Dti Application for Contractor's License

PCAB Form No. 101

APPLICATION FOR CONTRACTOR'S LICENSE with the PHILIPPINE CONTRACTOR'S ACCREDITATION BOARD The following pertinent documents and information are to be submitted in support of the license application of said firm: Checklist for New License Application A. Legal

[ ] 1. General Information (PCAB Form Nos. 101a and 102); [ ] 1.1 • For Sole Proprietorship: Certified true copy of BTRCP Certificate of Registration with pertinent BTRCP Form No. 16; • For Partnership or Corporation: Certified true copy of SEC Certificate of Registration and Articles of Partnership/Incorporation and By-Laws showing Construction as Primary Purpose and subsequent amendments thereto; [ ] 2. Authorized Managing Officer (AMO) (AMO) Nomination: [ ] 2.1 AMO Affidavit (PCAB Form No. 103) 103) with a passport size picture of AMO; • For corporations only: Original Corp. Secretary's certificate as to the nomination of the AMO (PCAB Form No. 104); [ ] 2.2 Original NBI clearance of Filipino AMO; [ ] 2.3 If AMO AMO is Non-Filipino (in (in addition to 2.1): [ ] 2.3.1 Working visa [ ] 2.3.2 Alien Certificate Certificate of Registration; [ ] 2.3.3 NBI clearance if AMO has resided in the Philippines for six (6) (6) months or longer if not, equivalent clearance from AMO's home country duly authenticated by the Philippine embassy.

Note:

For Corporations or Associations with foreign shareholders, the following documents must be submitted: 1. Corporate Secretary’s Certification as follows: a. List of stockholders stockholders showin showing g their nationaliti nationalities es and sharehold shareholdings; ings; and and b. List of of Board Board of Directors Directors showing showing their names and and nationalit nationality. y. 2. Copy of latest latest General General Information Information Sheet Sheet duly filed filed with SEC SEC showing showing the names of stockholde stockholders rs and directors, nationality and shareholdings. • The percentage control of the number of seats occupied by foreigners in the Board of Directors must not exceed the percentage of foreign shareholdings. •

B.

Financial

[ ] 3. Financial Statements dated within the last six (6) months immediately preceding the filing filing of application (duly audited and signed on every page by an Independent and PRC-BOA accredited external auditor) and a diskette/CD (compact disc) containing the firm’s Audited Balance Sheet & Income Statement Statement in the prescr ibed ibed template (PCAB Financial Statement Forms A & B downloadable from the DTI website at www.dti.gov.ph together with pertinent application forms). [ ] 3.1 For old companies, copy of the Quarterly or Annual Income Tax Return certified true by the BIR, covering the income reported in the Audited Income Statement submitted for the quarter or taxable year immediately preceding the filing of application, whichever is applicable; [ ] 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” will be deducted from the networth, If insupported.)

[ ] 3.2.1 Authorization to Depository Bank (PCAB Form No. 105); [ ] 3.3 List of Land and Building/s owned by the company and registered in its name (PCAB Form No. 106a); [ ] 3.3.1 Certified true copy of TCT TCT including back page; [ ] 3.3.2 Deed of Sale or Certified True Copy (CTC) (CTC) of Tax Declaration of Land / Bldg., owned by the firm. firm. [ ] 3.4 List of Construction and/or Transportation/Delivery Transportation/Delivery Vehicles/Equipment/Machineries/Plants Vehicles/Equipment/Machineries/Plants owned by the company and registered in its name (PCAB Form No. 106b); [ ] 3.4.1 Certified true copy by the LTO of the LTO Certificate Certificate of Registration and current Official Receipt of Registration of registrable Construction and/or Transportation/Delivery Vehicles/Equipment reported; [ ] 3.4.2 Certified true copy of Deed Deed of Sale or sales invoices/official receipts for non-registrable construction equipment/machineries/plants; [ ] 3.5 Additional documents to be submitted only if the values of each of the applicant's Inventories and Receivables Accounts exceed more than 20% of the contractor’s Networth, otherwise, the amount in excess of said account shall be deducted from networth. [ ] 3.5.1 Schedule of Inventories. (PCAB Form 107); [ ] 3.5.2 Schedule of Receivables. (PCAB Form 107); [ ] 4. Authorization to BIR & other agencies (PCAB Form No. 105a); C.

Technical

[ ] 5. List of Sustaining Technical Employee/s - STE (PCAB Form No. 106c) supported by the following documents for each STE: [ ] 5.1. STE Affidavit/s (PCAB Form No. 108) with a passport size picture/s of the nominated STE/s; [ ] 5.1.1 Certified true copy by PRC PRC of valid PRC ID of STE STE as licensed professional or original original Certification of Good Standing from PRC; [ ] 5.1.2 Original NBI Clearance/s of newly newly nominated STE/s; STE/s; [ ] 5.2 STE Affidavit/s of Construction Experience (PCAB (PCAB Form No. 109); [ ] 5.3 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 (PCAB Form No. 110) D. Original Signature of AMO on each and every page of the application forms including

supporting documents (except item 5.3) • 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; • 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 the original copies are presented for • authentication

DO NOT FILL (For PCAB use only) Tot Total al No. of Pages ages Subm ubmitte itted: d: ____ ______ ___ _ [ ] Self-stamped envelopes * (no. ______ )

Remarks:

_________________________________

Chec Checkl klis iste ted d by: ____ ______ ____ ____ ____ ____ ____ ___ _____ ______ ____ ____ ____ ___ ___ Signature Over Printed Name/Date

___________________________________

Applicants interested to participate in government projects should accomplish Form. No. 601 (Application for Registration and Classification of Government Projects) and file the same together with the PCAB Application Form.

Revised 11/16/07

Not for sale . May be reproduced for additional sheets


PCAB Form No. 101a

In behalf of _______________________ _____________________________________ ___________________________ _______________________, __________, (Name of Firm) I hereby request that its application for Contractor's License be approved. I hereby certify to the completeness of the information/documents contained in this application appertaining to the category/classification the company is applying for and that they are true and correct. I am fully aware that: 1. all all docu docume ment nts s subm submit itte ted d in supp suppor ortt of this this appl applic icat atio ion n are are subj subjec ectt to verification before PCAB action; 2. any any disco discover vered ed misre misrepre prese senta ntatio tion n of infor informat mation ion and/or and/or manife manifesta statio tions ns of fraud fraud on the applic applicati ation on docum document ents s submi submitte tted d by my firm firm appli applica cant nt or its Auth Author oriz ized ed Repr Repres esen enta tati tive ve/A /Age gent nt/L /Lia iais ison on Offi Office cerr shal shalll be subj subjec ecte ted d to inve invest stig igat atio ion n which hich may may resu result lt to the the disa disapp ppro rova vall of my appl applic icat atio ion, n, denial/suspension/revocation of license and blacklisting of my firm and myself as its Authorized Managing Officer; and 3. unco unconf nfir irme med d info inform rmat atio ion/ n/do docu cume ment nts s subm submit itte ted d to supp suppor ortt my firm firm's 's qualifications qualifications will be excluded for categorization/classific categorization/classification ation purposes. 4. the evaluatio evaluation n of my applicat application' ion's s qualificati qualification on shall be solely solely based on the documents submitted at the time the application was filed/accepted filed/accepted by PCAB.

_______________________________ Authorized Managing Officer (Signature over Printed Name)

Republic of the Philippines) ______________________)S.S. SUBSCRIB SUBSCRIBED ED AND SWORN SWORN TO before before me this ________ ________ day of _______ ___________ ________ ________ ____ 20____ at ______________________; affiant exhibited to me his Community Tax Certificate No. _______________ issued at __________________ on _________________ 20 ___. DOC. NO. _______________; PAGE NO._______________; BOOK NO._______________;

Not for sale. May be reproduced for additional sheets

__________________________ NOTARY PUBLIC (Until December 31, _______) _______)

PCAB Form No. 102

GENERAL INFORMATION A. CONTRACTOR’S IDENTIFICATION IDENTIFICATI ON Name of Firm: Office Address:

Tel./Fax No.:

If Provincial based, contact address in Manila, if any:

Tel./Fax No.:

Website:

E-mail Address:

Type of Organization (Please Check):. [ ] Corporation

[ ] Partnership

SEC/BTRCP Registration No.:

[ ] Sole Proprietorship

Date of Registration:

SSS Employer’s I.D.No.: CATEGORY APPLIED FOR

[ ] Joint Venture

SEC/BTRCP Expiry Date: Tax Identification No.:

CLASSIFICATION/S APPLIED FOR:

______________

Principal Principal Classification: Classification: Other Classification/s Classification/s :

B. OWNERS/STOCKHOLDERS/OFFICERS* (For Corporation, Partnership and Joint Venture) Capital Name Position Nationality Subscription

Paid-Up Capital

C. DIRECTORS / OFFICERS Name

Position

Nationality

Tax Identification No. for Filipinos/ Passport No. for Foreigners

CERTIFIED CORRECT BY: ____________________________________

Authorized Managing Officer Not for sale . May be reproduced for additional sheets

(Signature over Printed Name)

PCAB Form No. 103

Passport size Picture of AMO

Repu Republ blic ic of of the the Phil Philip ippi pine ness ) Province of of __ ______________ Muni Municcipal ipalit ity y of ____ _____ _____ ______ __

) ) S.S. S.S.

AMO AFFIDAVIT I, ____________________________ __________________________________________________________ ____________________________________________________________ ________________________________, __, LAST NAME

FIRST NAME

COMPLETE MIDDLE NAME

Filipino, of legal age, born on __________________________ _________________________________________________________ __________________________________ ___ single/married to __________________________ _________________________________________________________ _____________________________________________________________ _______________________________________ _________ LAST NAME

FIRST NAME

COMPLETE MAIDEN NAME

and residing at __________________________________________________________________________ __________________________________________________________________________ having duly sworn in accordance with law depose and say: 1. That I am the Authorized Authorized Managing Managing Officer (AMO) (AMO) of _____________ __________________ __________ __________ __________ __________ _______ __ empowered empowered to render general management and administrative decisions. 2. That I possess possess the following following educational educational qualificati qualifications: ons: NAME OF SCHOOL

ADDRESS

DEGREE EARNED

INCLUSIVE DATES OF ENROLLMENT

3. That I possess at least two (2) years of of experience in the construction industry as follows (Sec. 20, R.A. 4566): POSITION

COMPANY/ NATURE OF BUSINESS

ADDRESS

JOB DESCRIPTION

DATES OF EMPLOYMENT

(use additional sheet if necessary)

4. That I possess knowledge of the building, safety, health health , & lien laws of the Republic of the Philippines & the rudimentary administrative principles of construction contracting contracting from my work experiences in item 3 above and from the following training/seminars (Sec. 20, RA 4566): TRAINING/SEMINAR

CONDUCTED BY

ADDRESS

INCLUSIVE DATES OF TRAINING

5. That I am not involved involved in any any construction construction malperfor malperformance mance suggestive suggestive of negligen negligence, ce, incompetenc incompetencee or malpractice malpractice or any act of omission liable for disciplinary action by myself or in collaboration with any other other person (Rule 4, Section 4.2) 6. That I have have not been been convicted convicted by a court of of competent competent jurisdict jurisdiction ion of any any offense offense involving involving moral moral turpitude turpitude (Rule 4, 4, Section 4.2) 7. That I am fully aware aware that my failure failure to notify notify PCAB of my disassociat disassociation ion with my present present employer employer shall shall cause my disqualification to be an Authorized Managing Officer, a Sustaining Technical Employee or a license applicant with PCAB (For corporations and partnerships only) 8. That I authorize authorize the the PCAB to verify verify and investigat investigatee any or all informatio information n in this instrumen instrumentt from whatever whatever sources sources PCAB may consider appropriate; 9. That I certify certify under under pain of perjury perjury that all all information information on this this affidavit affidavit are true true and correct. correct. FURTHER AFFIANT SAYETH NAUGHT. _________________________________ Affiant SUBSCRIBED and sworn to before me this _____ day of _________________, 200 ___ affiant exhibited his/her Community Tax Certificate No. __________ issued at _____________________ on ________________. Doc. No. __________; Page No. __________; Book No. __________; __________; Series of 200 __. Not for sale . May be reproduced for additional sheets

Notary Public Until December 200__

PCAB Form No. 104

For Corporations Only AMO NOMINATION I ____________________________________________________, Filipino, of legal age, single/married and residing at -____________________________________________________________ do hereby certify, in my capacity as the duly elected and incumbent Board Secretary of __________________________________________________________________________, (Name of Firm)

that during the regular board/partners' meeting held on ___________________ wherein a quorum was present, the following resolution was unanimously approved, to wit:

"R E S O L V E as it is hereby resolved that _______________________ ___________________________________ ________________________ _________________________ __________________, _____, (Surname,

First Name,

Middle Name)

a senior executive who has been granted the power to render general management and admini administr strati ative ve decisio decision, n, be appoint appointed ed as the firm's firm's authori authorized zed sole sole managem management ent representative to act on all matters concerning the requirements of the PCAB and implementation of R.A. 4566 as amended by P.D. 1746." In WITNESS WHEREOF, I have hereunto affixed my hand this ______________ day of ___________________ 200___, in ______________________________, Philippines.

_________________________________ Board Secretary

(Signature Over Printed Name) SUBSCRIB SUBSCRIBED ED and sworn to before before me this ________ ________ day of ______________ ____________________ _____________ ______________ ___________ ____ at __________________________________________________, affiant exhibited to me his/her Community Tax Certificate. No. ____________ issued on _________________________ at ______________________________________________.

Doc. No No. __________ Page No. __________ Book No. __________ Series of 200 __.

Revised 10/01/2007


NOTARY PUBLIC Until December 200 ____

PCAB Form No. 105

THE MANAGER

_________________________________ _________________________________ _________________________________

Subject: Account # _______________________ _______________________ Sir: Please provide the Philippine Contractors Accreditation Board (PCAB), a government agency under the Department of Trade and Industry, any information they need regarding the subject account with your bank. 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. This will serve as your authorization to release any information that may be requested by PCAB regarding the above subject account. Thank you.

Very truly yours,

___________________________________ Signature over Printed Name ________________________ __________________________________ __________ Company Name

___________________________________ Date

Note: To be submitted in two (2) copies.

Revised 10/01/2007


PCAB Form No. 105a

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.Bureau of Internal Revenue 2.Securities and Exchange Commission 3.Land Registration Authority 4.Land Transportation Office 5.Social Security System

Name of Applicant Firm

_____________________________________

By:

_____________________________________ Signature over Printed Name of Proprietor or Authorized Managing Officer

Date: _________________________________

Not for sale . May be reproduced for additional sheets Revised 10/01/2007

PCAB Form No. 106a

LIST OF LAND, BUILDING AND OTHER IMPROVEMENTS OWNED BY AND REGISTERED IN THE NAME OF THE COMPANY AS OF THE BALANCE SHEET DATE

TCT/CCT NUMBER

COMPLETE DESCRIPTION (Type of land/building land/building and area)

LOCATION (St. #, Barangay, Municipality/ City, Province)

ACQUISITION COST

Please reproduce if additional sheets are needed.

_________________________________________ Signature over Printed Name of AMO

_________________________________________ Company Name _________________________________________ PCAB License No. (If applicable) ________________________________________ Date Signed

CFY ___________________ CFY ___________________ Type of Application: (Pls. check) -

New Upgrading Renewal Others, pls. specify _______________________


ACQUISITION DATE

Revised 10/01/2007

PCAB Form No. 106b

LIST OF DELIVERY AND TRANSPORTATION EQUIPMENT OWNED BY AND REGISTERED IN THE NAME OF THE COMPANY ASOF THE BALANCE SHEET DATE

ACQUISITION

COMPLETE DESCRIPTION Plate No.

Chassis No.

Engine No.

M.V. File No.

CR No.

Date

TOTAL

BOOK VALUE

Cost P

P

P

P

LIST LIST OF MA MACH CHIN INER ERIE IES/P S/PLA LANT NTS S AND AND OTHE OTHER R CONS CONSTR TRUC UCTI TION ON EQUI EQUIPM PMEN ENT T OWNE OWNED D BY THE THE COMPANY AS OF THE BALANCE SHEET DATE

COMPLETE DESCRIPTION

SERIAL NO.

ACQUISITION Date

TOTAL

Cost P

P

P

P

Please reproduce if additional sheets are needed. Revised 10/01/2007

_________________________________________

Signature over Printed Name of AMO _________________________________________

Company Name _________________________________________

PCAB License No. (If applicable) ________________________________________

Date Signed

CFY _________________ Type of Application: (Pls. check) New Upgrading Renewal Others, pls. Specify __________________________ Not for sale . May be reproduced for additional sheets

BOOK VALUE

PCAB Form No. 106c

LIST OF NOMINATED SUSTAINING TECHNICAL EMPLOYEES OF THE COMPANY

PRC REGISTRATION NAME Number

Date

Profession

Date Employed

Please reproduce if additional sheets are needed.

_______________________________________ Signature over Printed Name of AMO _______________________________________ Company Name _______________________________________ PCAB License No. (If applicable) ______________________________________ Date Signed

CFY __________________ Type of Application: (Pls. check) New Upgrading Renewal Others, pls. Specify __________________________ Not for sale . May be reproduced for additional sheets

Position in the Firm

Revised 10/01/2007

PCAB Form No. 107

SCHEDULE OF RECEIVABLES To be accompl accomplish ished ed if the applic applicant ant's 's receiv receivabl able e accoun accounts ts (accou (accounts nts/co /contr ntract acts s & other other receiv receivabl able) e) exceed exceed 20% of the total total networth/equity as of the latest audited balance sheet submitted in support of its application.

TYPES

AMOUNT

AGE

NAME/ADDRESS OF DEBTOR/CLIENTS

Notes: * All receivable receivable accounts must be substantiated by confirmation of debtors/clients Please use additional sheets if necessary

Certified Correct by: _______________________________ Printed Name and Si Signature of External Au Auditor

___________________________ Printed Name and Signature of AM AMO

SCHEDULE OF 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.

Types

Amount

Age/Date Acquired

Intended Use or

Purpose for Storing

Physical Condition

Place of Storage

Please use additional sheets if necessary

Certified Correct by: _______________________________ Printed Name and Si Signature of External Au Auditor

___________________________ Printed Name and Signature of AM AMO

* The above schedules should be certified by the firm’s external auditor and signed by the authorized managing officer.l


PCAB Form No. 108

Passport size Picture of STE

Repu Republ blic ic of of the the Phil Philip ippi pine ness ) Province Province of _____ _________ ________ ____ ) Municipality of ___________) S.S.

STE AFFIDAVIT I,_____________________________________________________________ I,_______________________________ _____________________________________, _______, Filipino, of legal age, LAST NAME

FIRST NAME

born on

COMPLETE MIDDLE NAME

single/married to __________________________________________and M M / D D/ Y Y

Y Y

residing residing at __________ _______________ __________ __________ __________ __________ __________ __________ __________ __________ __________ __________ ________ ___ having having duly sworn in accordance with law depose and say: 1. That I am a duly duly licensed __________________________ __________________________ and holder holder of PRC registration no. no. ___________ (PROFESSION)

valid up to _______________ (copy of my PRC is attached at the back hereof); 2. That I hold a Bachelor's Degree Degree in ____________ _________________ __________ __________ __________ __________ __________ __________ __________ __________ _____ at ______________________________________________________ __________________________________ ____________________ given given on _____________________; (NAME OF SCHOOL) 3. That my Tax Identification Number (T ( TIN) and Social Security No. are and respectively; 4.

That That I am not presentl presently y employ employed ed in any governm government ent office office or gover governme nment nt owned/co owned/contr ntroll olled ed corpora corporatio tion, n, nor a full full time time instructor, nor working abroad;

5. That I am employed by __________________________ ________________________________________________________ _______________________________________ _________ (NAME OF FIRM)

on regular regular and full-time full-time basis with the position position of __________ _______________ __________ __________ __________ ________an ___and d presently presently being nominated as Sustaining Technical Employee for CFY _____________; 6.

That I am not a holder of a contractor's license;

7. That I am not involved involved in in any constructio construction n malperformanc malperformancee suggestiv suggestivee of neglige negligence, nce, incompet incompetence ence or malpractice malpractice or any act of omission liable for disciplinary action by myself or in collaboration with any other person; 8. That I have have not not been convicted convicted by a court court of competen competentt jurisdicti jurisdiction on of any offense offense involv involving ing moral moral turpitude; turpitude; 9.

That I am fully aware that my failure to notify notify the PCAB of my disassociation with my present employer shall cause my disqualification to be sustaining technical employee or authorized managing officer or a license applicant with PCAB;

10. That I authorize the PCAB to verify and investigate investigate any or all information in this affidavit from whatever sources PCAB may consider appropriate; 11. That I am executing this affidavit to attest to to the truth of the foregoing. FURTHER AFFIANT SAYETH NAUGHT.

_________________________________ Affiant SUBSCRIBED and sworn to before me this _____ day of ___________________, 200___ affiant exhibited his/her Community Tax Certificate No. _____________ issued at ___________________ on ______________. Doc. No. __________; Page No. __________; Book No. __________; __________; Series of 200 _______.

Notary Public Until December 200 ___

CFY ___________________ Type of Application: (Pls. check) New Upgrading Renewal Others, pls. specify _____________________ Revised 10/01/2007


INSTRUCTIONS ON FILLING UP PCAB FORM NO. 108

QUALIFICATION REQUIREMENTS OF SUSTAINING TECHNICAL EMPLOYEE 1. A technology technology professiona professional, l, such as engineer engineer or architect, architect, duly licensed licensed by the Profession Professional al Regulation Regulation Commission Commission.. 2. Holder Holder of of a Profess Profession ional al I.D. I.D. valid valid for curre current nt year. year. 3. Possesses Possesses at least least three (3) years years of experience experience in implemen implementation tation of of construction construction to to which he is to to be nominated nominated 4. A full-time full-time employee employee of the nominating nominating contractor, contractor, not associated associated profess professionall ionally y or by employment employment with any other other party, particularly a party engaged in construction or construction-related activities 5. Have Have none none of the foll followi owing ng disqu disquali alific ficati ations ons:: a)

Invo Involv lvem emen ent, t, in any any capa capaci city ty,, in any const constru ruct ctio ion n malp malper erfo form rman ance ce of grav gravee cons conseq eque uenc nce, e, sugge suggest stiv ivee of his negligence, incompetence and/or malpractice; b) Involvement, Involvement, by himself himself or in collabo collaboration ration with with any other other person or firm, firm, in any act or omissio omission n liable for for disciplinary action of which he is or the other person or firm was found guilty by the Board; c) Conviction Conviction by a court court of competent competent jurisdict jurisdiction ion of any offense offense involving involving moral moral turpitude turpitude;; and d)

If formerly a Sustaining Technical Employee or an Authorized Managing Officer of any construction firm but disassociated therefrom, failure to notify the Board of his disassociation in accordance with paragraph 5 and 6 of the Affidavit of Undertaking.

6. Not a holde holderr of a Contra Contractor ctor’s ’s Lice License nse.. If you meet the above requirements, kindly accomplish this affidavit. Erasure must be properly initialled. All statements are subject to verification and any false statement or willful misrepresentation of a material fact in obtaining a license shall be grounds for disapproval of this application.

PASTE

PASTE

PROF. I.D. CARD

PROF. I.D. CARD

VALID FOR

VALID FOR

CURRENT YEAR

CURRENT YEAR (Back) (xerox copy)

(Front) (xerox copy)

This is to certify that I have verified with PRC the abovestated professional eligibility/registration of the Sustaining Technical Employee. Affiant herein and found the same to be true and correct.

__________________________________________ Signature over Printed Name of the AMO Date: _______________________


PCAB Form No. 109

Republic of of th the Ph Philippines ) Province of of __ _____________ ) Municipality of ___________) S.S.

AFFIDAVIT OF STE CONSTRUCTION EXPERIENCE I, _______ ___________ _______ _______ _______ _______ _______ _______ _____, _, single/ single/mar marrie ried, d, Filipi Filipino, no, of legal legal age, with with postal postal address address at ________________________________________________, having been duly sworn in accordance with law depose and say that the projects enumerated below constitute my full & complete construction experience. NAME and COMPLETE ADDRESS of EMPLOYER/ NAME & LOCATION of PROJECTS UNDERTAKEN

Work Classification (GE, GB, SP)

Nature/Scope of Work Assignment (Proj. Engr.)

PROJECT DURATION (mm/dd/yy)

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; That I am executing this affidavit to attest to the truth of the foregoing. FURTHER AFFIANT SAYETH NAUGHT.

_________________________________ Affiant SUBSCRIBED and sworn to before me this _____ day of _________________, 200__ affiant exhibited his/her Community Tax Certificate No. ______________ issued at ____________________ on ____________________. Doc. No. __________; Page No. __________; Book No. __________; Series of 200 _______.


CFY ___________________

Company Name ____________________________ Name ____________________________

Type of Application: (Pls. check)

PCAB License No. __________________________

New Upgrading Renewal Others, pls. specify

___________________________ Revised 10/01/2007


PCAB Form No. 110

SUSTAINING TECHNICAL EMPLOYEE (STE) PERSONAL APPEARANCE FORM (To be accomplished fully by the STE)

Name: ______________________________________________ Sex: __________________ Address: ____________________________________________________________________ Profession: __________________________________ PRC Reg. : _____________ Nominating Firm: ____________________________________________________________ Contractor's License No.: ______________________ I hereby confirm the following: 1. The veracity veracity of the informati information on reflected reflected on the STE Affidavit Affidavit and Affidavit Affidavit of Construct Construction ion Experience Experience (PCAB Form Nos. 107 & 108, copies attached) that I executed in favor of the above firm; 2. That That I am fully fully aware that my failure failure to notify notify the PCAB of my disass disassoci ociati ation on from the above-st above-state ated d nomina nominati ting ng firm firm and any misrep misrepres resent entati ation on in the attach attached ed forms forms shall shall cause cause my disqua disqualif lifica icatio tion n as sustaining technical employee, or authorized managing officer, or a licensee applicant with PCAB per Board Resolution No. 401, Series of 2001. 3. That I have have been previo previously usly connect connected ed with with the followi following ng companie companies: s: Previous Employers

Date of Employment

Date of Resignation

Position

4. Other Remarks:

___________________________________________________________________________ ______________________________________________________________________ _____

______________________________ STE's Signature

Date Signed: _______________________

Identification Documents Presented : PRC ID No. ____________________ valid until ______________________

1. ________ ____________ _______ _______ ________ ________ _______ ___ Personal Appearance and Presentation of Two (2) Identification Documents attested by PCAB designated staff or DTI Regional/Provincial Staff

_______________________________ Signature over Printed Name/Position

DTI Office Address: ______________________________________________ Date: ____________________________ Not for sale . May be reproduced for additional sheets

PCAB Form 111-A (For sole proprietorship)

Republic of the Philippines) s.s. ______________________)

AFFIDAVIT I, ____ _______ _____ _____ ______ ______ ______ _____ _____ _____ ____ ___, _, of lega legall age, age, Filip Filipino ino,, marr married ied/s /sing ingle le with with post postal al addr address ess at ____________________________________, after having been sworn to in accordance with law, hereby depose and say: 1.

That I am the Proprietor/Authorized Managing __________________________________________________________; (Name of Firm)

Officer

(AMO)

of

2. That I appoint appoint ____________ __________________ ____________ __________, ____, whose whose picture picture and signature signature appear below, below, to transact transact business with PCAB; i.e, present for pre-screening my application for contractor’s license or any application related related thereto, thereto, file/foll file/follow-up ow-up,, submit submit documents, documents, receive notices/li notices/license cense in connection connection with the said application and the like.

Passport size Picture of Representative

__________

______________________________ (Signature over Printed Name) ______________________________ ______________________________ HOME /MAILING ADDRESS

3. That I am aware aware that I am respons responsible ible/liab /liable le for any or all all acts/repres acts/representat entation ion made by my my representat representative ive in connection with the functions stated herein. 4. That I undertak undertake e to notify PCAB PCAB in the event event that this this appointment appointment is modifi modified, ed, amended amended or revoked. revoked.

_______________________________________ AFFIANT

SUBSCR SUBSCRIBE IBED D and sworn to before before me this this ______ ______ day of __________ ____________, __, 20___, 20___, affiant affiant exhibited exhibited his/her his/her Community Tax Certificate No. _______________ issued at ___________ on ___________________. Doc No. __________ Page No. _________ Book No. _________ Series of _________


(Note: Please submit original and one duplicate to PCAB. Keep another copy for presentation everytime you transact with PCAB)


PCAB Form 111-B (For corporation.,partnership,cooperative joint venture or consortium) Republic of the Philippines) s.s. ______________________)

AFFIDAVIT

I, ____ _______ _____ _____ ______ ______ ______ _____ _____ _____ ____ ___, _, of lega legall age, age, Filip Filipino ino,, marr married ied/s /sing ingle le with with post postal al addr address ess at ____________________________________, after having been sworn to in accordance with law, hereby depose and say: 1.

That I am the Authorized Managing ________________________________________; (Name of firm)

Officer

(AMO)

of

__________

2. That That the abovestat abovestated ed firm firm had duly duly appoin appointed ted ______ _________ ______ ______ ______ ______ ______ ______ ____, _, whose whose pictur picture e and signature appear below, to transact business with PCAB; i.e, present for pre-screening its application for contra contracto ctor’s r’s licen license se or any appli applicat cation ion relate related d theret thereto, o, file/f file/foll ollowow-up, up, submi submitt docume documents nts,, receiv receive e notices/license in connection with the said application and the like.

Passport size Picture of Representative

______________________________ (Signature over Printed Name)

______________________________ ______________________________ HOME /MAILING ADDRESS

3. That That we are aware that we are respons responsibl ible/l e/liab iable le for any or all acts/rep acts/repres resent entati ation on made by the above above representative in connection with the functions stated herein. 4.

That the firm undertakes undertakes to notify PCAB PCAB in in the event that this appointment appointment is modified, amended amended or revoked.

________________________ AFFIANT

SUBSCR SUBSCRIBE IBED D and sworn sworn to before before me this this ______ ______ day of _______ __________ _______ ____,, 20__ 20__ affiant affiant exhibited exhibited his/her his/her Community Tax Certificate No. _______________ issued at ___________ on ___________________. Doc No. __________ Page No. _________ Book No. _________ Series of _________


(Note: Please submit original and one duplicate to PCAB. Keep another copy for presentation everytime you transact with PCAB)



ARC Form 601

Application for REGISTRATION AND CLASSIFICATION OF CONTRACTOR FOR GOVERNMENT INFRASTRUCTURE PROJECTS with the Philippine Contractors Accreditation Board In behalf of ____________________________________________________________ (Name of Firm) a contractor duly licensed with the Philippine Contractors Accreditation Board. I hereby request for registration pursuant to the implementing Rules and Regulations of PD 1594, as amended.

I hereby certify that the information and documents contained in this application are true and correct of my own personal knowledge. I am fully aware that I shall be held personally liable for any misrepresentation that may be found herein. ____________________________________ Authorized Managing Officer (Signature over Printed Name)

Republic of the Philippines} _______________________ } s.s.

SUBS SUBSCR CRIBE IBED D AND AND SWORN SWORN to befor before e me this this ____ ______ ___ _ day day of ____ ______ ____ ____ ____ _____ _____ ____ __ 200 200 ___ ___ at ______ _________ _______ ________ _______ _______ _______ _______ ________ ____ affiant affiant exhibit exhibited ed to me his Commun Community ity Tax Certifica Certificate te No. ______________ issued at _________________________ on ________________ 200 ____. Doc. No. :

Page No. : Book No. : Series of :

NOTARY PUBLIC Until December 31, 200 ___

The following documents and information are hereby submitted in support of this registration application: ]

Checklist of Registration Application:

1. General Information Information (PCAB Form Form No. 602). 2. List of Single Largest Contract completed by the contractor of each Project Kind being applied for (PCAB Form Form No. 603). 3. Copy of Contract Agreement listed in PCAB Form No. 603 of each Project Kind being applied for duly authenticated by the tendering agency or project owner or in case of subcontract by the prime/main contractor. 4. Copy of Certificate of Acceptance/Completion from Tendering Agency/Project Owner of each Contract Agreement submitted duly authenticated by the tendering agency or project owner or in case of subcontract by the prime/main contractor. 5.Cop .Copy y of Cer Certif tificat icatee of Cred redita itable ble Incom ncomee Tax Tax With Withhe held ld (Form orm 1743.1/1743.750/2307), stamped-received stamped-received by BIR for each private contracts and sub-contracts. NOTE: Application for registration and supporting documents must be submitted in a folder and signed on each and every page by the Proprietor/Authorized Proprietor/Authorized Managing Officer . Do not fill, for PCAB use only: Total no. of pages pages submitted ________ ________ Checklisted by: ________________________ ___________________________________ ___________ (Signature over Printed Name)

Remarks: ________________________ _____________________________________ __________________________ _____________ ________________________ _____________________________________ __________________________ _____________

_________________ _________________ (Date) (Revised 032601_GSD)

Note: Only citizens or entities with at least 75% Filipino equity may apply


PCAB Form No. 602

GENERAL INFORMATION SHEET Contractors Particulars FIRM NAME

:

OFFICE ADDRESS:

TEL, NO.:

TYPE OF ORGANIZATION:



EQUITY:

Corporation



Filipino:

%

Partnership



Foreign:

Sole Proprietorship

%

License Particulars Contractor’s License No.:

Date Issued:

Last Renewal:

Principal Classifications: Other Classification(s): Classification(s):

CFY _____ - _____

Present Category:

_________________________ ______________________________________ __________________________ _________________________ __________________ ______ _________________________ ______________________________________ __________________________ __________________________ __________________ _____

Type of application for PCAB License amendment, if any:

Ref. No.:

Government Registration Particulars

PRESENT REGISTRATION VALIDITY PERIOD, if applicable : from _______________ to ________________

APPLICATION APPLIED FOR: 



New Registration

Re-registration



Upgrading



Additional Project Kind

SIZE RANGE Please indicate if: Small A, Small B, Medium A, Medium B, Large A, Large B

__________________ __________________ __________________ __________________ __________________

KIND OF PROJECT (Please check)

GENERAL ENGINEERING     

__________________ __________________ __________________ __________________

GE-1 GE-2 GE-3 GE-4 GE-5

Road, Highway pavement, pavement, Railways, Airport Airport horizontal structures, & Bridges Irrigation and and Flood Control Dam, Reservoir, Reservoir, and Tunneling Water Supply Port, Harbor, Harbor, and Offshore Offshore Engineering

GENERAL BUILDING    

GB-1 GB-2 GB-3 GB-4

Building and and Industrial Plant Sewerage and Sewage Sewage Treatment/Disposal Treatment/Disposal Plant Water Treatment Treatment Plant and System Park, Playground, Playground, and Recreational Recreational Work

SPECIALTY __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________ __________________

             

SP-1 Foundation Work SP-2 Structural Steel Work SP-3 Concrete Pre-casting and Pre-stressing SP-4 Plumbing and Sanitary Work SP-5 Electrical Work SP-6 Mechanical Work SP-7 Air-conditioning Air-conditioning and Refrigeration Refrigeration Work Work SP-8 Elevator and Escalator Work SP-9 Fire Protection Work SP-10 Waterproofing Work SP-11 Painting Work SP-12 Well Drilling Work SP-13 Navigational Facilities SP-14 Communications Facilities

CERTIFIED CORRECT BY: _______________________________ Authorized Managing Officer/ Proprietor (Signature over Printed Name)


PCAB Form No. 603 TRACK RECORD FORM (Only complete form & supporting documents will be considered)

_________________________________________________________________________

Name of Firm

__________________

License No.

SINGLE LARGEST CONTRACTS COMPLETED ________________________________________ For ________________________________________ Project Kind applied for (e.g. Road, Building etc.)

I. CONTRA CONTRACT CT Project Title: ________________________________________________________ _______________________________________________________ ________________________________________________________ Project Location: ________________________________________________________ Project Owner: ________________________________________________________ Date of Contract:___________________ Amount of Contract: P _________________ Name of Main Contractor or Joint Venture, if any: _________________________________ Percent (%) share of the applicant in the contract: ____________ %

II.

ACCEPTANCE Date of Document________________________ Date Accepted: __________________ Name Name of Signa Signato tory ry:: ____ ______ ____ ____ ____ ____ ____ ____ ____ ____ ____ ___ _

Posi Positi tion on:: ____ ______ ____ ____ ____ ____ ____ ____ ____ ____ ___ _

III. WITHHOLDING TAX (for subcontract and non-government contract) Withholding agent: ____________________________ ________________________________________________________ ____________________________ Name of the withholding agent's signatory: _____________________________________ Received and Stamped by: {

BIR

{

BANK

RDO No.____ No._______ ______ ______ ______ ______ ______ ____ _ Name: Name: ______ _________ ______ ______ ______ ______ ______ ___ Addres Address:__ s:_____ ______ ______ ______ ______ ______ ______ ___ Address Address:: ______ _________ ______ ______ ______ ______ ____ _ _______________________________ _____________________________ Date: __________________________ Date: _________________________

INSTRUCTIONS: 1.Attach at the back of this form clear & legible copies of the following documents: a) Contrac Contractt agreem agreement ent duly authent authentica icated ted by the tendering tendering agency/p agency/proj roject ect owner/ owner/ prime prime contracto contractorr in case of subcontract. b) Lett Letter er or cert certifi ificate cate of accepta acceptance nce duly duly authenti authenticate cated d by the tend tenderi ering ng agency agency// project project owner/ owner/prim primee contractor in case of subcontract. c) Certificate of creditable income tax withheld of source (BIR Form 1743.1, 1743.750 or 2307) duly stamped-received by the BIR or Bank Collecting Agent for subcontracts & non-government or private contracts) 2.Submit only one track record for each project kind. _______________________________________________ Authorized Managing Officer/Proprietor (Signature over Printed Name)


Dti Application for Contractor's License

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