DPMC Contractor Classification (DPMC- 27)
PO Box 034
Trenton, NJ 08625-0034
DEPARTMENT OF THE TREASURY
DIVISION OF PROPERTY MANAGEMENT AND CONSTRUCTION
ATTENTION CONTRACTOR
Enclosed is the Contractors Request for Classification Booklet (DPMC 27) which, when completed and submitted with the mandatory
financial statement and other documentation provides the data required to post your firm on the active bid list for State projects
described herein.
Please submit the completed application and all required documentation to this office. Upon review and approval of this application,
your firm will be notified by mail of the effective and expiration dates, type of work, and rating assigned to your firm.
There is a non-refundable fee of $100.00 which must be submitted with the application. All payments must be made on company
checks (no-cash) made payable to "Treasurer, State of New Jersey". No application will be processed without the fee.
If you have any questions, please contact the Contractor Classification unit by accessing the DPMC web site at
www.state.nj.us/treasury/dpmc/. NOTE: It is suggested that a photocopy of this completed form be retained for your
records.
(DPMC-27) - 01/1
Page 1 of 10
RETURN ALL FORMS AND FINANCIAL STATEMENTS TO:
DPM&C Contractor Classification
33 W State St, PO Box, 034 Trenton, NJ 08625-0034
REQUEST FOR CLASSIFICATION (DPMC27)
STATE OF NEW JERSEY - DIVISION OF PROPERTY MANAGEMENT AND CONSTRUCTION
FORM 1 - CERTIFICATION, EXPERIENCE AND LICENSING
Check One:
Renewal
New
Contact Person :
Name : ____________________
Signature
of Officer
Title
Signature
of Preparer
Phone: ( ____)_______________
Title
Fed ID #
Date
TELEPHONE NO
SUBMITTED BY
TYPE OF BUSINESS
(___)_________
SOLE PROPRIETOR
FAX NO
PARTNERSHIP
(___)_________
E-Mail Address
If the books and accounts of the organization are not at the above address, enter location where they are
kept.
CORPORATION
LLC
Is your firm certified as a
Minority Business Enterprise
Woman Business Enterprise with NJ Commerce Dept
Small Business Enterprise
CONSTRUCTION EXPERIENCE
1. Name of Equal Opportunity Officer
2. Location of Equal Opportunity Officer
4. How many years has your organization been
in business as a contractor under
your present business name?
_____Years
7. Are any owners, partners or principals of your
company affiliated with any other firm(s) as
employees, shareholders or directors?
NO
3. Percentage of contract work performed by
your own employees excluding
subcontracting
_____%
5. Is your company owned by another firm?
NO
6. Has your company been owned by
another firm in the past?
YES (If yes, attach details)
NO
YES
(If yes, attach details)
8. In the past 5 years, have any of the owners, partners, or principals of your company held similar positions
or been employees, shareholders or directors of a company engaged in the same or similar type of
business for which classification is sought?
YES (If yes, attach details)
NO
YES
CONSTRUCTION EXPERIENCE OF THE PRINCIPAL INDIVIDUALS OF YOUR COMPANY
PRESENT POSITION
OR OFFICE
INDIVIDUAL'S NAME
LENGTH OF TIME
EMPLOYED BY YOUR
ORGANIZATION
NO. OF YEARS
CONSTRUCTION
EXPERIENCE
BIRTH
DATE
SOCIAL
SECURITY #
NOTE: If more space is required for the principal individuals of your company, attach additional sheets.
THIS SECTION TO BE COMPLETED FOR A CORPORATION
IF NOT INCORPORATED
IN NEW JERSEY
Submit copy of current Certificate of Authority to perform work in
New Jersey as issued by N.J. Secretary of State.
Name of Registered Agent in New Jersey:
_________________________________________
LICENSE INFORMATION
TYPE OF LICENSE
LICENSE / CERTIFICATION
NUMBER
ELECTRICAL
E
PLUMBING
B
LICENSEE NAME (NOT COMPANY
NAME, MUST BE SAME AS LICENSEE)
WELL DRILLING
ASBESTOS
LEAD PAINT
ABATEMENT
UNDERGROUND
STORAGE TANK
SPRINKLER
SYSTEMS
FIRE ALARM/
SIGNAL
Landscape Irrigation
HVACR
(DPMC27 -01/15)
Page 2 of 10
EFFECTIVE
DATE
EXPIRATION
DATE
BIRTH
DATE
SOC SEC NO
FORM 2—STOCKHOLDER/COMMON DISCLOSURE
STATE OF NEW JERSEY—DIVISION OF PROPERTY MANAGEMENT AND CONSTRUCTION
➪
FIRM NAME
FEDERAL ID NO
INSTRUCTIONS: List below the names, home addresses, dates of birth, social security numbers, offices held and ownership interest of all officers
and all individuals, partnerships, corporations or any other owner with 10% or more named on the preceding page. All questions must be
answered. If more space is needed, list on separate sheet.
NAME
HOME ADDRESS
BIRTH
DATE
SOC SEC NO
OFFICE HELD
PERCENT OF
OWNERSHIP
PRESIDENT
VICE PRESIDENT
SECRETARY
TREASURER
COMPLETE ALL QUESTIONS BELOW
YES
NO
1. Is the firm identified above owned or affiliated with any other company and/or corporation or are any principals listed above
an owner or shareholder of any other company, partnership or corporation?
(If yes,complete a separate disclosure form for the parent company and/or affiliates.)
□
□
2. Has any agency of government experienced delay in completion, additional expense, liens or claims filed against the performance or payment bonds in the past five years? (If yes, attach a detailed explanation for each instance.)
□
□
3. Within the past five years has the firm identified above been owned by another company or corporation?
(If yes, complete a separate disclosure form for the previous owner and/or affiliates.)
□
□
4. Has any person or entity listed in this application ever been arrested, charged, indicted or convicted of a crime by the State of
New Jersey, any other State or the U.S. Government? (If yes, attach a detailed explanation for each instance.)
□
□
5. Has any person or entity listed in this form ever been suspended, debarred or otherwise declared ineligible by an Agency of
Government from bidding or contracting to provide services, labor, material, or supplies? (If yes, attach a detailed explanation
for each instance.)
□
□
6. Have there been any administrative, civil or criminal matters pending in any federal, state, or local governmental jurisdiction
in which this firm or its responsible employees are involved? (If yes, attach a detailed explanation for each instance.) This also
includes any prevailing wage adjudications.
□
□
7. Has any federal, state, or local government license, permit or similar authorization necessary to perform the work applied for
herein and held or applied for by any person or entity listed in this form been suspended or revoked, or is it the subject of
any pending proceedings specifically seeking or litigating the issue of suspension or revocation? (If yes to any part of this
question attach a detailed explanation for each instance.)
□
□
CERTIFICATION: I, being duly sworn, upon my oath, hereby represent and state that the foregoing information and any attachments thereto to
the best of my knowledge are true and complete. I acknowledge that the State of New Jersey is relying upon the information contained herein and
thereby acknowledge that I am under continuing obligation from the date of this certification through the completion of any contracts with the
State to notify the State in writing of any changes to the answers or information contained herein. I acknowledge that I am aware that it is a criminal offense to make a false statement or misrepresentation in this certification, and if I do so, I recognize that I am subject to criminal prosecution
under the law and that it will also constitute a material breach of my obligations to the State of New Jersey and that the State, at its option, may
declare any contract(s) resulting from this certification void and unenforceable and take any other action including debarment, suspension, etc.,
that the State may deem appropriate. I, being duly authorized, certify that the information supplied above, including all attached pages, is complete and correct to the best of my knowledge.
ATTESTED: Sworn and subscribed to before me
SIGNATURE: ________________________ DATE: ____________
(Officer or Principal)
on the ______ day of ________________________, 20____
CORP
NAME: ________________________________________
(Please print or type)
SEAL
Signature: ________________________________________
(Notary Public - Not an officer of the firm)
(DPMC-27)—03/07)
TITLE: __________________________________________
Page 3 of 10
Initials of Preparer ________
Firm Name
Form 3-TRADES REQUESTED
STATE OF NEW JERSEY-DIVISION OF PROPERTY MANAGEMENT AND CONSTRUCTION
INSTRUCTIONS: Place a check( ) next to each trade classification that your company intends to submit a bid. See N.J.A.C 17:19-2.7 for further details
__ C097 Detention Equipment
__ C006 Construction Manager
Systems
__
C068
Roofing
Membrane
Modified
as Constructor
__ C035 Solar Energy Systems
__ C098 Energy Management
Bitumen
__ C007 Design Build
__ C036 Energy Services (ESCO)
Systems
__ C069 Roofing-Urethane
__ C038 Geothermal Loop Systems
__ C099 Elevators
__ C008 General Construction
__ C070 Roofing-Built Up
__ C040 Fireproof Applications
__ C100 Museum Exhibits
__ C009 General Construction/
__ C071 Roofing -Metal
__ C041 Insulation/Mechanical
__ C101 Test Boring
Alterations and Additions
__ C072 Roofing-Tile/Slate/Shingles
__ C042 Incinerators
__ C102 Well Drilling*
__ C010 Partitions /Ceilings
__ C073 Caulking and Waterproofing
__ C043 Control Systems
__ C103 Microbial Remediation
__ C011 Doors and Hardware
__ C074 Scaffolding
__ C044 Parking and Control Systems
__ C104 Food Service Equipment
__ C012 Windows
__ C075 Roofing-Historical Sites
__ C045 Sprinkler Systems *
__ C105 School Furnishings
__ C013 Siding and Gutters
__ C076 Roofing-TPO
__ C046 Sheet Metal (Mechanical)
__ C106 Lab Furniture/Equipment
__ C014 Carpeting
__ C077 Painting-General
__ C047 Electrical*
__ C107 Seating/Bleachers
__ C015 Flooring/Tile
__ C078 Painting-Tanks/Steel
__ C048 Communications Systems
__ C108 Swimming Pools
__ C016 Millwork
Structures/Elevated Structures
__ C049 Fire Alarm/Signal Systems *
__ C109 Dust Collectors
__ C017 Insulation
__ C079 Painting-Historical Sites
__ C050 Security/Intrusion Alarms
__ C110 Signage and Graphics
__ C018 Acoustical
__ C080 Sandblasting
__ C052 Audio Visual Systems
__ C111 Septic Systems
__ C019 Concrete/Foundation
__ C081 Divers
__ C054 Site Work
__ C112 Stage Equipment
Footings/Masonry work
__ C082 Barges
__ C055 Sewage and Water
__ C113 Underground Storage
__ C020 Gunite
__ C083 Bulkhead and Docks
Treatment Plants
Tanks/Closure & Installation*
__ C021 Demolition
__ C084 Jetty and Breakwater
__ C056 Sewer Piping and Storm
__ C114 Underground Storage
__ C022 Fencing
__ C085 Dredging
Drains
Tanks/Installation*
__ C023 Historical Light
__ C086 Pile Driving
__ C057 Landscape Construction
__ C115 Underground Storage
Fixture Restoration
__ C089 Prefabrication Buildings
__ C058 Underground Water and
Tanks/Closure*
__ C024 Historical Restoration
__ C090 Prefabrication Music/Sound
Utilities
__ C116 UST/Tank Testing
__ C025 Pre-cast Concrete
Clean Rooms
__ C059 Road Construction and
__ C117 Underground Storage
__ C026 Curtain Walls
__ C091 Relocatable Buildings
Paving
Tanks/Corrosion Protection
__ C027 Architectural Cast Iron
__ C092 Asbestos Removal/ Treatment*
__ C060 Athletic Fields/Tracks/Courts
Systems Analysis*
__ C028 Welding
__ C093 Asbestos Removal/
__ C061 Athletic Fields/Synthetic Turf
__ C118 Above Ground Storage
__ C029 Structural Steel and
Mechanical*
__ C062 Pumping Stations
Tanks
Ornamental Iron
__ C094 Waste Removal Toxic/
__ C065 Landscape Irrigation*
__ C119 Site Remediation*
__ C030 Plumbing*
Hazardous
__ C066 Roofing-Membrane EPDM
__ C120 Inside Plant cable*
__ C031 Oil and Gas Burners
__ C095 Radon Mitigation
__ C067 Roofing-Membrane PVC/CPE/
__ C121 Outside Plant cable*
__ C032 HVACR*
__ C096 Lead Paint Abatement*
CSPE
__ C122 Fiber Installation &
__ C033 Boilers (New Repair)
Splicing*
__ C034 Service Station
*Copies of License must be attached
(a) A Contractor who is classified in trade C006,
Construction Manager as Constructor, shall also be
classified in the C008 trade. Both C006 and C008 trades
shall also be deemed classified for the following trades:
C009
C010
C011
C012
C013
C014
C015
C016
C017
C018
C019
C022
C026
C054
C055
C057
C059
C062
C073
C077
C080
C089
C090
C097
C104
C105
C106
C107
(b) A contractor who is classified in trade C008,
General Construction, shall also be eligible to bid
on contracts including the following specialty
trades but shall be required to engage a subcontractor who is classified in the specialty trades
listed
C072
C020
C060
C076
C066
C067
C068
C069
C070
C071
C091
C099
C061
(C) A contrator who is classified in trade C009,
General Construction/Alterations & Additions, shall
also be deemed classified for the following trades:
C010
C011
C012
C013
C014
C015
C016
C017
C018
C019
C020
C022
C054
C057
C059
C073
C077
C080
C089
(d) A contractor who is classified in trade C009, General
Construction/Alterations & Additions, shall also be
eligible to bid on contracts including the following
specialty trades, but shall be required to engage a
subcontractor who is classified in the specialty trades
listed.
C076
C026
C034
C066
C067
C068
C069
C070
C071
C072
C091
C099
(e) A contractor who is classified in trade C030,
Plumbing, shall also be deemed classified in trade
C041.
A contractor who is classified in trade C030, Plumbing,
shall also be eligble to bid on contracts including the
following specialty trades, but shall be required to
engage a subcontractor who is classified in the specialty
trades listed:
(i) A contractor who is classified in trade
C047 Electrical, shall be deemed classified
for the following trades:
C048 C049 C050
(j) A contractor who is classified in trade
C047, Electrical shall also be eligible to bid
on contracts including the following
specialty trades, but shall be required to
engage a subcontractor who is classified in
the specialty trades listed.
(f)
C055 C056
C058
C062 C104
(g) A contractor who is classified in trade C032,
HVACR, shall also be deemed classified for the
following trades:
C041
C031
C033
C109
C042
C046
(h) A contractor who is classified in trade C032, HVACR,
shall also be eligible to bid on contracts including the
following specialty trades, but shall be required to
engage a subcontractor who is classified in the specialty
trades listed:
C043 C090
C043
(k) A contractor who is classified in trade
C058 Underground Water and Utilities shall
also be deemed classified in C111.
(l) A contractor who is classified in C113
Underground Storage Tanks/Closure &
Installation shall also be deemed classified
for the following trades listed:
C114 C115
C118
(m) A contractor who is classified in C114
Underground storage Tanks/Installation,
shall also be deemed classified in C118
(n) A contractor who is classified in C092
Abestos Removal/Treatment, shall also be
deemed classified in C093
(o) A contractor who is classified in trade
C029 Shall also be deemed classified in C028
(DPMC-27) - 01/15)
Page 4 of 10
Initials of Preparer _________
Note: If this form is not completed your application will be rejected.
Instructions: List at least two completed projects for each classification
requested for on page 4 of this booklet. Be sure to use the largest projects
for each trade. List only projects completed within the past 5 years.
Give details. Use additional Sheets if necessary.
Firm Name
Form 4—Project Experience
STATE OF NEW JERSEY—DIVISION OF PROPERTY MANAGEMENT AND CONSTRUCTION
NAME OF OWNER, COMPLETE ADDRESS
AND TELEPHONE NO.
PROJECT LOCATION AND SPECIFIC TYPE OF
WORK PERFORMED BY YOUR ORGANIZATION
CHECK
PRIME OR
SUB-CONTR
PR
SUB
LIST NAME AND
APPROX
TELEPHONE NO. OF
CONTRACT PRICE
DATE
ARCHITECT/ENGINEER
(Omit Cents)
COMOR PERSON IN
(Your portion of
PLETED
CHARGE FOR OWNER
the contract)
MO YR
WAS TIME
EXTENSION
NECESSARY?
WERE ANY
PENALTIES
IMPOSED?
WERE LIENS
CLAIMS OR
STOP NOTICE
FILED?
“YES” ANSWERS: ATTACH EXPLANATION
1
Trade
C______
2
Trade
C______
3
Trade
C______
4
Trade
C______
5
Trade
C______
6
Trade
C______
7
Trade
C______
8
Trade
C______
(DPMC-27)—03/07
Page 5 of 10
Initials of Preparer __________
FORM 5—AFFIRMATIVE ACTION AFFIDAVIT
STATE OF NEW JERSEY—DIVISION OF PROPERTY MANAGEMENT AND CONSTRUCTION
Firm name
______________________________________________________________________________________________________________________
NOTE: This form must be completed and returned with your classification form, or your application to be classified will not be considered.
STATE OF __________________________
COUNTY OF ________________________
}
________________________________________________ of the firm of ____________________________________________________________________
(Name)
(Firm Name)
being sworn according to law on his oath deposes and says that:
1. I am authorized to make this affidavit on behalf of
____________________________________________________
(Firm Name)
2. In addition to an agreement to comply with an Affirmative Program as required by the New Jersey Public Law 1975,
Chapter 127 for equal employment opportunity as part of classification requirements, we do hereby further affirm that
we will comply with the rules and regulations which are and/or may be promulgated by the State Treasurer pursuant to
the Affirmative Action Law (PL 1975, C.127), as amended and supplemented.
BY ________________________________
TITLE ______________________________
CORP
SEAL
ATTESTED: Sworn and subscribed to before me
on the ______ day of ________________________, 20_____
SIGNATURE: ________________________________________
(Notary Public—Not an officer of the firm)
(DPMC-27)—03/07
Page 6 of 10
Initials of Preparer ________
FORM 6—SURETY AFFIDAVIT (to be completed by bonding company).
STATE OF NEW JERSEY—DIVISION OF PROPERTY MANAGEMENT AND CONSTRUCTION
*Please note: Surety Company completing this form must currently be authorized to do business in the State of New Jersey.
TO:
FIRM NAME
FROM:
SUBJECT:
SURETY COMPANY NAME
Classification to perform Construction for the State of New Jersey:
Reserving our rights to practice our normal underwriting functions, we are prepared to provide favorable consideration for the
suretyship on behalf of ______________________________________ covering construction performance and payment bonds for
(Name of Contractor)
construction contracts in the aggregate amount of outstanding contracts during the twenty four (24) month period ______________.
(Date)
The applicant firm’s bonding capacity is;
Aggregate: $ _______________________
The surety amount indicated is based upon the applicant’s 䡺 compiled 䡺 reviewed
financial report for the fiscal period ending ____________________________.
䡺 audited
Our willingness to extend suretyship will be based on our underwriting of the account at the time the contractor requests approval.
We, as surety, will maintain the absolute discretion to issue or withhold bonds as to each project which the contractor may seek to
bid.
In writing bonds for the applicant firm, does the surety company rely on the indemnity of any individual(s) or any other firm(s)?
䡺 NO
䡺 YES
If YES, supply names and addresses of others: _______________________________________________________
______________________________________________________________________________________________________________________
NOTARY PUBLIC
SURETY COMPANY
ATTESTED: Sworn and subscribed to before me
BY: ___________________________________________
on the _________ day of _____________________
SIGNATURE ____________________ 20 _____.
___________________________________
_________
(Signatory Capacity)
(Date)
ADDRESS: _____________________________________
_______________________________________________
(NOTARY SEAL)
TELEPHONE NO: _______________________________
(If signed by an individual other than an Authorized Officer,
include properly executed Power of Attorney.)
(DPMC-27)—03/07
Page 7 of 10
Initials of Preparer ________
FORM 7
Firm Name
Financial Record Information
1) For each working capital line of credit provided by a certified lending institution, provide details below and attach Current documentation evidencing the amount available as of the date of notarized certification on this DPMC-27. (Attach a copy of lending
covenants and agreements).
Amount of
Credit
Amount
Owed
Termination
Date (Mo/Yr)
Name and Address of
Lending Institution
Name and Phone # of
Loan Officer
2) Has the applicant firm or its principals ever failed to complete a contract due to the following?
Financial Constraints
□ Yes
No □
Non-Compliance with Loan Covenant
□ Yes
No □
Non-Compliance with Surety Covenant
□ Yes
No □
Contractual Dispute
□ Yes
No □
If yes, provide details in a separate attachment.
(DPMC-27)—03/07
Page 8 of 10
Initials of Preparer ________
Firm Name
FORM 8—WORK FORCE DETAIL NON-SUPERVISORY—If the entity is a union shop, submit current signed copies of agreements. If the entity uses trades
and/or employees from a leasing company, submit current signed copies of leasing agreements and a copy of the New Jersey Department of Labor Registration of each leasing
company.
Does the entity participate in registered Federal and/or State apprenticeship and journeyman programs?
journeyman program agreement.
Last Name
(DPMC-27)—03/07
First Name
Trade
Years In
Trade
Yes 䡺
Skill Level
(Journeyman,
Master, Apprentice)
Page 9 of 10
No 䡺
If yes, please attach a copy of the apprenticeship and/or
Union
Affiliation
(Y/N)
Union
Local
No.
Union Local
Telephone No.
Years with
Company
Initials of Preparer ________
Firm Name: ________________________________________
ATTENTION: If you do not complete your Request for Classification Booklet (DPMC-27) correctly, you may miss out on the opportunity to bid construction projects. Incorrect applications will delay the processing of your classification or may cause rejection of
your application.
Please be sure the Contractor checklist has been completed to help ensure timely processing of your application.
CONTRACTOR CHECKLIST
□ Did you affix your signature on pages 2, 3 and 6?
□ Did you answer all questions on pages 2, 3, 5 and 8?
□ Did you affix Corporate seal and notarize pages 3 and 6?
□ Did you complete and attach a Financial Statement composing at least a six (6) month accounting cycle in accordance with
NJAC 17:19-2.1? The Financial Statement cannot be more than 12 months old.
□ Did you complete and attach the license information as requested on page 2?
*Electrical and Plumbing licenses must be in the name of the company. The Plumbing licensee must be at least a 10% owner
in the company.
□ If you are incorporated in another state, did you attach a current (issued within the last year) “Certificate of Authority”to
perform work in New Jersey as requested on page 2?
□ Have you completed a separate form 2 for each affiliated company?
□ New applicants and contractors seeking to add a trade(s) must include copy of signed contracts for 2 completed projects as
required by NJAC 17:19-2.7. Each contract must include a detailed scope of work.
□ Original copy of Surety Affidavit (page 7) must be submitted by firms requesting rating in excess of $200,000. The Surety
Affidavit must be based on the same financial statement submitted with the application.
□ Small Business Enterprise firms must submit a copy of the approval notice issued by the Set-Aside and Certification Office,
Commerce and Economic Growth Commission.
□ Did you attach a copy of your “Business Registration” issued by the New Jersey Department of Treasury, Division of Revenue?
□ Did you attach a current copy of your “Public Works Contractor Registration Act Certificate” issued by the New Jersey
Department of Labor?
□ Did you attach a company check (non-refundable) in the amount of $100.00 made payable to the “Treasurer State of
New Jersey?”
(DPMC-27)—03/07
Page 10 of 10
Initials of Preparer ________