New Contractor's License Application Form

Construction Industry Authority of the Philippines PHILIPPINE CONTRACTORS ACCREDITATION ACCREDITATION BOARD

NEW REGULAR CONTRACTOR’S LICENSE APPLICATION PCAB-PAD-NE-!"#$ Re%ision No$ "&' "()#*)("#+ "()#*)("#+ , This Form is NOT for sale $ Reproduction is Alloed The folloin. pertinent docu/ents 0nd infor/0tion sh0ll 1e su1/itted in support to PCAB License Ne Applic0tion$

Checklist of Reqireme!ts A" LEGAL A$#$ Affid0%i Affid0%itt of Attest0tio Attest0tion n 0nd 2ener0l 2ener0l Infor/0ti Infor/0tion on 3p0.e 3p0.e * of (+ (+ 0nd p0.e p0.e + of of (+45 A$#$#$ !or Sole Proprietorship6 Certified Certified true copy of Business N0/e N0/e Re.istr0tion Certific0te5 Certific0te5 A$#$($ !or P0rtnership or Corpor0tion6 Certified true copy of SEC Certific0te of Re.istr0tion 0nd Articles of P0rtnershi P0rtnership)Inc p)Incorpor orpor0tion 0tion 0nd By-L0s By-L0s ith construct construction ion contr0ctin contr0ctin. . 0s one of the purposes purposes 0nd su1se7uent 0/end/ents thereto' if 0ny5 0ny5 A$($ PCAB PCAB Inte.rity Inte.rity Pled.e 3P0.e 8 of (+45 (+45 A$*$ Authori9e Authori9ed d :0n0.in. :0n0.in. Officer Officer 3A:O4 3A:O4 No/in0tion6 No/in0tion6 A$*$#$ A:O A:O Affid0%it Affid0%it 3p0.e & of (+4 ith 0 p0ssport p0ssport si9e picture of A:O5 A:O5 A$*$#$#$ A$*$#$#$ For Cor#oratio!s o!l$6 o!l$6 Ori.in0l Corpor0te Secret0ry;s certific0te 0s to the no/in0tion of the A:O 3p0.e < of (+45 A$*$($ Ori.in0l Ori.in0l NBI cle0r0nce cle0r0nce of !ilipino A:O A:O 3%0lid 3%0lid 0s of of the d0te d0te of filin.45 filin.45 A$*$*$ If A:O A:O is Non-!ili Non-!ilipino pino 3in 0ddition 0ddition to A$*$#46 A$*$#46 A$*$*$#$ A$*$*$#$ or=in. or=in. >is0 >is0 A$*$*$($ A$*$*$($ Alien Alien Certific0 Certific0te te of Re.istr Re.istr0tion 0tion A$*$*$*$ A$*$*$*$ NBI cle0r0nce cle0r0nce if A:O A:O h0s resided resided in the Philippines Philippines for si? 3&4 /onths /onths or lon.er if not' e7ui%0lent cle0r0nce fro/ A:O;s ho/e country duly 0uthentic0ted 1y the Philippine E/10ssy5 For Cor#oratio!s or Associatio!s %ith forei&! sharehol'ers( the follo%i!& 'ocme!ts shall )e s)mitte'* #$ Corpor0te Secret0ry@s Certific0tion 0s follos6 0$ List of stoc=holders shoin. their their n0tion0lities 0nd sh0reholdin.s5 0nd 0nd 1$ List of Bo0rd of Directors Directors shoin. their n0/es 0nd n0tion0lity$ ($ Copy of l0test 2ener0l Infor/0tion Sheet duly filed ith SEC shoin. the n0/es of stoc=holders 0nd directors' n0tion0lity 0nd sh0reholdin.s$ 0$ The percent0.e control of the nu/1er of se0ts occupied 1y forei.ners in the Bo0rd of Dir ectors sh0ll not e?ceed 8"$

+" FINANCIAL B$#$ Co/plete !in0nci0l !in0nci0l St0te/ents St0te/ents ith 0cco/p0ny 0cco/p0nyin. in. Auditor@s notes d0ted ithin ithin the l0st si? 3&4 /onths /onths i//edi i//edi0te 0tely ly preced precedin. in. the filin. filin. of 0pplic 0pplic0ti 0tion on ,'l ,'l$ $ a'i a'ite te' ' a!' a!' si&! si&!e' e' o! e-er e-er$ $ #a&e #a&e )$ a! I!'e#e!'e!t CPA %ith -ali' PRC.+OA accre'itatio!/ 0nd accre'itatio!/ 0nd 0 CD-R 3co/p0ct disc record01le4 cont0inin. the fir/@s Audited B0l0nce Sheet  Inco/e St0te/ent in the prescri1ed te/pl0te to 1e uplo0ded 1y the CIAP-RID in CIAP d0t010se$ The PCAB !in0nci0l St0te/ent !or/s A  B 3A$ B0l0nce Sheet ) B$ Inco/e St0te/ent4 c0n 1e donlo0ded 0t CIAP e1site' $ci0p$dti$.o%$ph5 B$#$#$ !or old co/p0nies' 0udited fin0nci0l st0te/ents for the i//edi0tely precedin. t0?01le ye0r 0nd copy of the u0rterly or Annu0l Annu0l Inco/e T0? T0? Return certified 1y the BIR5 B$#$($ C0sh6 Ori.in0l copy of B0n= Certific0tion)B0n= st0te/ent of 0ccount certified 1y B0n= :0n0.er of c0sh c0sh deposi deposits ts 0s of the B0l0nc B0l0nce e Sheet Sheet d0te5 ,NOTE* Amo!t i! e0cess of 1 of 23 of the mi!imm !et%orth reqire' for cate&or$ a##lie' for or P 45(555"55 %hiche-er is hi&her( reflecte' as 6Cash7 or 6Cash o! 8a!'7 shall )e 'e'cte' from the !et%orth( if !s##orte'/5 B$#$($#$ Authori90tion to Depository B0n= 3p0.e  of (+45 (+45 B$#$*$ List of L0nd 0nd Buildin.)Industri0l Pl0nts oned 1y the 0pplic0nt 0nd re.istered in its n0/e 3p0.e ## of (+45 B$#$*$#$ Certified Copy of Tr0nsfer of Certific0te of Title 3TCT4 includin. 10c= p0.e5 B$#$*$($ Deed of S0le or Certified Copy of T0? T0? Decl0r0tion of L0nd ) Buildin. oned 1y the 0pplic0nt5 B$#$8$ List of Construction 0nd)or Tr0nsport0tion)Deli%ery >ehicles)E7uip/ent):0chineries)Pl0nts oned 1y the 0pplic0nt 0nd re.istered in its n0/e 3p0.e #( of (+45 B$#$8$#$ B$#$8$#$ Certified Certified Copy 1y L0nd Tr0nsport0t Tr0nsport0tion ion Office Office 3LTO4 3LTO4 of Certific0t Certific0te e of Re.istr0ti Re.istr0tion on 0nd Current Current Offici0l Receipt Receipt of Re.istr0tion Re.istr0tion of Construc Construction tion 0nd)or Tr0nsport0ti Tr0nsport0tion)De on)Deli%er li%ery y >ehicles)E7uip/ent >ehicles)E7uip/ent reported5 B$#$8$($ Certified Copy of Deed of S0le or s0les in%oices)offici0l receipts of other construction e7uip/ent)/0chineries5 B$#$+$ Docu/ents to 1e su1/itted if the %0lues of the 0pplic0nt;s Recei%01les Recei%01les 0nd In%entories Accounts e?ceed /ore th0n +"  ("'respecti%ely' of the contr0ctor@s netorth' otherise' the 0/ount in e?cess of s0id 0ccount sh0ll 1e deducted for c0te.ori90tion purposes5 B$#$+$ B$#$+$#$ #$ Schedu Schedule le of Recei% Recei%01l 01les es duly si.ned si.ned 1y A:O 0nd Certif Certified ied 1y the fir/@s fir/@s PRC BOA BOA 0ccredited CPA CPA 3p0.e #* of (+45 B$#$+$ B$#$+$($ ($ Sched Schedule ule of In%ent In%entori ories es duly duly si.ned si.ned 1y A:O A:O 0nd Certif Certified ied 1y the fir/@s fir/@s PRC BOA 0ccredited CPA 3p0.e #* of (+45 B$($ Authori90tion Authori90tion to %erify docu/ents fro/ BIR  other 0.encies 0.encies 0nd)or 7u0rterly inco/e t0? return to co%er inco/e reported on interi/ fin0nci0l st0te/ents$3p0.e  of (+ 0nd p0.e #" of (+45

Remarks

PCAB-PAD-NE-!"# Re%ision No$ "&' "()#*)("#+ This Form is NOT for sale$ sale $ Reproduction is Alloed P0.e 9 of 94

Remarks C" TEC8NICAL C$#$ List of Sust0inin. Technic0l Technic0l E/ployee)s - STE 3p0.e #8 of (+4 supported 1y the folloin. docu/ents for e0ch STE6 C$#$#$ Co/pl Co/pleti etion on of 8"-hou 8"-hourr S0fety S0fety Se/in0 Se/in0rr 3COSH4 3COSH4 of 0ny of the listed listed Sust0i Sust0inin nin. . Technic0 chnic0ll E/ployees5 C$#$($ STE Affid0%it)s Affid0%it)s 3p0.e #+ of (+4 ith recent p0ssport si9e picture)s5 C$#$*$ Certified true copy of %0lid PRC ID of STE 0s licensed profession0l5 C$#$8$ Ori.in0l NBI Cle0r0nce)s of no/in0ted STE)s5 C$#$+$ STE Affid0%it)s Affid0%it)s of Construction E?perience 3p0.e #< of (+45 C$#$&$ Person0l Appe0r0nce !or/ duly 0cco/plished 0nd si.ned 1y the STE)s 0ppe0rin. 1efore the desi.n0ted officer of the PCAB or the ne0rest DTI re.ion0l)pro%inci0l office 3p0.e # of (845 C$#$<$ Affid0%it of No Construction Acti%ity 3p0.e # of (+45 C$($ Certific0te of DOLE-0ccredited S0fety Pr0ctitioner for C0te.ory FAAAG 0pplic0nts 3for 0ddition0l credit points45 :" GENERAL INFOR;ATION - fill out 2I Sheet 3p0.e 8 of (+4 D$#$ :e/1ership ith SSS' PHILHEALTH  PA2-IBI25 D$($ Co/pletion of6 D$($#$ 9.'a$ 9.'a$ A;O A;O Semi! Semi!ar ar  to 1e co/p co/ple lete ted d 1y the the A:O hi/s hi/sel elff heth hether er the the fir/ fir/ 1e sole sole proprietorship or corpor0te)p0rtnership 0nd the li=e5 D$($($ <5.hor <5.hor Safet$ Semi!ar ,COS8( +OS8 %ith Co!strctio! Co!strctio! Safet$ Com#o!e!ts Com#o!e!ts// = to 1e co/pleted 1y the A:O hi/self in c0se of sole proprietorships or 1y 0ny responsi1le)senior officer of the corpor0tion)p0rtnership 0nd the li=e5 D$*$ E-/0il Address5 D$8$ Certific0te of ISO 0ccredit0tion 3for 0ddition0l credit points45 E" OT8ERS E$#$ Acco/plished Affid0%it Affid0%it for !ir/@s Authori9ed Represent0ti%es 3p0.e (" of (+45 E$#$#$ Copy of co/p0ny ID of the represent0ti%es5 E$#$($ L0test CCL - for/erly SSS !or/ R-* 3for 1elo &" ye0rs old4 or Certific0te of Inco/e T0? T0? itheld BIR !or/ (*#&' for/erly BIR -( 3for &" ye0rs old 0nd 01o%e4 of the represent0ti%es5 E$($ Ori.in0l si.n0ture of A:O on e0ch 0nd e%ery p0.e of the 0pplic0tion for/s includin. supportin. docu/ents5 E$*$ Certified docu/ents$ In lieu of certified copies' photocopies /0y 1e 0ccepted pro%ided ori.in0l copies 0re presented for 0uthentic0tion5 E$8$ Self-0ddressed' self-st0/ped l0r.e 1ron en%elope or 0 prep0id courier pouch for /0ilin. of license certific0te5 E$+$ Proof of p0y/ent of Prep0id Courier Pouch for /0ilin. of license certific0te$ Ple0se refer to p0.e (+ of (+ for B0n=)Account Nu/1er 0nd !rei.ht R0tes ,o#tio!al/5 ,o#tio!al/5 E$&$ Docu/ent0ry St0/p T0? for e0ch ori.in0l or certified true copy of Contr0ctor@s License 3Sections #<* 0nd # of the T0? T0? Code of #< 0nd Re%enue :e/or0ndu/ Circul0r No$ *&-("#(45 E$<$ A:O E?0/in0tion5 0nd E$$ The Bo0rd /0y re7uire the A:O inter%ie 0nd su1/ission of pertinent docu/ents)infor/0tion other th0n the 01o%e in order to fully deter/ine the 7u0lific0tions of the 0pplic0nts5 F" ARC APPLICATION !$#$ Applic Applic0ti 0tion on for re.ist re.istr0t r0tion ion in .o%ern .o%ern/en /entt proec proects ts should should 1e 0cco/ 0cco/pli plishe shed d in PCABPCAB-P PAD-AR AD-ARC-! C-!"# "# 3Appli 3Applic0t c0tion ion for Re.istr0tion 0nd Cl0ssific0tion of Contr0ctor for 2o%ern/ent Infr0structure Proects4 hich /0y 1e filed si/ult0neously in 0 sep0r0te folder ith the PCAB License Applic0tion$

FOR PCA+ > :TI.ROG USE ONL? ONL? 2st Pr P rescree!i!& Item No"

J K PCAB :0=0ti J K DTI-RO2  Prescreener6

D0te6

Accepted J K Co/ply l0c=in. ite/s J K Accepted

9 !' Prescree!i!&

@ r' Pr Prescree!i!&

< th Prescree!i!&

J K PCAB :0=0ti

J K PCAB :0=0ti

J K PCAB :0=0ti

J K DTI-RO2 

J K DTI-RO2 

J K DTI-RO2 

PCAB-PAD-NE-!"# Re%ision No$ "&' "()#*)("#+ This Form is NOT for sale$ Reproduction is Alloed P0.e @ of 94

AFFI:AIT OF ATTESTATION In 1eh0lf of

ESTAKA ENTERPRISES 3N0/e of !ir/4

I here1y re7uest th0t its 0pplic0tion for Contr0ctor;s License 1e 0ppro%ed$ I certify to the co/pleteness of the infor/0tion)docu/ents cont0ined in this 0pplic0tion 0ppert0inin. to the c0te.ory)cl0ssific0tion the co/p0ny is 0pplyin. for 0nd th0t the infor/0tion)docu/ents 0re true 0nd correct$ I further certify th0t the 1usiness n0/e 0nd)or SEC re.istr0tion of this fir/ is %0lid 0nd e?istin.$ I certify further/ore th0t the SSS' P0.-IBI2' 0nd PhilHe0lth contri1utions ere re/itted in f0%or of the e/ployees of this fir/$ I 0/ fully 00re th0t6 #$ All docu/ents su1/itted in support to this 0pplic0tion 0re su1ect to %erific0tion 1efore PCAB 0ction5 ($ Any disco%ered /isrepresent0tion of infor/0tion 0nd)or /0nifest0tions of fr0ud on the 0pplic0tion docu/ents su1/itted 1y /y fir/ 0pplic0nt or its Authori9ed Represent0ti%e)A.ent)Li0ison Officer sh0ll 1e su1ected to in%esti.0tion hich /0y result to the dis0ppro%0l of /y 0pplic0tion' deni0l)suspension)re%oc0tion of license 0nd 1l0c=listin. of /y fir/ 0nd /yself 0s its Authori9ed :0n0.in. Officer5 0nd *$ Mnconfir/ed infor/0tion)docu/ents su1/itted to support /y fir/;s 7u0lific0tions sh0ll 1e e?cluded for c0te.ori90tion)cl0ssific0tion purposes$ 8$ The e%0lu0tion of /y 7u0lific0tion sh0ll 1e solely 10sed on the docu/ents su1/itted 0t the ti/e the 0pplic0tion 0s filed)0ccepted 1y PCAB$ REYNALD T. SIBELIUS

AthoriBe' ;a!a&i!& Officer 3Si.n0ture o%er Printed N0/e4

Repu1lic of the Philippines 4 Pro%ince of 4 City):unicip0lity of 4 S$S

SU+SCRI+E: AN: SWORN to 1efore /e this  d0y of  (" 0t 5 0ffi0nt e?hi1ited to /e his)her Co//unity T0? Certific0te No$  issued 0t  on  (" $

NOTAR? PU+LIC Mntil Dece/1er *#' ("  Doc$ No$ P0.e No$ Boo= No$ Series of (" $

PCAB-PAD-NE-!"# Re%ision No$ "&' "()#*)("#+ This Form is NOT for sale$ Reproduction is Alloed P0.e < of 94

PCA+ INTEGRIT? PLE:GE e 1elie%e th0t the construction industry is one of the /ost suscepti1le to 0ll for/s of corruption th0t h0/pers the no1le o1ecti%es to0rds n0tion0l pro.ress 0nd .lo10l co/petiti%eness$ As frontrunners of n0tion-1uildin.' e 0c=noled.e our /0or role 0nd responsi1ility in ensurin. th0t e c0rry out our t0s=s .uided 1y ethic0l st0nd0rds 0nd e7uipped ith the necess0ry c0p01ility for the successful prosecution of our contr0cts$ In %ie thereof' e pled.e the folloin.6 •

•

•

•

•

•

•

•

•

e ill present only true 7u0lific0tions to PCAB so th0t e /0y 1e e%0lu0ted properly 0nd 1e .i%en the c0te.ory 0nd cl0ssific0tion here e should ri.htfully 1elon.5 e ill uphold the di.nity of the license 0nd not 1e instru/ents for unlicensed contr0ctors to undert0=e construction proects throu.h license lendin. nor throu.h f0lse oint %entures)consortiu/ or pseudo co/1in0tions hich is ini/ic0l to the pu1lic s0fety)interest5 e ill not e/ploy unlicensed su1-contr0ctors)speci0lty contr0ctors hich is 0 cle0r circu/%ention of the re7uire/ent th0t 0ll contr0ctors /ust 1e licensed5 e ill 01solutely shun 00y fro/ 0ny for/ of collusion th0t destroys the %ery essence 0nd inte.rity of 1iddin.s5 e ill not en.0.e in 1ri1ery or do 0ny 0ct hich constitutes .r0ft or corrupt pr0ctice hich is the root c0use of 1lo0ted contr0ct 0/ounts5 e ill not use su1-st0nd0rd /0teri0ls hich ill in 0ny 0y co/pro/ise the s0fety' reli01ility 0nd perfor/0nce of the 1uilt en%iron/ent5 e ill not 010ndon our contr0cts 0nd e ill i/ple/ent our proects f0ithfully in 0ccord0nce ith the prescri1ed specific0tions thereof5 e ill pro%ide the necess0ry resources' fin0nci0l 0nd technic0l c0p01ility in c0rryin. out our contr0ctu0l o1li.0tions' 0nd 0s f0r 0s possi1le' ithin the stipul0ted ti/e of co/pletion5 e 0re 00re th0t e ill 1e i/posed disciplin0ry 0ction should e %iol0te 0ny of the co//it/ents hereof or the PCAB Code of Ethics or 1e found to 1e 0 p0rty to corruption$ REYNALD T. SIBELIUS

AthoriBe' ;a!a&i!& Officer 3Si.n0ture o%er Printed N0/e4

ESTAKA ENTERPRISES

Name of Com#a!$ Repu1lic of the Philippines 4 Pro%ince of 4 City):unicip0lity of  4S$S

SU+SCRI+E: AN: SWORN to 1efore /e this  d0y of  (" 0t 5 0ffi0nt e?hi1ited to /e his)her Co//unity T0? Certific0te No$  issued 0t  on  (" $


PCAB-PAD-NE-!"# Re%ision No$ "&' "()#*)("#+ This Form is NOT for sale$ Reproduction is Alloed P0.e 4 of 94

CONTRACTOR’S GENERAL INFOR;ATION Note6 Ple0se use 0ddition0l sheets if necess0ry$ Name of Firm* 30s per SEC or DTI4

ESTAKA ENTERPRISES Tele#ho!e>Fa0 No" 3include 0re0 code4

Office A''ress

462 SLIDE, TUDING, ITOGON, BENGUET If Pro-i!cial )ase'( co!tact a''ress i! ;a!ila( if a!$

N/A We)site

E.mail A''ress

;o)ile No"

N/A

reysibs@ya!!."!#

$%%%&&'()'*

T$#e of Firm 3ple0se chec= only one4

Eqit$

J  K Sole Proprietorship J K P0rtnership J K Corpor0tion

!ilipino6



!orei.n6



N0tion0lity6

I!ter!atio!al Or&a!iBatio! for Sta!'ar'iBatio! ,ISO/ Certificatio! 3ple0se chec=4 J K ISO #8""#6(""8 J K OSHAS #""#6(""< J K ISO ""#6("" J  K Not A%0il01le SEC > +si!ess Name Re&istratio! No" Firm’s SSS No"

Re&istratio! :ate 3//)dd)yyyy4

Ta0 I'e!tificatio! No"

Phil8ealth No"

(%6+4*6+%$'

(%+$$$&(%4'4+)

E0#ir$ :ate 3//)dd)yyyy4 PAG.I+IG No"

Cate&or$ A##lie' for

Pri!ci#al Classificatio! A##lie' for

Other Classificatio!>s A##lie' for

3ple0se chec= only one4

3ple0se chec= only one4

3ple0se chec=' if 0ny4

J K 2ener0l En.ineerin. J K 2ener0l Buildin. J K Tr0de J K Speci0lty 3ple0se specify 1elo46

J K 2ener0l En.ineerin. J  K 2ener0l Buildin.

J J J J

K AAA K AA KA KB

J KC J KD J K E)Tr0de

J K Speci0lty 3ple0se specify 1elo46

9.'a$ A;O Semi!ar P0rticip0nt

Host)Or.0ni9er

Inclusi%e D0tes

>enue

REYNALD SIBELIUS

NAAP

-AR 2$+2(, 2$(*

BAGUIO ITY

<5.hor Safet$ Semi!ar 3 J K COSH ) J K BOSH ith Construction S0fety Co/ponents 4 P0rticip0nt

Co/p0ny Position

Course Pro%ider

Inclusi%e D0tes

>enue

REYNALD SIBELIUS

A-O

PE-E ONSULTANY

-AR 22+2*, 2$(*

BAGUIO ITY

O%!ers > Stockhol'ers > Officers 3for corpor0tion ) p0rtnership4 NA:E

POSITION

NATIONALIT

CAPITAL SMBSCRIPTION

NATIONALIT

ADDRESS

PAID-MP CAPITAL

PERCENTA2E Peso Sh0res %0lue

N/A

:irectors > Officers 3for corpor0tion only4 NA:E

POSITION

N/A

Certified correct 1y6 REYNALD T. SIBELIUS

AthoriBe' ;a!a&i!& Officer 3Si.n0ture o%er printed n0/e4

PCAB-PAD-NE-!"# Re%ision No$ "&' "()#*)("#+ This Form is NOT for sale$ Reproduction is Alloed P0.e  of 94

AUT8ORIDE: ;ANAGING OFFICER ,A;O/ AFFI:AIT Note6 Ple0se 0cco/plish this 0ffid0%it properly$ Ple0se use 0ddition0l sheets if necess0ry$ Recent Picture of A:O Pass#ort siBe 38$+ c/ ? *$+ c/4

Repu1lic of the Philippines 4 Pro%ince of 4 City):unicip0lity of 4 S$S Last Name

I'

First Name E0t" Name 3Qr)Sr' if 0ny4 ;i''le Name REYNALD TUANGO mm $$$$ Last Name First Name ;i''le Name '' Sin.le ) Born on (%)) (% ($ BALLASIO BE0ERLY LANGGOYAN :0rried to Room>Floor>U!it>+l'&" Name( Lot>+lock>Phase No"( Street( S)'i-isio!( +ara!&a$( Cit$>;!ici#alit$( Pro-i!ce( Di# Co'e

SIBELIUS

CitiBe!shi#

ILIPINO

0nd residin. 0t6

8&(' SLIDE' TMDIN2' ITO2ON' BEN2MET

h0%in. duly sorn to in 0ccord0nce ith l0 depose 0nd s0y6 #$ Th0t I 0/ the Authori9ed :0n0.in. Officer of 6 ESTAA ENTERPRISES ,Name of Firm/

ith position of6 AMTHORIED :ANA2IN2 O!!ICER ,Positio! i! the Firm/

($ Th0t I possess the folloin. educ0tion0l 0tt0in/ents 30tt0ch 0ddition0l sheet if necess0ry4 Name of School

A''ress

Corse

I!clsi-e :ates

SAINT LOMIS MNI>ERSIT

BA2MIO CIT

AB POLSCI 32RADMATE4

#8-#

SAINT LOMIS MNI>ERSIT

BA2MIO CIT

BS CE 3DROP-OMT4

#-("""

*$ Th0t I possess 0t le0st to 3(4 ye0rs e?perience in the construction industry 0s follos 3Ref$ Sec$ (" of IRR of R$A$ 8+&&4 :esi&!atio! > Positio!

PROQECT SMPER>ISOR

Com#a!$ > Natre of +si!ess

CO:PASS ROSE BMILDERS

A''ress

o) :escri#tio!

:ates of Em#lo$me!t

TMBLA' BEN2MET

Conduct onsite %isits 0nd coordin0te ith construction cre 0nd oper0tions personnel continuously

#-("""

LIAISON O!!ICER

SIBELCON

ITO2ON' BEN2MET

PROQECT SMPER>ISOR) LIAISON O!!ICER

CO:PASS ROSE BMILDERS

TMBLA' BEN2MET

Mi d dl ema nf o rt h e c o ns t r u ct i o nc r e wa nd t h ed e v e l o pme nt agency Conduct onsite %isits 0nd coordin0te ith construction cre 0nd oper0tions personnel continuously

(""&-("#"

("#"PRESENT

8$ Th0t I possess =noled.e of the 1uildin.' s0fety' he0lth '  lien l0s of the Repu1lic of the Philippines  the rudi/ent0ry 0d/inistr0ti%e principles of construction contr0ctin. fro/ /y or= e?periences in ite/ * 01o%e 0nd fro/ the folloin. tr0inin.)se/in0rs 3Ref$ Sec$ (" of IRR of R$A$ 8+&&46 +$ Th0t I 0/ not in%ol%ed in 0ny construction /0lperfor/0nce su..esti%e of ne.li.ence' inco/petence or /0lpr0ctice or 0ny 0ct of o/ission li01le for disciplin0ry 0ction 1y /yself or in coll01or0tion ith 0ny other person 3Section 8$( of IRR of R$A$ 8+&&4 &$ Th0t I h0%e not 1een con%icted 1y 0 court of co/petent urisdiction of 0ny offense in%ol%in. /or0l turpitude 3Section 8$( of IRR of R$A$ 8+&&4 <$ Th0t I 0/ fully 00re th0t /y f0ilure to notif y PCAB of /y dis0ssoci0tion ith /y present e/ployer sh0ll c0use /y dis7u0lific0tion to 1e 0n Authori9ed :0n0.in. Officer' 0 Sust0inin. Technic0l E/ployee or 0 license 0pplic0nt ith PCAB $ $ Th0t I 0uthori9e the PCAB to %erify 0nd in%esti.0te 0ny or 0ll infor/0tion in this instru/ent fro/ h0te%er sources PCAB /0y consider 0ppropri0te $ Th0t I certify under p0in of perury th0t 0ll infor/0tion on this 0ffid0%it 0re true 0nd correct$ FURT8ER AFFIANT SA?ET8 NAUG8T" RENALD T$ SIBELIMS Affia!t SU+SCRI+E: AN: SWORN to 1efore /e this  d0y of  (" 0t 5 0ffi0nt e?hi1ited his)her Co//unity T0? Certific0te No$  issued 0t  on  ("$ NOTAR? PU+LIC

PCAB-PAD-NE-!"# Re%ision No$ "&' "()#*)("#+ This Form is NOT for sale$ Reproduction is Alloed P0.e  of 94

SECRETAR?’S CERTIFICATION Note6 !or Corpor0tions only

Repu1lic of the Philippines 4 Pro%ince of 4 City):unicip0lity of 4 S$S I' 0nd residin. 0t6

Last Name

First Name

E0t" Name 3Qr)Sr' if 0ny4

;i''le Name

N)A Room>Floor>U!it>+l'&" Name( Lot>+lock>Phase No"( Street( S)'i-isio!( +ara!&a$( Cit$>;!ici#alit$( Pro-i!ce( Di# Co'e

do here1y certify' in /y c0p0city 0s the duly elected 0nd incu/1ent Corpor0te Secret0ry of  ,Name of Firm/

Th0t durin. its re.ul0r /eetin. held on

''

mm

$$$$

held 0t

Cit$ > ;!ici#alit$ of ;eeti!&

herein 0 7uoru/ 0s present ' the folloin. resolution 0s un0ni/ously 0ppro%ed' to it6

A;O NO;INATION

R E S O L > E 0s it is here1y resol%ed th0t

' 3!IRSTNA:E

:IDDLENA:E

SMRNA:E4

0 senior e?ecuti%e ho h0s 1een .r0nted the poer to render .ener0l /0n0.e/ent 0nd 0d/inistr0ti%e decision' 1e 0ppointed 0s the fir/;s Authori9ed :0n0.in. Officer to 0ct on 0ll /0tters concernin. the re7uire/ents of the PCAB 0nd i/ple/ent0tion of R$A$ 8+&& 0s 0/ended 1y P$D$ #<8&$

IN WITNESS W8EREOF' I h0%e hereunto 0ffi?ed /y h0nd this  d0y of  ("' in ' Philippines$  Cor#orate Secretar$ 3Si.n0ture o%er Printed N0/e4

SU+SCRI+E: AN: SWORN to 1efore /e this  d0y of  (" 0t 5 0ffi0nt e?hi1ited his)her Co//unity T0? Certific0te No$  issued 0t  on  ("$

NOTAR? PU+LIC Mntil Dece/1er *#' ("  Doc$ No$ P0.e No$ Boo= No$ Series of (" 

PCAB-PAD-NE-!"# Re%ision No$ "&' "()#*)("#+ This Form is NOT for sale$ Reproduction is Alloed P0.e  of 94

AUT8ORIT? TO ERIF? +ANH ACCOUNT

THE :ANA2ER BANCO BAMN MCAB' ITO2ON' BEN2MET' ITO2ON BRANCH

Su1ect6 B0n= Account U 

Sir6 Ple0se pro%ide the Phili##i!e Co!tractors Accre'itatio! +oar' ,PCA+/' 0 .o%ern/ent 0.ency under the Dep0rt/ent of Tr0de 0nd Industry' 0ny infor/0tion they need re.0rdin. the su1ect 0ccount ith your 10n=$ I 0/ 0pplyin. for 0 contr0ctor;s license fro/ PCAB 0nd p0rt of their e%0lu0tion process is the %erific0tion of 10n= deposits 0nd other 0ssets of 0n 0pplic0nt$ This ill ser%e 0s your 0uthori90tion to rele0se 0ny infor/0tion th0t /0y 1e re7uested 1y PCAB re.0rdin. the 01o%e su1ect 0ccount$ Th0n= you$

>ery truly yours' N0/e of !ir/6   By6  Si.n0ture o%er Printed N0/e of Authori9ed :0n0.in. Officer or Authori9ed Si.n0tory ith the B0n=

D0te6

Type of Applic0tion6 3Pls$ chec=4 Ne Mp.r0din. Rene0l Others' pls$ specify 

PCAB-PAD-NE-!"# Re%ision No$ "&' "()#*)("#+ This Form is NOT for sale$ Reproduction is Alloed P0.e  of 94

AUT8ORIT? TO ERIF? ITR > AFS FRO; +"I"R" THE RE>ENME DISTRICT O!!ICER BEN2MET PRO>INCE Su1ect6 Inco/e T0? Return 0nd Audited !in0nci0l St0te/ent 0s of 

Sir6 Ple0se pro%ide the Phili##i!e Co!tractors Accre'itatio! +oar' ,PCA+/' 0 .o%ern/ent 0.ency under the Dep0rt/ent of Tr0de 0nd Industry' 0ny infor/0tion they need re.0rdin. the su1ect ITR 0nd A!S filed ith your office$ I 0/ 0pplyin. for 0 contr0ctor;s license fro/ PCAB 0nd p0rt of their e%0lu0tion process is the %erific0tion of ITR 0nd A!S' of 0n 0pplic0nt$ This ill ser%e 0s 0 0i%er on the confidenti0lity pro%ision of Section (<" of the N0tion0l Intern0l Re%enue Code of #< 3/e/or0ndu/ circul0r No$(' (""& d0ted :0y "' (""&4 0nd your 0uthori90tion to rele0se 0ny infor/0tion th0t /0y 1e re7uested 1y PCAB re.0rdin. the 01o%e su1ect docu/ent)s$ Th0n= you$ >ery truly yours' RE?NAL: T" SI+ELIUS Si.n0ture o%er Printed N0/e of Authori9ed :0n0.in. Officer

D0te6 ;ARC8 9524



AUT8ORIT? TO ERIF? FRO; GOERN;ENT AGENC?>IES

AUT8ORIDATION

The Phili##i!e Co!tractors Accre'itatio! +oar' ,PCA+/ is here1y 0uthori9ed to %erify 0nd secure infor/0tion 0nd)or copies of docu/ents su1/itted 1y or in the n0/e of the fir/ to 0ny or 0ll of the folloin. 0.encies rel0ti%e to its 0pplic0tion filed ith the PCAB6

#$ Securities 0nd E?ch0n.e Co//ission 3SEC4 ($ L0nd Re.istr0tion Authority 3LRA4 *$ L0nd Tr0nsport0tion Office 3LTO4 8$ Soci0l Security Syste/ 3SSS4 +$ Profession0l Re.ul0tion Co//ission 3PRC4 &$ Philippine He0lth Insur0nce Corpor0tion 3PhilHe0lth4 <$ Ho/e De%elop/ent :utu0l !und 3P0.-IBI24

RE?NAL: T" SI+ELIUS Si.n0ture o%er Printed N0/e of Authori9ed :0n0.in. Officer D0te* ;ARC8 9524

Type of Applic0tion6 3Pls$ chec=4 J Ne Mp.r0din. Rene0l Others' pls$ specify 


LIST OF CONSTRUCTOR’S REAL PROPERTIES Note6 Ple0se use 0ddition0l sheets if necess0ry$

REAL PROPERTIES OF T8E FIR; AS OF T8E +ALANCE S8EET :ATE CO;PLETE :ESCRIPTION 3Type of l0nd)1uildin.4

RESIDENTIAL

O--ERIAL LOT

KTCT.CLT> CCT>T: NU;+ER

TD12$($+ $(+$)+ $')'2 TD1 2$($+$(+ $)+$''$6

LOCATION 3Street No$' B0r0n.0y' :unicip0lity)City' Pro%ince4

SLIDE, TUDING, ITOGON, BENGUET SLIDE, TUDING, ITOGON, BENGUET

KLEGEN:* TCT = Tra!sfer Certificate of Title CCT = Co!'omi!im Certificate of Title T: = Ta0 :eclaratio! CLT = Certificate of La!' Title

RE?NAL: T" SI+ELIUS Si.n0ture o%er Printed N0/e of Authori9ed :0n0.in. Officer D0te* ;ARC8 9524 Type of Applic0tion6 3Pls$ chec=4 J Ne Mp.r0din. Rene0l Others' pls$ specify 

ACUISITION COST

ACUISITION :ATE


LIST OF CONSTRUCTOR’S PLANTS( E8ICLES AN: EUIP;ENT Note6 Ple0se use 0ddition0l sheets if necess0ry$

A" :ELIER? AN: TRANSPORTATION EUIP;ENT OF T8E FIR; AS OF +ALANCE S8EET :ATE CO;PLETE :ESCRIPTION ?ear ;o'el

OR No" > :ate

:ate

AL4)% (%%) AA*))% 2$(4

6(%&)&%%( *62'$*6*6

2$($ 2$(4

ehicle +ra!' > T$#e

YUNDAI PORTER ORD E0EREST

ACUISITION

Plate No"

OERALL TOTAL ALUE

Cost 3in Php4

+OOH ALUE 3in Php4

(6$,$$$ (2$,$$$ (,'$$,$$$ (,2)$,$$$

Php

Php

(,46$,$$$

(,'%$,$$$

+" ;AC8INERIES>PLANTS AN: OT8ER CONSTRUCTION EUIP;ENT OF T8E FIR; AS OF +ALANCE S8EET :ATE CO;PLETE :ESCRIPTION

ACUISITION SERIAL NO"

+OOH ALUE 3in Php4

Cost 3in Php4

:ate

(+BAGGER ONRETE -I3ER ELDING -AINE '$$A-P

UT+O -AINE BAR UTTER AND DRILL GRINDER

OERALL TOTAL ALUE REYNALD T. SIBELIUS

Si.n0ture o%er Printed N0/e of Authori9ed :0n0.in. Officer D0te6 -AR 2$(*

 Ne Mp.r0din. Rene0l Others' pls$ specify 

Php

Php

PCAB-PAD-NE-!"# Re%ision No$ "&' "()#*)("#+ This Form is NOT for sale$ Reproduction is Alloed P0.e 2@ of 94

SC8E:ULES Note6 Ple0se use 0ddition0l sheets if necess0ry$

RECEIA+LES To 1e 0cco/plished if the 0pplic0nt;s recei%01le 0ccounts 30ccounts)contr0cts  other recei%01le4 e?ceed +" of the tot0l netorth)e7uity 0s of the l0test 0udited 10l0nce sheet su1/itted in support of its 0pplic0tion$

Name of ProMects

Amo!t :e for Collectio!

A&e

Clie!t Name > Com#lete A''ress

N/A

Certified Correct 1y6  Printed N0/e 0nd Si.n0ture of E?tern0l Auditor

REYNALD T. SIBELIUS

Printed N0/e 0nd Si.n0ture of A:O

INENTORIES To 1e 0cco/plished if the 0pplic0nt;s in%entory 0ccounts e?ceed (" of the tot0l netorth)e7uity 0s of the l0test 0udited 10l0nce sheet su1/itted in support of its 0pplic0tion$ T$#es

Amo!t

A&e>:ate Acqire'

I!te!'e' Use or Pr#ose for Stori!&

Ph$sical Co!'itio!

Place of Stora&e

N/A

Certified Correct 1y6  Printed N0/e 0nd Si.n0ture of E?tern0l Auditor

REYNALD T. SIBELIUS

Printed N0/e 0nd Si.n0ture of A:O

PCAB-PAD-NE-!"# Re%ision No$ "&' "()#*)("#+ This Form is NOT for sale$ Reproduction is Alloed P0.e 2< of 94

LIST OF NO;INATE: SUSTAINING TEC8NICAL E;PLO?EES Name of STE Pre-iosl$ Nomi!ate' #$N)A ($ *$ 8$ +$ &$ <$ $ $ #"$ ##$ #($ #*$

Ne%l$ Nomi!ate' #$ ($ *$ 8$ +$ &$ <$  $ #"$

RE?NAL: T" SI+ELIUS Si.n0ture o%er Printed N0/e of Authori9ed :0n0.in. Officer D0te6 ;ARC8 9524


Prof"

PRC Re&istratio! :ate of Lice!se Nm)er Re&istratio! ali'it$

:ate Positio! Em#lo$e' i! the Firm


SUSTAINING TEC8NICAL E;PLO?EE AFFI:AIT Note6 Ple0se 0cco/plish this 0ffid0%it properly$ Refer to the ne?t p0.e for STE 7u0lific0tion re7uire/ents$ Recent Picture of STE Pass#ort siBe 38$+ c/ ? *$+ c/4


I' mm

Born on

$$$$


;i''le Name

First Name

;i''le Name

Last Name

Sin.le ) :0rried to

Room>Floor>U!it>+l'&" Name( Lot>+lock>Phase No"( Street( S)'i-isio!( +ara!&a$( Cit$>;!ici#alit$( Pro-i!ce( Di# Co'e

0nd residin. 0t ith

''

First Name

Tele#ho!e > ;o)ile No" 3re7uired4

Email A''ress 3re7uired4

h0%in. 1een duly sorned in 0ccord0nce ith l0 depose 0nd s0y6 #$

Th0t I 0/ 0 duly licensed   0nd holder of PRC License No$  3Profession4

%0lid up to ' 0s e%idenced 1y 0 copy of /y PRC ID posted 1elo5 Corse > Professio!

Th0t I hold 0 B0chelor;s De.ree in ($ 2i%en 0t6 *$

8$

Name of School

&$ <$ $ $

#"$ ##$

I!clsi-e :ates

Th0t /y T0? Identific0tion Nu/1er is 6 0nd /y Soci0l Security Syste/ Nu/1er6 Name of Firm

Th0t I 0/ e/ployed on 0 re.ul0r 0nd full-ti/e 10sis 1y6 ith the position of

+$

2i%en on6

Positio! i! the Firm

CF?

0s STE for

Th0t I 0/ not presently e/ployed 1y either 0 pri%0te co/p0ny or 0ny .o%ern/ent office or .o%ern/ent oned)controlled corpor0tion' nor 0 full ti/e instructor' nor or=in. 01ro0d5 Th0t I 0/ not 0 holder of 0 %0lid contr0ctor;s license5 Th0t I 0/ not in%ol%ed in 0ny construction /0lperfor/0nce su..esti%e of ne.li.ence' inco/petence or /0lpr0ctice or 0ny 0ct or o/ission li01le for di sciplin0ry 0ction 1y /yself or in coll01or0tion ith 0n y other person5 Th0t I h0%e not 1een con%icted 1y 0 court of co/petent urisdiction of 0ny offense in%ol%in. /or0l turpitude5 Th0t I 0/ fully 00re th0t /y f0ilure to notify the PCAB of /y dis0ssoci0tion fro/ /y present e/ployer %ithi! @5 'a$s from sch 'isassociatio! sh0ll c0use /y dis7u0lific0tion fro/ 1ein. 0 Sust0inin. Technic0l E/ployee' 0n Authori9ed :0n0.in. Officer 0nd 0n 0pplic0nt for 0 contr0ctor@s license ith PCAB5 Th0t I 0uthori9e the PCAB to %erify 0nd in%esti.0te 0ny or 0ll infor/0tion in this 0ffid0%it fro/ h0te%er sources PCAB /0y consider 0ppropri0te5 Th0t I 0/ e?ecutin. this 0ffid0%it to 0ttest to the truth of the fore.oin.$

FURT8ER AFFIANT SA?ET8 NAUG8T"

 Affia!t SU+SCRI+E: AN: SWORN to 1efore /e this  d0y of ' (" 0t 5 0ffi0nt e?hi1ited his)her Co//unity T0? Certific0te No$  issued 0t  on  ("$ Doc$ No$ P0.e No$ Boo= No$ Series of ("  PASTE

NOTAR? PU+LIC Mntil Dece/1er *#' (" 

PASTE

PROF. I.D. CARD

PROF. I.D. CARD

VALID FOR

VALID FOR

CURRENT YEAR

CURRENT YEAR

(Front) (photocopy)

(Back) (photocopy)

PCAB-PAD-NE-!"# Re%ision No$ "&' "()#*)("#+ This Form is NOT for sale$ Reproduction is Alloed P0.e 2 of 94

UALIFICATION REUIRE;ENTS FOR STE

#$ A technolo.y profession0l' such 0s en.ineer or 0rchitect' duly licensed 1y the Profession0l

Re.ul0tion Co//ission 3PRC4$ ($

Holder of 0 %0lid PRC I$D$

*$

ith three 3*4 ye0rs /ini/u/ 0ctu0l construction e?perience$

8$ A full-ti/e e/ployee of the no/in0tin. contr0ctor' not 0ssoci0ted profession0lly or 1y

e/ploy/ent ith 0ny other p0rty' p0rticul0rly 0 p0rty en.0.ed in construction or constructionrel0ted 0cti%ities$ +$

H0%e none of the folloin. dis7u0lific0tions6 04 In%ol%e/ent' in 0ny c0p0city' in 0ny construction /0lperfor/0nce of .r0%e conse7uence' su..esti%e of his ne.li.ence' inco/petence 0nd)or /0lpr0ctice5 14 In%ol%e/ent' 1y hi/self or in coll01or0tion ith 0ny other person or fir/' in 0ny 0ct or o/ission li01le for disciplin0ry 0ction of hich he)she is or the other person or fir/ 0s found .uilty 1y the PCAB Bo0rd 5 c4 Con%iction 1y 0 court of co/petent urisdiction of 0ny offense in%ol%in. /or0l turpitude5 0nd d4 If for/erly 0 Sust0inin. Technic0l E/ployee or 0n Authori9ed :0n0.in. Officer of 0ny construction fir/ 1ut dis0ssoci0ted there fro/' f0ilure to notify the Bo0rd of his dis0ssoci0tion in 0ccord0nce ith p0r0.r0ph + 0nd & of the Affid0%it of Mndert0=in.$

This is to certify th0t I h0%e %erified ith PRC the 01o%est0ted profession0l eli.i1ility)re.istr0tion of the Sust0inin. Technic0l E/ployee$ Affi0nt herein 0nd found the s0/e to 1e true 0nd correct$

RE?NAL: T" SI+ELIUS

AthoriBe' ;a!a&i!& Officer 3Si.n0ture o%er printed n0/e4 ;ARC8 9524

:ate


PCAB-PAD-NE-!"# Re%ision No$ "&' "()#*)("#+ This Form is NOT for sale$ Reproduction is Alloed P0.e 2 of 94

AFFI:AIT OF STE CONSTRUCTION WORH EPERIENCE Note6 Ple0se use 0ddition0l sheets if necess0ry$

Repu1lic of the Philippines 4 Pro%ince of 4 City):unicip0lity of 4 S$S I' ' sin.le)/0rried' !ilipino' of le.0l 0.e' ith post0l 0ddress 0t ' h0%in. 1een duly sorn in 0ccord0nce ith l0 depose 0nd s0y th0t the proects enu/er0ted 1elo constitute /y full  co/plete construction e?perience$ Name a!' Com#lete A''ress of Em#lo$er> Name  Locatio! of ProMects U!'ertake!

Work Classificatio! 32E' 2B' SP4

Natre>Sco#e of Work Assi&!me!t 3Pro$ En.r$4

ProMect :ratio! 3//)dd)yyyy4 From

To

Th0t I 0uthori9e the PCAB to %erify 0nd in%esti.0te 0ny or 0ll infor/0tion in this 0ffid0%it fro/ h0te%er sources PCAB /0y consider 0ppropri0te5 Th0t I 0/ e?ecutin. this 0ffid0%it to 0ttest to the truth of the fore.oin.$ FURT8ER AFFIANT SA?ET8 NAUG8T"  Affia!t SU+SCRI+E: AN: SWORN to 1efore /e this  d0y of  (" 0t 5 0ffi0nt e?hi1ited his)her Co//unity T0? Certific0te No$  issued 0t  on  ("$

NOTAR? PU+LIC Mntil Dece/1er *#' ("  Doc$ No P0.e No$ Boo= No$ Series of (" $

PCAB-PAD-NE-!"# Re%ision No$ "&' "()#*)("#+ This Form is NOT for sale$ Reproduction is Alloed P0.e 2 of 94

STE PERSONAL APPEARANCE Note6 To 1e 0cco/plished 1y the STE Name of STE L0st N0/e

!irst N0/e

Professio!

E?t$ N0/e 3Qr)Sr' if 0ny4

:iddle N0/e

PRC I: No"

E0#iratio! :ate

Prese!t Em#lo$er

I here1y confir/ the folloin.6 #$ The %er0city of the infor/0tion reflected on the STE Affid0%it 0nd Affid0%it of Construction E?perience th0t I e?ecuted in f0%or of the 01o%e present e/ployer5 ($ Th0t I 0/ fully 00re th0t /y f0ilure to notify the PCAB of /y dis0ssoci0tion fro/ the 01o%e-st0ted no/in0tin. fir/ 0nd 0ny /isrepresent0tion in the 0tt0ched for/s sh0ll c0use /y dis7u0lific0tion 0s sust0inin. technic0l e/ployee' or 0uthori9ed /0n0.in. officer' or 0 licensee 0pplic0nt ith PCAB per Bo0rd Resolution No$ 8"#' Series of (""#$ *$ Th0t I h0%e 1een pre%iously connected ith the folloin. co/p0nies 0nd dis0ssoci0ted therefore6 Pre-ios Em#lo$ers

:ate of Em#lo$me!t

:ate of Resi&!atio!

Positio!

8$ Other Re/0r=s6   >0lid I$D$3s4 Presented6 #$



No6 

($



No6 

 STE@s Si.n0ture  D0te Si.ned

----------------------------------------------------------------------To )e fille' ot )$ PCA+>:TI Perso!!el

 Si.n0ture o%er Printed N0/e PCAB ) DTI Office6 D0te 6

STE@s Speci/en Si.n0ture 3durin. inter%ie46 

PCAB-PAD-NE-!"# Re%ision No$ "&' "()#*)("#+ This Form is NOT for sale$ Reproduction is Alloed P0.e 2 of 94

AFFI:AIT OF NO CONSTRUCTION ACTIIT? FOR NEW LICENSE APPLICANTS Repu1lic of the Philippines 4 Pro%ince of 4 City):unicip0lity of 4 S$S I' REYNALD T. SIBELIUS of le.0l 0.e' !ilipino' /0rried' 0nd residin. 0t 462 SLIDE, TUDING, ITOGON, BENGUET 0fter h0%in. 1een sorn to in 0ccord0nce ith l0' depose 0nd s0y th0t6 (. I 0/ the Proprietor ) A:O of ESTAKA ENTERPTISES 2. I 0/ 00re of the pro%isions of Section *+ of R$A 8+&& 3the Contr0ctor@s License L04 th0t re7uires

0 contr0ctor to secure 0 license 1efore en.0.in. in the 1usiness of construction contr0ctin. in the Philippines5 '. I h0%e not undert0=en 0ny construction 0cti%ity th0t re7uires 0 contr0ctor@s license prior to the filin. of this 0pplic0tion5 4. I ill not en.0.e or h0%e not en.0.ed in 0ny construction 0cti%ity th0t re7uires 0 contr0ctor@s license durin. the pendency of this 0pplic0tion5 *. I 0/ e?ecutin. this 0ffid0%it to support /y 0pplic0tion for license 0nd to 0ttest to the truth of the fore.oin.$ RE?NAL: T" SI+ELIUS Affia!t

SU+SCRI+E: AN: SWORN to 1efore /e this  d0y of  (" 0t 5 0ffi0nt e?hi1itin. to /e his)her Co//unity T0? Certific0te No$  issued 0t  on  ("$


I;PORTANT* 2" S)mit this affi'a-it o!l$ if $o ha-e !ot !'ertake! a!$ co!strctio! acti-it$" 9" If co!strctio! has )ee! !'ertake! #rior to a##licatio! or 'ri!& the #e!'e!c$ of the a##licatio!( i!form the P)lic Assista!ce :esk for assessme!t of A''itio!al Lice!se Fee" @" ;isre#rese!tatio! i! the a##licatio! for a lice!se ma$ reslt i! the 'isa##ro-al thereof %ithot #reM'ice to a'mi!istrati-e( ci-il( a!' crimi!al #rosectio!


AFFI:AIT OF REPRESENTATIES Note6 To 1e 0cco/plished 1y the A:O$


I' 1orn on

''

mm

First Name $$$$

Sin.le ) :0rried to


;i''le Name

First Name

;i''le Name

Last Name

Room>Floor>U!it>+l'&" Name( Lot>+lock>Phase No"( Street( S)'i-isio!( +ara!&a$( Cit$>;!ici#alit$( Pro-i!ce( Di# Co'e 0nd residin. 0t6 h0%in. duly sorn to in 0ccord0nce ith l0 depose 0nd s0y6 Name of Firm Th0t I 0/ the Authori9ed :0n0.in. #$ Officer of 6

ith office 0ddress 0t6

Room>Floor>U!it>+l'&" Name( Lot>+lock>Ph" No"( Street( S)'i-isio!( +ara!&a$( Cit$>;!ici#alit$( Pro-i!ce( Di# Co'e

Th0t I 0ppoint to 3(4 represent0ti%es' hose pictures 0nd si.n0tures 0ppe0r 1elo6 Pictre Name of Re#rese!tati-e

3P0ssport Si9e Photo - t0=en ithin the l0st si? /onths prior to 0pplic0tion of PCAB license4

Si&!atre of Re#rese!tati-e o-er Pri!te' Name

A$

($

B$

*$ 8$ +$

to tr0ns0ct 1usiness ith PCAB5 i$e' present for pre-screenin. /y 0pplic0tion for contr0ctor@s license or 0ny 0pplic0tion rel0ted thereto' file)follo-up' su1/it docu/ents' recei%e notices)license in connection ith the s0id 0pplic0tion 0nd the li=e$ Th0t I 0/ 00re th0t I 0/ responsi1le)li01le for 0ny or 0ll 0cts)represent0tion /0de 1y /y represent0ti%es in connection ith the functions st0ted herein$ Th0t I undert0=e to notify PCAB in the e%ent th0t this 0ppoint/ent is /odified' 0/ended or re%o=ed$ Th0t I h0%e re0d 0nd fully understood 0nd co/plied ith the re7uire/ents of PCAB Bo0rd Resolution No$ +#+ s$ ("## 3copies of re7uired docu/ents 0re 0tt0ched4$

RE?NAL: T" SI+ELIUS Affia!t 3Authori9ed :0n0.in. Officer of !ir/4

SU+SCRI+E: AN: SWORN to 1efore /e this  d0y of ' (" 0t 5 0ffi0nt e?hi1ited his)her Co//unity T0? Certific0te No$  issued 0t  on  ("$ NOTAR? PU+LIC Mntil Dece/1er *#' ("  Doc$ No$ P0.e No$ Boo= No$ Series of (" 


I;PORTANT RE;IN:ERS ,A/ #$ All re7uired infor/0tion in the 0pplic0tion for/s should 1e properly filled out$ Do not le0%e 0n ite/ 1l0n=$ If 0n ite/ is not 0pplic01le' indic0te FN)AG5

($ The reco//ended p0per si9e in printin. the 0pplic0tion for/s is $(
0rr0n.ed 0ccordin. to p0.e nu/1er ith inde? t01s5 pl0ced in 0 lon. si9e folder ith f0stener$

8$ Only the Authori9ed :0n0.in. Officer or one of the to 3(4 Authori9ed Represent0ti%es of the !ir/ is 0lloed to tr0ns0ct ith PCAB 3Bo0rd Resolution No$ +#+' s$ ("##4$

+$ All 0pplic0nts 0re re7uired to p0y non-refund01le upfront fees for 0ll types of license 0pplic0tions upon 0ccept0nce 3Bo0rd Resolution No$ *#*' s$ ("##4$

&$ A%oid the rush 0nd del0y in the fili!&>#rocessi!& of re!e%al a##licatio! $ O1ser%e 0nd follo the re%ised filin. schedule 3Bo0rd Resolution No$ *<&' s$ ("#84 0s st0ted 1elo6

•

•

•

•

•

Last :i&it of Lice!se No"

Fili!& ;o!th

"

!e1ru0ry #-#8

#

!e1ru0ry #+-(

(

:0rch #-#+

*

:0rch #&-*#

8

April #-#+

+

April #&-*"

&

:0y #-#+

<

:0y #&-*#

 0nd ne license 0ppro%ed fro/ Q0nu0ry to :0rch

Qune #-#+

 0nd 0ppro%ed fro/ April to Qune

Qune #&-*"

Contr0ctors ith license nu/1er endin. "-* filin. on their ti/e schedule 0nd hose 0ccountin. period is on c0lend0r ye0r i$e$' fro/ Q0nu0ry #-Dece/1er *# /0y su1/it the pre%ious ye0r@s Audited !in0nci0l St0te/ents 3A!S4$ !or contr0ctors hose 0ccountin. periods 0re other th0n c0lend0r ye0r /0y su1/it the l0test A!S su1/itted to the Bure0u of Intern0l Re%enue5 Rele0se of the license certific0te for these contr0ctors is su1ect to the su1/ission of the current A!S filed ith the BIR 0nd th0t no si.nific0nt erosion of netorth or e7uity is suffered 1y the contr0ctor 0s not to 7u0lify it for its present c0te.ory5 Should the contr0ctor 1eco/e un7u0lified for its present c0te.ory due to fin0nci0l erosion' the 0pplic0tion sh0ll 1e re%ieed 1y the Bo0rd for issu0nce of the hi.hest c0te.ory sust0in01le 1y the contr0ctor@s 7u0lific0tion5 Contr0ctors filin. their rene0l 0pplic0tions 1eyond the schedule for their license nu/1er endin. sh0ll 1e 0ssessed 0n Addition0l Processin. !ee 3AP!4 of PhP +'"""$""5 0nd If the rene0l 0pplic0tion is filed 0fter the end of the C! hich is *" Qune' 0n Addition0l License !ee 3AL!4 hich e?isted 1efore the AP! ill still 1e i/posed or 0 tot0l of Php #"'""" ill 1e collected on top of the re.ul0r rene0l fees for e0ch c0te.ory$

<$ !ilin.)su1/ission of 0pplic0tion)s c0n 1e done 0t PCAB :0=0ti or thru the DTI Re.ion0l)Pro%inci0l Offices or thru PCAB Accredited Contr0ctors@ Associ0tions  Profession0l Or.0ni90tions$ $ Applic0tion !or/s (i.e. ARC, Amendments, Special License, etc.)' Citi9en@s Ch0rter' Bo0rd Resolutions' Ad%isories 0nd other rele%0nt infor/0tion 01out PCAB 0pplic0tion c0n 1e donlo0ded 0t $ci0p$dti$.o%$ph

$ !or further in7uiries or cl0rific0tions' ple0se co//unic0te ith us thru e/0il or thru cont0ct nu/1ers 1elo6 Construction Industry Authority of the Philippines P8ILIPPINE CONTRACTORS ACCRE:ITATION +OAR: +! E?ecuti%e Buildin. Center' *& Sen$ 2il Q$ Puy0t A%e$' :0=0ti City #(" Tel)Tele!0?6 +-8(+ ) +-8((" E-/0il Address6 pc01philVy0hoo$co/' pc01Vdti$.o%$ph

Note* :o !ot i!cl'e this #a&e i! $or a##licatio! fol'er" For refere!ce se o!l$"


I;PORTANT RE;IN:ERS ,+/

Co//on c0uses of docu/ent0ry deficiency resultin. to non-0ccept0nce)undue del0y in the filin.) processin. of 0pplic0tion for Ne Re.ul0r Contr0ctor@s License6

A" Le&al Reqireme!t* #$ No si.n0ture of Authori9ed :0n0.in. Officer 3A:O4)Proprietor on 0ll docu/ents 0nd 0pplic0tion for/s5 ($ Ori.in0l copies of the folloin. docu/ents ere not presented in lieu of the certified copies6 0$ Audited !in0nci0l St0te/ent 3A!S4)Inco/e T0? Return 3ITR45 1$ SEC Re.istr0tion' By-L0s 0nd 2ener0l Infor/0tion Sheet5 c$ Business N0/e Re.istr0tion5 d$ SSS' PHILHEALTH 0nd PA2-IBI2 :e/1ership of the fir/5 e$ Construction Occup0tion0l S0fety 0nd He0lth Se/in0r Certific0te5 f$ Offici0l Receipt Certific0te of Re.istr0tion 3ORCR45 .$ Tr0nsfer Certific0te of Title 3TCT45 h$ Deed of S0le5 *$ A:O f0iled the ritten e?0/in0tion5 +" Fi!a!cial Reqireme!t* #$ No Notes to !in0nci0l St0te/ent 3Audited !in0nci0l St0te/ents 3A!S445 ($ No Si.n0ture of the Auditor on the Audited !in0nci0l St0te/ent5 *$ E?pired Profession0l Re.ul0tion Co//ission 3PRC4 ID ) Bo0rd of Account0ncy 3BOA4 ) Accredit0tion5 8$ No Accounts Recei%01les)Schedule of In%entories5 C" Tech!ical Reqireme!t* #$ ($ *$ 8$ +$

Sust0inin. Technic0l E/ployee 3STE4 Affid0%it of Mndert0=in. not duly 0cco/plished5 No Person0l Appe0r0nce of STE5 E?pired PRC ID5 STE@s Affid0%it of or= E?perience not duly 0cco/plished5 No SSS R-*)CCL for the 7u0rter precedin. the 0pplic0tion

Ple0se /0=e sure to chec= the co/pleteness of your 0pplic0tion to 0%oid non-0ccept0nce$


PCAB-PAD-NE-!"# Re%ision No$ "&' "()#*)("#+ This Form is NOT for sale$ Reproduction is Alloed P0.e 9@ of 94

GUI:ELINES FOR CLASSIFICATION AN: CATEGORIDATION OF CONTRACTORS #$

Classification /e0ns the 0re0 of oper0tion th0t 0 contr0ctor c0n en.0.e is 10sed on the technic0l e?perience of his sust0inin. technic0l e/ployee 3STE4$ A contr0ctor /0y 0pply for 0nd 1e issued /ore th0n one cl0ssific0tion' one of hich sh0ll 1e desi.n0ted 0s his princip0l cl0ssific0tion$

($

Category indic0tes the .r0ded le%el of 0..re.0te c0p01ility of 0 contr0ctor ith respect to his princip0l cl0ssific0tion 0nd is 10sed on predeter/ined 7u0lific0tion criteri0 hich include fin0nci0l c0p0city' e?perience of STE' tr0c= record 0nd e7uip/ent$ E%0lu0tion of c0te.ory sh0ll 1e 10sed on the folloin. criteri0 7u0ntified 1y credit points in sc0les 0s deter/ined 1y the Bo0rd$ ($# Fi!a!cial ca#acit$ !in0nci0l c0p0city sh0ll 1e in ter/ of Netorth 10sed on the l0test 0udited fin0nci0l st0te/ents su1/itted to the Bure0u of Intern0l Re%enue 3BIR4' or p0id-up c0pit0l 10sed on the l0test 0udited fin0nci0l st0te/ents su1/itted to the Securities 0nd E?ch0n.e Co//ission 3SEC4' if 0 nely-or.0ni9ed p0rtnership or corpor0tion$ PCAB h0s the ri.ht to reect or reduce portion thereof if' upon %erific0tion' the reported 0ssets of the contr0ctor ere found to 1e erroneous or not 0de7u0tely supported ith 0ppropri0te docu/ents$ Correspondin. credit points is # for e%ery P#""'"""$"" of the %0lue of Netorth)Stoc=holder@s E7uity$ ($( Eqi#me!t Ca#acit$ E7uip/ent c0p0city sh0ll 1e in ter/ of 1oo= %0lue 0s reflected in the constructor@s l0test 0udited fin0nci0l st0te/ent su1/itted to the BIR or the SEC' hiche%er is 0pplic01le' or e7uip/ent oned hich 0re in oper0tion0l condition 0nd 0pplic01le to construction of the cl0ssific0tion in hich the constructor is to 1e c0te.ori9ed$ S0id oned e7uip/ent sh0ll include units under inst0ll/ent 0nd)or under le0se purch0se$ Correspondin. credit points is # for e%ery P#""'"""$"" of the NB> of the contr0ctor oned e7uip/ent$ ($* E0#erie!ce of firm E?perience of fir/ sh0ll 1e in ter/s of6 ($*$# A..re.0te nu/1er of ye0rs in hich the constructor fir/' under the s0/e 1usiness identify' h0s 1een 0cti%ely en.0.ed in construction contr0ctin. oper0tion$ Correspondin. credit points is #" for e%ery ye0r of 0ctu0l construction oper0tion 0s 0 licensed contr0ctor5 0nd ($*$( A%er0.e 0nnu0l %0lue of or= co/pleted 1y the fir/ durin. the p0st three 3*4 ye0rs or' if constructor@s license is less th0n three 3*4 ye0rs' since 1ein. licensed' 10sed on the 0udited fin0nci0l st0te/ents su1/itted to the BIR$ Correspondin. credit points is one 3#4 for e%ery P#""'"""$"" of the 0nnu0l %0lue of or= 0cco/plish/ent$ ($8 E0#erie!ce of tech!ical #erso!!el E?perience of technic0l personnel sh0ll 1e the su/ tot0l of indi%idu0l e?perience of e0ch STE no/in0ted to the cl0ssific0tion 0nd sh0ll 1e su1ect to the 7u0lific0tion re7uire/ent of e0ch c0te.ory 0s indic0ted in the PCAB Cl0ssific0tion 0nd C0te.ori90tion T01le$ S0id indi%idu0l e?perience of the STE sh0ll 1e 0s defined 0nd 7u0lified 1elo6 ($8$#$ The e?perience sh0ll 1e in ter/ of 0..re.0te nu/1er of ye0rs in hich the STE' in his present e/ploy/ent 0s ell 0s pre%ious' h0s 1een in%ol%ed i n construction is to 1e c0te.ori9ed$ ($8$($ It sh0ll include only the ye0rs in hich he 0s perfor/in. in /0n0.eri0l)super%isory c0p0city 1e0rin. on construction oper0tion 0nd)or contr0ct i/ple/ent0tion$ ($8$*$ It sh0ll 1e su1ect to 0 credit01le ceilin. of thirty 3*"4 ye0rs' o%er hich no e?cess sh0ll 1e reco.ni9ed$ Correspondin. credit point is fi%e 3+4 for e%ery ye0r of e?perience in construction$ The c0te.ory of 0 contr0ctor sh0ll 1e deter/ined on the 10sis of the nu/1er of points credited on the 0..re.0te)co/1ined e?perience of 0ll its 7u0lified STE$ Only STEs ho /eet the /ini/u/ indi%idu0l e?perience re7uired sh0ll 1e considered in deter/inin. 0..re.0te e?perience 0nd credit points$ Thus' in order to 7u0lify to the technic0l c0p0city re7uire/ent for c0te.ory FAAAG' the contr0ctor /ust h0%e 7u0lified STEs hose indi%idu0l e?perience is not less th0n ten 3#"4 ye0rs ith 0 credit01le ceilin. of thirty 3*"4 ye0rs 0nd h0%e 0n 0..re.0te)co/1ined e?perience of 0t le0st si?ty 3&"4 ye0rs$

*$

In deter/inin. 0 contr0ctor@s c0te.ory' his 7u0lific0tion /ust s0tisfy 0ll the /ini/u/ re7uire/ents' correspondin. to the cl0ssific0tion 0nd c0te.ory 0pplied for' 7u0lified 0nd r0ted 0ccordin. to e7ui%0lent credit points 0nd sh0ll 1e the loest sust0in01le 1y 0ll three deter/in0nts 0s follos6 *$# *$( *$*

!in0nci0l C0p0city E?perience of STE O%er0ll credit points 10sed on the four 7u0lific0tion criteri0 referred to in ite/ ( of these .uidelines$


PCAB-PAD-NE-!"# Re%ision No$ "&' "()#*)("#+ This Form is NOT for sale$ Reproduction is Alloed P0.e 9< of 94

CATEGORIDATION = CLASSIFICATION TA+LE

CLASSIFICATION

C A T E G O R ?

3(4 STE :in$ Const$ E?p$ Re7uire/ent

3#4 !in0nci0l C0p0city

Stoc=holder@s E7uity

Credit Points 3C$P$4 Re7@d$

Indi%idu0l

A..re.0te

:in$ C$P$ Re7@d$

3*4 O%er0ll Credit Points Re7uired

P"'"""'"""$""

""$""

#"

&"

*""

#'+"$""

AA

8+'"""'"""$""

8+"$""

#"

+"

(+"

#+$#+

A

'"""'"""$""

"$""

<

(#

#"+

(&+$""

B

8'+""'"""$""

8+$""

+

#"

+"

#(($+"

GE.< 30ter Supply4

C

*'"""'"""$""

*"$""

*

*

#+

<+$+"

GE.4 3Port' H0r1or or Offshore En.ineerin.4

D

""'"""$""

$""

*

*

#+

(8$""

P"'"""'"""$""

""$""

#"

&"

*""

#'#"$""

A" GENERAL ENGINEERING GE.2 3Ro0d' Hi.h0ys' P0%e/ent' R0il0ys' Airport Hori9ont0l Structure' 0nd Brid.es4 GE.9 3Irri.0tion or !lood Control4 GE.@ 3D0/' Reser%oir or Tunnelin.4

AAA

;INI;U; UALIFICATION REUIRE;ENTS

+" GENERAL +UIL:ING

AAA

G+.2 3Buildin. or Industri0l Pl0nt4

AA

8+'"""'"""$""

8+"$""

#"

+"

(+"

+$""

A

'"""'"""$""

"$""

<

(#

#"+

(&#$""

B

8'+""'"""$""

8+$""

+

#"

+"

#("$+"

C

*'"""'"""$""

*"$""

*

*

#+

&&$+"

D

""'"""$""

$""

*

*

#+

(8$""

P"'"""'"""$""

""$""

#"

&"

*""

#'+#"$""

AA

8+'"""'"""$""

8+"$""

#"

+"

(+"

&+$""

A

'"""'"""$""

"$""

<

(#

#"+

(##$""

B

8'+""'"""$""

8+$""

+

#"

+"

##"$+"

C

*'"""'"""$""

*"$""

*

*

#+

&"$+"

D

""'"""$""

$""

*

*

#+

(8$""

TRADE

8+'"""$""

"$8"

none

none

none

"$8+

G+.9 3Seer0.e or Se0.e Syste/4 G+.@ 30ter Tre0t/ent Pl0nt  Syste/4 G+.< 3P0r=' Pl0y.round or Recre0tion0l or=4

C" SPECIALT? SP.FW 3!ound0tion or=4

AAA

SP.SS 3Structur0l Steel or=4 SP.CC 3Concrete Pre-c0stin.' PreStressin. or Post-tensionin.4 SP.PS 3Plu/1in.  S0nit0ry or=4 SP.EE 3Electric0l or=4 SP.;E 3:ech0nic0l or=4 SP.AC 3Air-conditionin. or Refri.er0tion4 SP.ES 3Ele%0tor or Esc0l0tor4 SP.FP 3!ire Protection or=4 SP.WP 30terproofin. or=4 SP.PN 3P0intin. or=4 SP.W: 3ell-Drillin. or=4 SP.CF 3Co//unic0tion !0cilities4 SP.;S 3:et0l Roofin.  Sidin. Inst0ll0tion4 SP.S: 3Structur0l De/olition4 SP.LS 3L0ndsc0pin.4 SP.E; 3Electro :ech0nic0l or=4 SP.NF 3N0%i.0tion0l !0cilities4

:" SP.TRA:E

 :ini/u/ u0lific0tion Re7uire/ents for Princip0l Cl0ssific0tion  !or Other Cl0ssific0tion)s' :ini/u/ of * e0rs Actu0l Construction E?perience  O%er0ll credit points inclusi%e of E7uip/ent C0p0city 3# point)P#""Th45 E?perience of !ir/ 3#" points)ye0r of 0cti%e e?istence45  # point)P#""Th of * ye0r A%er0.e Annu0l >olu/e of or= Acco/plished5 0nd CO:TCP points if STEs 0re CO:TCP certified



!ilin. !ee Princip0l Other)s Cl0ssific03ch0r.e01le for tion !ee e0ch cl0ssific0tion4 C0te.ori90tion !ee License !ee GRAN: TOTAL ,Ph#/K

CATEGOR? A + &"" &"" (8" #("

AAA &"" ('8""

AA &"" #'(""

C &"" <(

: E>Tra'e &"" &"" (8 n)0

#'(""

&""

#("

&"

*&

#(

n)0

(#'&"" +" 94(45

#"'"" +" 2@(945

*'&"" +" <(25

('8"" +" @(9@5

#'("" +" 2(4

&"" +" 2(9

n)0 +" 45

Docu/ent0ry St0/p T0? 3Php #+4 W Le.0l Rese0rch !und 3Php #"4 ill 1e 0dded' if 0pplic01le$

:ELIER? OF LICENSE CERTIFICATE T8RU COURIER ,L+C/ +a!k > Acco!t Nm)er • • • •

PNB ) #"<+<#"""#( BDO ) 8"#(+<< BPI ) **##"(8"<< RCBC ) "(<&"8#<

Rates ,L+C Air Frei&ht Rates ,9< hors 'eli-er$/ . :omestic/* •

A S#er SiBe ! NCR - Php #("5 ! Lu9on - Php #*"5 ! >is0y0s - Php #*+5 ! :ind0n0o - Php #*+$

Im#orta!t Remi!'er 6 Ple0se 1e 0d%ised th0t 0fter p0y/ent' 0 %0lid0ted copy of 10n= deposit slip should 1e 0tt0ched to the 0pplic0tion folder$


New Contractor's License Application Form

Recommend Documents