require the AMO interview and submission of pertinent documents/information other than the above in order to fully determine the qualifications of the applicants; D.3. AMO/Applicants for TRADE category may no longer be required to take the AMO examinations. Photocopies of documents, in lieu, of certified copies are accepted provided original copies are presented for authentication. D.4 Self-stamped envelopes (One self stamped mailing envelope is required for each supporting document submitted), or a prepaid courier pouch. D.5. Applicants interested to participate in government projects should accomplish PCAB-PADARC-F01 (Application for Registration and Classification of Contractor for Government Infrastructure Projects) and file the same together with the PCAB Application Form. D.6. Accomplished Affidavit for Firm’s Authorized Representatives [ ] [ ] [ ] [ ] [ ] [ ] [ [ [ [ [ [ [ [ [ [ [ [ ] ] ] ] ] ] ] ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] FOR PCAB/ DTI-ROG USE ONLY No. of Prescreening Prescreening Results Filed 1st [ ] Comply lacking items as listed in the Remarks [ ] Accepted [ ] PCAB Makati [ ] DTI-ROG 2nd [ ] Comply lacking items as listed in the Remarks [ ] Accepted [ ] PCAB Makati [ ] DTI-ROG 3rd [ ] Comply lacking items as listed in the Remarks [ ] Accepted [ ] PCAB Makati [ ] DTI-ROG REMARKS: LETTER / ITEM NO. COMMENTS: ] ] ] ] Pre-screener / Date [ ] [ ] affiant exhibited to me his Community Tax Certificate No. Book No. The evaluation of my qualification shall be solely based on the documents submitted at the time the application was filed/accepted by PCAB. No. and 3. Page No. Doc. Any discovered misrepresentation of information and/or manifestations of fraud on the application documents submitted by my firm applicant or its Authorized Representative/Agent/Liaison Officer shall be subjected to investigation which may result to the disapproval of my application. Series of 20 __. _______________ issued at __________________ on _________________ 20 ___. denial/suspension/revocation of license and blacklisting of my firm and myself as its Authorized Managing Officer. I certify furthermore that the SSS. 2. _______________________________ Authorized Managing Officer (Signature over Printed Name) Republic of the Philippines ) Province of ______________) City/Municipality of ___________) S. Unconfirmed information/documents submitted to support my firm's qualifications shall be excluded for categorization/classification purposes. I am fully aware that: 1. NOTARY PUBLIC Until December 20 ____ . (Name of Firm) I hereby request that its application for Contractor's License be approved. Date 6/22/2011 3 of 24 Page In behalf of _________________________________________________________________. I further certify that the business name and/or SEC registration of this firm is valid and existing. 4. Pag-IBIG. I certify to the completeness of the information/documents contained in this application appertaining to the category/classification the company is applying for and that the information/documents are true and correct. All documents submitted in support to this application are subject to verification before PCAB action. and PhilHealth contributions in favor of the employees of this firm were remitted to concerned agencies.F O R M AFFIDAVIT OF ATTESTATION PCAB PCAB-PAD-NEW-F01 Revision 03 Eff.S SUBSCRIBED AND SWORN TO before me this ________ day of ___________________ 20____ at ______________________. /Fax No. Date 6/22/2011 4 of 24 Page CONTRACTOR’S GENERAL INFORMATION Name of Firm: (as per SEC or DTI or CDA Registration) Main Office Address: Tel. Firm’s SSS No [ ] Corporation [ ] Cooperative Registration Date Tax Identification No.: If Provincial based. if any) AAA B C AA D A Trade General Building / General Engineering / General Building / General Engineering / Trade / Specialty(please specify below): Specialty(please specify): __________________________________ Owners / Stockholders / Officers (for corporation / partnership) NAME POSITION NATIONALITY CAPITAL SUBSCRIPTION PAID-UP CAPITAL PERCENTAGE Peso value Shares Directors / Officers (for corporation only) NAME POSITION NATIONALITY ADDRESS Certified Correct by: _______________________________ Authorized Managing Officer (Signature over printed name) .F O R M PCAB PCAB-PAD-NEW-F01 Revision 03 Eff.: Website: E-mail Address: Type of Firm (please check) [ ] Sole Proprietorship [ ] Partnership SEC / Business Name Registration No. PhilHealth No. Expiry Date PAG-IBIG No. Category Applied for Principal Classification Applied for Other Classification/s Applied for (encircle only one below) (encircle only one below) (please encircle. if any: Tel./Fax No. contact address in Manila. 2 of IRR of R. 8. Page No. That I am fully aware that my failure to notify PCAB of my disassociation with my present employer shall cause my disqualification to be an Authorized Managing Officer. safety. 20 of IRR of R. That I authorize the PCAB to verify and investigate any or all information in this instrument from whatever sources PCAB may consider appropriate That I certify under pain of perjury that all information on this affidavit are true and correct.A. FURTHER AFFIANT SAYETH NAUGHT. incompetence or malpractice or any act of omission liable for disciplinary action by myself or in collaboration with any other person (Section 4.A. __________ issued at _____________________ on ________________. That I possess at least two (2) years experience in the construction industry as follows (Ref. 20___ affiant exhibited his/her Community Tax Certificate No. 4566) 7. That I possess the following educational attainments (attach additional sheet if necessary) NAME OF SCHOOL ADDRESS COURSE INCLUSIVE DATES 3.F O R M AMO AFFIDAVIT Recent Photo Republic of the Philippines ) Province of ______________ ) City/Municipality of ___________ SURNAME I. _________________________________ Affiant SUBSCRIBED and sworn to before me this _____ day of _________________. FIRSTNAME MM YYYY ST. Date 6/22/2011 5 of 24 Page MIDDLE NAME Single / Married to BARANGAY SURNAME DISTRICT FIRSTNAME CITY/MUNICIPAL MIDDLE NAME PROVINCE ZIPCODE Having duly sworn in accordance with law depose and say: 1. 4566) (attach additional sheet if necessary) DESIGNATION / POSITION COMPANY / NATURE OF BUSINESS ADDRESS JOB DESCRIPTION DATES OF EMPLOYMENT 4.2 of IRR of R. # & NAME PCAB PCAB-PAD-NEW-F01 Revision 03 Eff.A.S. No.A. Doc. That I am the Authorized Managing Officer of : ________________________________________________________________________________ (Name of firm) 2. Series of 20__ NOTARY PUBLIC Until December 20__ . Sec. 4566) 6. 4566): 5. That I have not been convicted by a court of competent jurisdiction of any offense involving moral turpitude (Rule (Section 4. Born on DD and residing at: Passport Size ) S. a Sustaining Technical Employee or a license applicant with PCAB . That I am not involved in any construction malperformance suggestive of negligence. Book No. 20 of IRR of R. That I possess knowledge of the building. Sec. health . & lien laws of the Republic of the Philippines & the rudimentary administrative principles of construction contracting from my work experiences in item 3 above and from the following training/seminars (Ref. be appointed as the firm's Authorized Managing Officer to act on all matters concerning the requirements of the PCAB and implementation of R. in ______________________________. Date 6/22/2011 6 of 24 Page Republic of the Philippines ) Province of _____________ ) City/Municipality of ________) S. I have hereunto affixed my hand this ___________ day of ______ 200___. Series of 20 __. the following resolution was unanimously approved. (FIRSTNAME MIDDLENAME SURNAME) a senior executive who has been granted the power to render general management and administrative decision." In WITNESS WHEREOF. NOTARY PUBLIC Until December 20 ____ . to wit: AMO NOMINATION "R E S O L V E as it is hereby resolved that _______________________________________________________________________. Philippines. No. 4566 as amended by P.S I. Doc. # & NAME FIRSTNAME BARANGAY MIDDLE NAME DISTRICT CITY/MUNICIPAL PROVINCE ZIPCODE do hereby certify. No.SECRETARY’S CERTIFICATION F O R M (for corporation/cooperatives only) PCAB PCAB-PAD-NEW-F01 Revision 03 Eff.D. Book No. SURNAME and residing at: ST.A. _________________________________ Corporate Secretary (Signature Over Printed Name) SUBSCRIBED and sworn to before me this ________ day of _______ 20___ affiant exhibited to me his/her Community Tax Certificate. in my capacity as the duly elected and incumbent Corporate Secretary of ______________________________________________________________________________ (Name of firm) DD MM YYYY Held CITY / MUNICIPALITY OF MEETING That during its regular meeting held on at Wherein a quorum was present . ____________ issued on _____________ at ________________________. 1746. Page No. specify _______________________ Signature over Printed Name of Authorized Managing Officer or Authorized Signatory with the Bank Date:_______________________ . check) New Upgrading Renewal Others. Very truly yours. pls. Thank you. I am applying for a contractor's license from PCAB and part of their evaluation process is the verification of bank deposits and other assets of an applicant. Name of Firm: ____________________________ ____________________________ By:_________________________ Type of Application: (Pls. Date 6/22/2011 7 of 24 Page AUTHORITY TO VERIFY BANK ACCOUNT THE MANAGER _________________________________ _________________________________ _________________________________ Subject: Bank Account # _______________________ Sir: Please provide the Philippine Contractors Accreditation Board (PCAB). This will serve as your authorization to release any information that may be requested by PCAB regarding the above subject account.F O R M PCAB PCAB-PAD-NEW-F01 Revision 03 Eff. a government agency under the Department of Trade and Industry. any information they need regarding the subject account with your bank. 28. ___________________________ Signature over Printed Name of Authorized Managing Officer Date:_______________________ Type of Application: (Pls. of an applicant. specify _______________________ .R. pls. Thank you. Very truly yours. I am applying for a contractor's license from PCAB and part of their evaluation process is the verification of ITR and AFS. Date 6/22/2011 8 of 24 Page THE REVENUE DISTRICT OFFICER _________________________________ _________________________________ _________________________________ Subject: Income Tax Return and Audited Financial Statement as of ______ Sir: Please provide the Philippine Contractors Accreditation Board (PCAB).I. 2006 dated May 08. a government agency under the Department of Trade and Industry. 2006) and your authorization to release any information that may be requested by PCAB regarding the above subject document/s. This will serve as a waiver on the confidentiality provision of Section 270 of the National Internal Revenue Code of 1997 (memorandum circular No. check) New Upgrading Renewal Others.AUTHORITY TO VERIFY ITR / AFS FROM B. any information they need regarding the subject ITR and AFS filed with your office. F O R M PCAB PCAB-PAD-NEW-F01 Revision 03 Eff. F O R M PCAB PCAB-PAD-NEW-F01 Revision 03 Eff. pls. Professional Regulation Commission __________________________ Signature over Printed Name of Authorized Managing Officer Date:______________________ Type of Application: (Pls. specify _______________________ . Land Transportation Office 4. check) New Upgrading Renewal Others. Social Security System 5. Securities and Exchange Commission 2. Land Registration Authority 3. Date 6/22/2011 9 of 24 Page AUTHORITY TO VERIFY FROM GOVERNMENT AGENCY/IES AUTHORIZATION The Philippine Contractors Accreditation Board (PCAB) is hereby authorized to verify and secure information and/or copies of documents submitted by or in the name of the firm to any or all of the following agencies relative to its application filed with the PCAB: 1. pls. check) New Upgrading Renewal Others. Barangay. Municipality/ City. Date 6/22/2011 10 of 24 Page REAL PROPERTIES OF THE FIRM AS OF THE BALANCE SHEET DATE COMPLETE DESCRIPTION (Type of land/building) *TCTCLT/CCT/TD NUMBER LOCATION (St.F O R M LIST OF CONSTRUCTOR’S REAL PROPERTIES PCAB PCAB-PAD-NEW-F01 Revision 03 Eff. * TCT – Transfer Certificate of Title CCT – Condominium Certificate of Title TD – Tax Declaration CLT – Certificate of Land Title ___________________________ Type of Application: (Pls. #. Province) ACQUISITION COST ACQUISITION DATE Please reproduce if additional sheets are needed. specify _______________________ Signature over Printed Name of Authorized Managing Officer Date:_______________________ . Model OR No. specify _______________________ BOOK VALUE (in Php) Cost (in Php) Php Php By:_________________________ Signature over Printed Name of Authorized Managing Officer Date:________________ . / Date Date OVER ALL TOTAL VALUE Cost (in Php) Php BOOK VALUE (in Php) Php Please reproduce if additional sheets are needed. check) New Upgrading Renewal Others. Date 6/22/2011 11 of 24 Page A.F O R M LIST OF CONSTRUCTOR’S PLANTS. MACHINERIES/PLANTS AND OTHER CONSTRUCTION EQUIPMENT OF THE FIRM AS OF BALANCE SHEET DATE COMPLETE DESCRIPTION ACQUISITION SERIAL NO. DELIVERY AND TRANSPORTATION EQUIPMENT OF THE FIRM AS OF BALANCE SHEET DATE ACQUISITION COMPLETE DESCRIPTION Vehicle Brand / Type Year Plate No. B. Date OVER ALL TOTAL VALUE Type of Application: (Pls. pls. VEHICLES AND EQUIPMENT PCAB PCAB-PAD-NEW-F01 Revision 03 Eff. 8 9. 5. 10. 10. 4. 6. Newly Nominated 1. Date 6/22/2011 12 of 24 Page Date:_______________________ . 7. 11. 2 3 4. 13. check) New Upgrading Renewal Others. 7. specify _______________________ PCAB PCAB-PAD-NEW-F01 Revision 03 Eff. 5. Date of License Number Registration Validity F O R M Date Position Employed in the Firm Previously Nominated 1. 12. By:_________________________ Signature over Printed Name of Authorized Managing Officer Type of Application: (Pls. 8 9. 6. 3.LIST OF NOMINATED SUSTAINING TECHNICAL EMPLOYEES PRC REGISTRATION NAME OF STE Prof. pls. 2. F O R M SCHEDULES PCAB PCAB-PAD-NEW-F01 Revision 03 Eff. Date 6/22/2011 13 of 24 Page RECEIVABLES To be accomplished if the applicant's receivable accounts (accounts/contracts & other receivable) exceed 50% of the total networth/equity as of the latest audited balance sheet submitted in support of its application. Intended Use or Age/Date Physical Types Amount Place of Storage Purpose for Acquired Condition Storing Certified Correct by: ______________________________________ Printed Name and Signature of External Auditor _____________________________ Printed Name and Signature of AMO . NAME OF PROJECTS AMOUNT DUE FOR COLLECTION AGE CLIENT NAME COMPLETE ADDRESS Please use additional sheets if necessary Certified Correct by: ______________________________________ Printed Name and Signature of External Auditor _____________________________ Printed Name and Signature of AMO INVENTORIES To be accomplished if the applicant's inventory accounts exceed 20% of the total networth/equity as of the latest audited balance sheet submitted in support of its application. That I authorize the PCAB to verify and investigate any or all information in this affidavit from whatever sources PCAB may consider appropriate. Series of 20 ___ Notary Public Until December 20 ___ PASTE PASTE PROF. FURTHER AFFIANT SAYETH NAUGHT. 8. That I am fully aware that my failure to notify the PCAB of my disassociation with my present employer shall cause my disqualification to be a Sustaining Technical Employee or an Authorized Managing Officer or an applicant for a contractor’s license with PCAB.. COURSE / PROFESSION That I hold a Bachelor's Degree in 2. ___________ (PROFESSION) valid up to _______________. 20___ affiant exhibited his/her Community Tax Certificate No. 10. NAME OF SCHOOL INCLUSIVE DATES Given on: That my Tax Identification Number is : And my Social Security System Number: That I am employed by: (name of firm) 4. nor working abroad. 9. specify (Back) (photocopy) . Page No. That I am executing this affidavit to attest to the truth of the foregoing. 11. Born on DD and residing at: MM Passport size Picture of STE FIRSTNAME YYYY ST. That I am not a holder of a valid contractor's license. incompetence or malpractice or any act or omission liable for disciplinary action by myself or in collaboration with any other person.F O R M SUSTAINING TECHNICAL EMPLOYEE AFFIDAVIT Please accomplish this affidavit properly. I. That I am not involved in any construction malperformance suggestive of negligence. That I am not presently employed by either a private company or any government office or government owned/controlled corporation. 7. No. That I am a duly licensed __________________________ and holder of PRC License No. check) (Front) New (photocopy) Upgrading Renewal Others. _______________________________ Affiant SUBSCRIBED and sworn to before me this _____ day of ___________________. I. # & NAME Single / Married to BARANGAY MIDDLE NAME SURNAME DISTRICT FIRSTNAME MIDDLE NAME CITY/MUNICIPAL PROVINCE ZIPCODE having duly sworn to in accordance with law depose and say: 1. Refer to the next page for STE qualification requirements. _____________ issued at ___________________ on ______________. CARD PROF. Book No. That I have not been convicted by a court of competent jurisdiction of any offense involving moral turpitude. 6.S SURNAME I. Date 6/22/2011 14 of 24 Page Republic of the Philippines ) Province of _____________ ) City/Municipality of ________) S. ) PCAB PCAB-PAD-NEW-F01 Revision 03 Eff. NAME OF FIRM POSITION IN THE FIRM With position of as a STE for CFY 5. pls. nor a full time instructor. Doc.D.D. Given at: 3. CARD VALID FOR VALID FOR CURRENT YEAR CURRENT YEAR Type of Application: (Pls. pls. This is to certify that I have verified with PRC the above stated professional eligibility/registration of the Sustaining Technical Employee. A technology professional. Affiant herein and found the same to be true and correct. by himself or in collaboration with any other person or firm. __________________________________________ Signature over Printed Name of the AMO Date: _______________________ Type of Application: (Pls. 3. 4. in any capacity. particularly a party engaged in construction or construction-related activities. Date 6/22/2011 15 of 24 Page 1. check) New Upgrading Renewal Others.D. Holder of a valid PRC I. 5. A full-time employee of the nominating contractor. c) Conviction by a court of competent jurisdiction of any offense involving moral turpitude. failure to notify the Board of his disassociation in accordance with paragraph 5 and 6 of the Affidavit of Undertaking. in any act or omission liable for disciplinary action of which he/she is or the other person or firm was found guilty by the PCAB Board . With three (3) years minimum actual construction experience. duly licensed by the Professional Regulation Commission (PRC). not associated professionally or by employment with any other party. Have none of the following disqualifications: a) Involvement. 2. in any construction malperformance of grave consequence. and d) If formerly a Sustaining Technical Employee or an Authorized Managing Officer of any construction firm but disassociated there from. such as engineer or architect.QUALIFICATION REQUIREMENTS FOR STE F O R M PCAB PCAB-PAD-NEW-F01 Revision 03 Eff. specify _______________________ . suggestive of his negligence. incompetence and/or malpractice. b) Involvement. single/married. That I am executing this affidavit to attest to the truth of the foregoing. NAME and COMPLETE ADDRESS of EMPLOYER/ NAME & LOCATION of PROJECTS UNDERTAKEN Work Classification (GE. SP) PROJECT DURATION (mm/dd/yy) Nature/Scope of Work Assignment (Proj. Notary Public Until December 20 ___ .AFFIDAVIT OF STE CONSTRUCTION WORK EXPERIENCE F O R M PCAB PCAB-PAD-NEW-F01 Revision 03 Eff. Series of 20 _______.) From To That I authorize the PCAB to verify and investigate any or all information in this affidavit from whatever sources PCAB may consider appropriate. Page No. Filipino. _________________________________ Affiant SUBSCRIBED and sworn to before me this _____ day of _________________. GB. 20__ affiant exhibited his/her Community Tax Certificate No.S I. _________________________________. FURTHER AFFIANT SAYETH NAUGHT. Date 6/22/2011 16 of 24 Page Please use additional sheets if necessary Republic of the Philippines ) Province of _____________ ) City/Municipality of ________) S. Book No. with postal address at ________________________________________________. Engr. having been duly sworn in accordance with law depose and say that the projects enumerated below constitute my full & complete construction experience.. No .. of legal age. Doc. ______________ issued at ____________________ on ____________________. That I have been previously connected with the following companies and disassociated therefore: Previous Employers Date of Employment Date of Resignation Position 4. The veracity of the information reflected on the STE Affidavit and Affidavit of Construction Experience that I executed in favor of the above present employer. ________________ No: ______________ ________________________ STE’s Signature ________________________ Date Signed ----------------------------------------------------------------------To be filled up by PCAB/DTI Personnel ____________________________ Signature over Printed Name PCAB / DTI Office:_______________ Date :__________________________ STE’s Specimen Signature (during interview): ____________________________ .(s) Presented: 1.D. Date 6/22/2011 17 of 24 Page STE PERSONAL APPEARANCE (TO BE ACCOMPLISHED BY THE STE) NAME OF STE: __________________________________________________________ LAST NAME FIRST NAME MIDDLE NAME Profession: ________________ PRC ID No: ____________ Expiration Date: __________ Present Employer: ________________________________________________________ I hereby confirm the following: 1. Series of 2001. 2. ________________ No: ______________ 2. or authorized managing officer. or a licensee applicant with PCAB per Board Resolution No. 3. That I am fully aware that my failure to notify the PCAB of my disassociation from the above-stated nominating firm and any misrepresentation in the attached forms shall cause my disqualification as sustaining technical employee. Other Remarks: _________________________________________________________________________________________ _________________________________________________________________________________________ Valid I. 401.F O R M PCAB PCAB-PAD-NEW-F01 Revision 03 Eff. Series of 20___ Important: 1. .F O R M PCAB PCAB-PAD-NEW-F01 Revision 03 Eff. Filipino. after having been sworn to in accordance with law. 5. I am the Proprietor / AMO of ____________________________________________________ 2. Date 6/22/2011 18 of 24 Page AFFIDAVIT OF NO CONSTRUCTION ACTIVITY FOR NEW LICENSE APPLICANTS I. depose and say that: 1. Misrepresentation in the application for a license may result in the disapproval thereof without prejudice to administrative. 3. Book No. 3.A 4566 (the Contractor’s License Law) that requires a contractor to secure a license before engaging in the business of construction contracting in the Philippines. I am aware of the provisions of Section 35 of R. Page No. and criminal prosecution. _________________________ Issued at __________________________ on_______________________________ _____________________________ Notary Public Doc. single/married. affiant exhibiting to me his / her Community Tax Certificate No. I will not engage or have not engaged in any construction activity that requires a contractor’s license during the pendency of this application. Submit this affidavit only if you have not undertaken any construction activity. If construction has been undertaken prior to application or during the pendency of the application. and residing at ___________________________________________. I have not undertaken any construction activity that requires a contractor’s license prior to the filing of this application. No. ____________________________ Affiant Subscribed and sworn to before me this ____ day of ____________ 20____. _________________________________ of legal age. 4. I am executing this affidavit to support my application for license and to attest to the truth of the foregoing. inform the Public Assistance Desk for assessment of Additional License Fee. civil. 2. Series of 20 __. file/follow-up. Date 6/22/2011 19 of 24 Page Republic of the Philippines ) Province of _____________ ) City/Municipality of ________) S. submit documents. receive notices/license in connection with the said application and the like. Filipino. That I am the Proprietor/Authorized Managing Officer (AMO) of ______________________________________________________________________. whose picture and signature appear below. of legal age. present for pre-screening my application for contractor’s license or any application related thereto. _______________ issued at ___________ on ___________________. hereby depose and say: 1. to transact business with PCAB. Book No. i. 4.S I. _______________________________. That I undertake to notify PCAB in the event that this appointment is modified. No.e. ______________________________________ AFFIANT (Authorized Managing Officer of Firm) SUBSCRIBED and sworn to before me this ______ day of ____________. affiant exhibited his/her Community Tax Certificate No. amended or revoked. NOTARY PUBLIC Until December 20 ____ Doc. That I appoint ____________________________. Page No. (Name of Firm) 2. That I am aware that I am responsible/liable for any or all acts/representation made by my representative in connection with the functions stated herein. 20___. Representative Signature over printed Passport Size Photo Most Recent Taken within the last six months prior to application of PCAB license Address: _______________________ _______________________________ 3.AFFIDAVIT OF REPRESENTATIVE F O R M PCAB PCAB-PAD-NEW-F01 Revision 03 Eff. after having been sworn to in accordance with law. . married/single with postal address at ____________________________________. the contractor must have qualified STEs whose individual experience is not less than ten (10) years with a creditable ceiling of thirty (30) years and have an aggregate/combined experience of at least sixty (60) years.4. A contractor may apply for and be issued more than one classification.00 of the NBV of the contractor owned equipment. qualified and rated according to equivalent credit points and shall be the lowest sustainable by all three determinants as follows: 3. one of which shall be designated as his principal classification. if constructor’s license is less than three (3) years. corresponding to the classification and category applied for. in order to qualify to the technical capacity requirement for category “AAA”.4. 2. 3. whichever is applicable. Only STEs who meet the minimum individual experience required shall be considered in determining aggregate experience and credit points. his qualification must satisfy all the minimum requirements. Corresponding credit points is 1 for every P100.3 Experience of firm Experience of firm shall be in terms of: 2. the reported assets of the contractor were found to be erroneous or not adequately supported with appropriate documents. In determining a contractor’s category. upon verification. 2.3. Corresponding credit point is five (5) for every year of experience in construction.3 It shall be subject to a creditable ceiling of thirty (30) years. Corresponding credit points is one (1) for every P100. based on the audited financial statements submitted to the BIR. or paid-up capital based on the latest audited financial statements submitted to the Securities and Exchange Commission (SEC). 2. over which no excess shall be recognized.F O R M PCAB PCAB-PAD-NEW-F01 Revision 03 Eff. under the same business identify. since being licensed.2 Equipment Capacity Equipment capacity shall be in term of book value as reflected in the constructor’s latest audited financial statement submitted to the BIR or the SEC. and 2. 2.000. 2. if a newly-organized partnership or corporation.1 The experience shall be in term of aggregate number of years in which the STE. PCAB has the right to reject or reduce portion thereof if. in his present employment as well as previous.000.1 Financial capacity Financial capacity shall be in term of Networth based on the latest audited financial statements submitted to the Bureau of Internal Revenue (BIR).1 Aggregate number of years in which the constructor firm. . experience of STE.2 Average annual value of work completed by the firm during the past three (3) years or. 2.3 Financial Capacity Experience of STE Over all credit points based on the four qualification criteria referred to in item 2 of these guidelines. 2. Thus. Evaluation of category shall be based on the following criteria quantified by credit points in scales as determined by the Board.2 3. Said individual experience of the STE shall be as defined and qualified below: 2. has been actively engaged in construction contracting operation. Corresponding credit points is 10 for every year of actual construction operation as a licensed contractor. Classification means the area of operation that a contractor can engage is based on the technical experience of his sustaining technical employee (STE).000.2 It shall include only the years in which he was performing in managerial/supervisory capacity bearing on construction operation and/or contract implementation.3. Category indicates the graded level of aggregate capability of a contractor with respect to his principal classification and is based on predetermined qualification criteria which include financial capacity. Corresponding credit points is 1 for every P100.4 Experience of technical personnel Experience of technical personnel shall be the sum total of individual experience of each STE nominated to the classification and shall be subject to the qualification requirement of each category as indicated in the PCAB Classification and Categorization Table. has been involved in construction is to be categorized. The category of a contractor shall be determined on the basis of the number of points credited on the aggregate/combined experience of all its qualified STE.4.1 3. Date 6/22/2011 20 of 24 Page GUIDELINES FOR CLASSIFICATION AND CATEGORIZATION OF CONTRACTORS 1. or equipment owned which are in operational condition and applicable to construction of the classification in which the constructor is to be categorized. track record and equipment.00 of the annual value of work accomplishment. Said owned equipment shall include units under installment and/or under lease purchase.00 of the value of Networth/Stockholder’s Equity. 000.50 C 3.00 3 3 15 66. and COMTCP points if STEs are COMTCP certified .00 0.00 3 3 15 24.00 30.F O R M CATEGORIZATION – CLASSIFICATION TABLE CLASSIFICATION I.00 90.00 P90.00 900.000.00 7 21 105 261.000.000. Playground or Recreational Work III.00 90.000.00 900.00 5 10 50 122.000.45 GE-3 Dam. & 1 point/P100Th of 3 year Average Annual Volume of Work Accomplished. INDIVIDUAL AGGREGATE MIN.00 90.000. Pavement.000.000.00 30. SPECIALTY AAA SP-FW Foundation Work SP-SS Structural Steel Work SP-CC Concrete Pre-casting. Airport horizontal Structure.000. CONST.00 3 3 15 60.000.00 B 4.000.00 A 9. SP-TRADE * Minimum Qualification Requirements for Principal Classification ** For Other Classification/s. Date 6/22/2011 21 of 24 Page MINIMUM QUALIFICATION REQUIREMENTS (1) FINANCIAL CAPACITY STOCKHOLDER'S EQUITY (2) STE MIN.000.00 10 50 250 695.00 5 10 50 120.00 900.000.P.910. EXP.000.00 10 60 300 1.000. Highways.00 450.00 45.00 3 3 15 75.00 10 60 300 1.500.15 A 9.00 10 50 250 915.00 P90.00 TRADE 45.00 5 10 50 110.000.40 none none none 0. GENERAL BUILDING GB-1 Building or Industrial Plant GB-2 Sewerage or Sewage System AAA GB-3 Water Treatment Plant & System GB-4 Park.) REQ'D.50 D 900.00 30.00 7 21 105 211.000.00 AA 45.00 10 60 300 1.00 9. Reservoir or Tunneling GE-4 Water Supply GE-5 Port.000.000.00 3 3 15 24. and Bridges GE-2 Irrigation or Flood Control C A T E G O R Y AAA PCAB PCAB-PAD-NEW-F01 Revision 03 Eff.00 7 21 105 265.000. REQ'D. Minimum of 3 Years Actual Construction Experience *** Overall credit points inclusive of Equipment Capacity (1 point/P100Th).510. (3) OVERALL CREDIT POINTS REQUIRED P90.00 9.50 D 900.00 3 3 15 24.P. Pre-Stressing or Posttensioning SP-PS Plumbing & Sanitary Work SP-EE Electrical Work SP-ME Mechanical Work SP-AC Air-conditioning or Refrigeration SP-ES Elevator or Escalator SP-FP Fire Protection Work SP-WP Waterproofing Work SP-PN Painting Work SP-WD Well-Drilling Work SP-CF Communication Facilities SP-MS Metal Roofing & Siding Installation SP-SD Structural Demolition SP-LS Landscaping SP-EM Electro Mechanical Work SP-NF Navigational Facilities IV.950.00 AA 45.500.000.00 45. Experience of Firm (10 points/year of active existence.00 45. Railways. REQUIREMENT CREDIT POINTS (C.000.000.000.00 B 4.00 10 50 250 895.000.500.000.00 A 9.000.00 B 4.00 AA 45.50 C 3.50 D 900. GENERAL ENGINEERING GE-1 Road. C.50 C 3.000.00 450. Harbor or Offshore Engineering II.00 450.00 9.000.000. 11.2 of the IRR of RA 9184 allows Small A and Small B contractors without similar experience to bid only for contracts not more than fifty percent (50%) of the allowable range of contract cost of their respective size ranges.F O R M PCAB PCAB-PAD-NEW-F01 Revision 03 Eff. 23. 3 of Sec. Up to P200M Up to P100M .0M Small A Trade < P500T < or above P150 M Above P150M < or above P300 M Above P100M Up to P150M Above P50M Up to P100M Above P10M Up to P50M Up to P300M Up to P10M < P10M Up to P15M Up to P500T < P500T Up to P500T Up to P150M Up to P100M Up to P50M * Par. Date 6/22/2011 22 of 24 Page CATEGORIZATION – CLASSIFICATION TABLE FOR GOVERNMENT REGISTRATION ADJUSTMENT TO TRACK RECORD & ALLOWABLE RANGES OF CONTRACT COST (ARCC) st nd CFYs 2004-2007 (1 Stage) 2 Stage 01 July 2009 SLP ARCC SLP ARCC Size Range License Category Large B AAA Above P75M Large A AA Medium B A Medium A B Above P50M Up to P75M Above P25M Up to P50M Above P5M Up to P25M Small B C&D < P5. A.200 240 120 72 24 exempt Others (Chargeable for each classn.400 1.400 1. A 50 50 50 50 50 50 50 New Application Renewal Application Categorization Fee Additional Classification Principal Classification License Revision/Re-issue Upgrading of Category Categorization Fee License Revision/Re-issue Other Types of Petitions Change of AMO.400 50 1. N. A.800 3.400 1.600 10.800 960 480 exempt 1.600 50 2. N. 21.400 7.600 10. A.600 2.200 50 600 50 N.600 50 10.800 960 480 exempt License Renewal Fee 50 50 50 50 50 50 50 Surcharge for late Renewal 20 20 20 20 20 20 20 Filling Fee 600 600 600 600 600 600 600 License Fee (per project basis) 50 50 50 50 50 50 50 Categorization Fee (per CFY basis) 21.200 600 exempt 50 50 50 50 50 50 50 600 600 600 600 600 600 600 TYPE OF FEES New Application Filing Fee Classification Fee License Fee Renewal Application Filing Fee Category Review Special License 14.200 600 120 60 36 12 exempt Categorization Fee 21.400 7.200 2.400 1.800 50 3.200 50 600 50 120 50 60 50 36 50 12 50 N.200 600 exempt Filling Fee 600 600 600 600 600 600 600 License Fee 50 50 50 50 50 50 50 14.600 2. Change of Business Name /Status & License Replacement License revision (for each type of petition) .F O R M PCAB PCAB-PAD-NEW-F01 Revision 03 Eff.) 1.400 1. Date 6/22/2011 23 of 24 Page LICENSING FEE STRUCTURE AAA (Pesos) AA (Pesos) A (Pesos) B (Pesos) C (Pesos) D (Pesos) TRADE (Pesos) 600 600 600 600 600 600 600 Principal Classn.800 3.200 2. 2. 400 600 1. Project Kind Fee (if any) 60 600 60 1. Re-Registration a. New Registration a.200 600 60 60 60 a.400 600 1. Filing Fee b. Size Range (SR) Fee Small A to Small B Small A/B to Medium A/B Small A/B to Large A/B Medium A to Medium B Medium A/B to Large A/B Large A to Large B 4. Filing Fee b.400 a.F O R M PCAB PCAB-PAD-NEW-F01 Revision 03 Eff. Filing Fee b.200 60 1.200 600 60 60 60 3. Filing Fee b.600 600 2. Additional Project Kind 2. Upgrading of Size Range Small A& B (Pesos) 60 60 60 3. effective CFY 2001-2002 Registration (new) P 20.000 Renewal of registration P 10.000 .200 60 Revised Miscellaneous Fees Listing (per page) Certification (per page) Replacement of License SIZE RANGE Medium A & B (Pesos) P 12 P 24 P 60 60 600 60 600 PHILIPPINE OVERSEAS CONSTRUCTION BOARD Revised Schedule of Fees. Project Kind (PK) Fee First Project Kind Succeeding PK (if any) 3. Project Kind (PK) Fee First Project Kind Succeeding PK (if any) 2. Date 6/22/2011 24 of 24 Page REGISTRATION FEES Large A & B (Pesos) TYPE OF FEES 1.600 600 2.