Dpmc 27 Form PDF Details

The DPMC-27 form is a critical document for contractors seeking classification to bid on state projects in New Jersey, managed by the Department of the Treasury's Division of Property Management and Construction. As part of the application process, contractors are required to fill out this form meticulously, attaching a financial report and other necessary documentation to provide a comprehensive overview of their business's financial health, experience, and qualifications. This form facilitates the inclusion of a firm on the active bid list, dictating the effective and expiration dates of classification, specific types of work, and aggregate rating that are pivotal for securing state projects. Additionally, the form outlines the $100 non-refundable application fee policy, stresses the importance of retaining a copy for the firm's records, and provides contact information for further assistance. The expansive nature of the DPMC-27 form encompasses various segments such as contractor certification, licensing details, stockholder disclosure, and a detailed account of trades requested, making it a comprehensive resource for both the contracting firm and the reviewing body. It also emphasizes the legal undertones of false statements, advocating for transparency and honesty throughout the process to ensure mutual trust and legal compliance. This extensive procedure underscores the state's commitment to maintaining a high standard of contracting work, safeguarding public projects through meticulous contractor screening and classification.

QuestionAnswer
Form NameDpmc 27 Form
Form Length34 pages
Fillable?No
Fillable fields0
Avg. time to fill out8 min 30 sec
Other namesdpmc nj classification, new jersey dpmc form, nj dpmc renewal get, new jersey dpmc classification

Form Preview Example

DPMC CONTRACTOR CLASSIFICATION UNIT

33 WEST STATE STREET – 9TH FLOOR (PO BOX 034) TRENTON, NJ 08625-0034

State of New Jersey

DEPARTMENT OF THE TREASURY

DIVISION OF PROPERTY MANAGEMENT AND CONSTRUCTION

REQUEST FOR CLASSIFICATION

ATTENTION CONTRACTOR

Enclosed is the Contractor’s Request for Classification Form (DPMC-27) which, when completed and submitted with the mandatory financial report 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. An analyst will review your application and will be in touch with your firm via the email address provided on Form 1 if additional information is required for processing. Upon receipt of all necessary information, the application will be processed, and your firm will be notified via email of the effective and expiration dates, type of work, and aggregate rating assigned to your firm on the following business day.

There is a non-refundable application fee of $100 which must be submitted with the application in the form of a company check made payable to “Treasurer, State of New Jersey.” No application will be processed without the fee.

Cash and credit are not acceptable forms of payment.

If you have any questions, please contact the Contractor Classification Unit at (609) 943-5098 or access the DPMC website at www.nj.gov/treasury/dpmc.

NOTE: It is strongly recommended that a photocopy of this completed form be retained for your records.

(DPMC-27) – 7/20

Page 1 of 9

 

 

 

REQUEST FOR CLASSIFICATION (DPMC-27)

RETURN ALL FORMS & FINANCIAL STATEMENTS TO:

 

 

 

 

 

DPMC Contractor Classification

 

STATE OF NEW JERSEY – DIVISION OF PROPERTY MANAGEMENT AND CONSTRUCTION

 

33 W State St, 9th Floor, Trenton, NJ 08625-0034

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FORM 1 – CERTIFICATION, EXPERIENCE, AND LICENSING

 

 

NEW

 

 

RENEWAL

 

 

Signature

 

 

 

 

 

 

 

 

 

 

CONTACT PERSON

 

 

 

 

 

 

 

 

 

Name: ____________________________

 

of Officer

__________________________________ Title ______________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone: (______)_____________________

 

Signature

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

of Preparer __________________________________ Title ______________________ Date ____________ Fed ID # ______________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SUBMITTED BY (Firm Name, Street, City, State, ZIP)

 

 

TELEPHONE

 

 

 

 

 

TYPE OF BUSINESS

 

 

 

 

 

 

 

 

 

 

 

 

 

(_____)________________

 

Sole Proprietor

 

 

 

 

 

 

 

 

 

 

 

 

 

FAX

 

 

 

 

 

Partnership

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LLC

 

 

 

 

 

 

 

 

 

 

 

 

 

(_____)________________

 

EMAIL: __________________________________________________________________

 

Corporation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CERTIFIED WITH THE NJ DIVISION OF REVENUE AS:

1. Is your company currently owned by another

2. Has your company ever been

 

 

 

 

(attach certificate)

 

firm?

 

 

 

 

owned by another firm?

 

Small Business Enterprise (SBE)

 

Yes – attach a Form 2 for the parent

 

Yes – attach details

 

Minority Business Enterprise (MBE)

 

No

 

 

 

No

 

 

 

Woman Business Enterprise (WBE)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Veteran-Owned Business (VOB)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Disabled Veteran-Owned Business (DVOB)

3. Are any owners, partners, or principals of

4. Does your company currently use,

5. In what state was your company formed? If not

 

your company affiliated with any other

 

or has it ever used, any name other

NJ, please provide a current short form standing

 

firm(s) as employees, shareholders, or

 

than the official, legal name of the

certificate issued by the NJ Division of Revenue.

 

 

directors?

 

 

company?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes – attach a Form 2 for each firm

 

Yes – attach details

__________________________________________

 

 

No

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6. 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 - identify all such companies indicating if they remain actively engaged in the business in an attachment. If not, explain why.

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LICENSE INFORMATION – A PHOTOCOPY OF ALL LICENSES IN COMPANY AND INDIVIDUAL NAMES MUST BE ATTACHED

 

Type of License

License Number

 

Licensee (Indiv.)

Effective Date

Expiration Date

 

 

 

 

 

 

Note

 

ASBESTOS REMOVAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Trades C092, C093

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ELECTRICAL

 

 

 

 

 

 

 

 

 

 

 

 

Trades C047, C120, C121, C122

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FIRE ALARM/

 

 

 

 

 

 

 

 

 

 

 

 

Permit issued by NJDCA; Trade C049

 

SIGNAL SYSTEMS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FIRE SUPPRESSION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Trade C042

 

 

 

SYSTEMS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HVACR

 

 

 

 

 

 

 

 

 

 

 

Licensee must own 10% or be bona fide

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

rep (attach proof); Trade C032

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LANDSCAPE IRRIGATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Trade C065

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LEAD PAINT ABATEMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Trade C096

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PLUMBING

 

 

 

 

 

 

 

 

 

 

 

 

Licensee must own 10%; Trade C030

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SITE REMEDIATION/

N/A

 

 

 

 

 

must be updated

 

 

 

OSHA HAZWOPER certificate(s);

WASTE REMOV. TOX/HAZ

 

 

 

 

 

 

annually

 

 

 

 

 

Trades C094, C119

 

 

 

 

 

 

 

 

 

 

 

 

 

SPRINKLER SYSTEMS

 

 

 

 

 

 

 

 

 

 

 

 

Permit issued by NJDCA; Trade C045

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

UNDERGROUND STORAGE

 

 

 

 

 

 

 

 

 

 

 

 

Trades C113, C114, C115, C117

 

 

 

TANKS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WELL DRILLING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Trade C102

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WIRING EXEMPTION

 

 

 

N/A

N/A

 

N/A

 

 

 

Trades C120, C121, C122 if electrical

 

 

 

 

 

 

 

 

 

license is not provided

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(DPMC-27) – 7/20

 

 

 

Page 2 of 9

 

 

 

 

 

 

 

 

 

 

 

 

 

FORM 2—STOCKHOLDER/COMMON DISCLOSURE

STATEOFNEW JERSEY—DIVISION OFPROPERTYMANAGEMENTAND CONSTRUCTION

FIRM NAME

FEDERAL ID NO

INSTRUCTIONS: List below the names, home addresses, offices held and ownership interest of all owners, officers, and principals of the firm. All questions must be answered. If more space is needed, list on separate sheet.

NAME

HOME ADDRESS

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 attach a detailed explanation)

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:

 

 

 

 

 

 

 

 

SEAL

 

 

(Please print or type)

 

Signature:

TITLE:

 

 

(Notary Public - Not an officer of the firm)

 

 

 

 

 

 

 

 

(DPMC-27) – 7/20

Page 3 of 9

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