Department of Trade & Industy Philippines Construction Industy Authority ofthe Philippines PHILIPPINE CONTRACTORS ACCREDITATION BOARD RENEWAL OF REGULAR CONTRACTOR'S LICENSE APPLICATION PCAB-F-SVD-002b-1. Revision No, 00, 05/14/2020 | This Form is NOT for sale. Reproduction is Allowed AFFIDAVIT 1, LEA MAY VALERIE A. LAPANIETE, the Authorized Managing Officer of UAMBRETT CONSTRUCTION INC. holder of Contractor's License No. 45413, originally issued on 08/01/2019, with the principal office address at UNIT 2 70 TIMOG AVE. CORNER SCOUT SANTIAGO ST. BRGY LAGING HANDA, QUEZON CITY, having been duly authorized to file for this PCAB License Renewal Application, hereby request for the Renewal of its Contractor's License for Contracting Fiscal Year 2020 to 2021. After having duly sworn to in accordance with law hereby depose and state that: 1. continuously reaffirm the Integrity Pledge originally submitted by this firm to PCAB. 2. I certify that the business name and/or Securities and Exchange Commission (SEC) registration of the Construction firm is valid and existing, with the changes in the Owners/Stockholders/Directors/Officers and their shareholdings as shown in the attached updated General Information Sheet (GIS). 3 I certify to the truthfulness and authenticity of all information/documents encoded in the financial documentary requirements I have accomplished, and the documents thereto attached are true and correct. 4. I certify furthermore that the Social Security System (SSS), Pag-IBIG, and PhilHealth contributions were remitted in favor of the employees of this firm. 5. PCAB is hereby authorized to verify and secure information and/or copies of documents submitted by or in the name of the construction firm to any of the following agencies relative to its application for license renewal filed with the PCAB: “a. Securities and Exchange Commission (SEC) with Registration Number €$201707812 b. _ Buredu of Internal Revenue (BIR) for documents submitted for TIN Number 009-588-784-000 (This serves as a waiver on the confidentiality provision of Section 270 of the National Internal Revenue Code of 1997 (Memorandum Circular No. 28, s2006 dated May 08, 2006, and your authorization to release any information that may be requested by PCAB) ¢. Social Security System (SSS) Registration Number 03-9562595-4-000 dd. Pagtutulungan sa Kinabukasan: Tkaw, Bangko, Industriya at Gobyerno (Pag-IBIG) Registration Number 20176463-0000 Philippine Health Insurance Corporation (PhilHealth) Registration Number 003000045728 f. Professional Regulation Commission (PRC) for the following Engineers and Architect 1. JAIME RAMOS MENDOZA, 5. JOHN ALEX PASTOR SAN JOAQUIN 2. CESAR CAMPOS SISON 6. RENATO TAMBOBOY GONZALES 3, ARTHUR OBA ANKONUEVO 7. ROLITO MARTE LUNA 4, RENATO ABUAN LAFUENTE 8. ARSENIO LAFRAGUE REYES g National Bureau of Investigation (NBI) for the AMO and following Engrs. 1. JAIME RAMOS MENDOZA, 5. JOHN ALEX PASTOR SAN JOAQUIN 2. CESAR CAMPOS SISON 6. RENATO TAMBOBOY GONZALES 3, ARTHUR OBA ARIONUEVO 7. ROLITO MARTE LUNA 4, RENATO ABUAN LAFUENTE 8. ARSENIO LAFRAGUE REYES i, Land Transportation Office (LTO) for the following vehicles with OR and CR Nos. 1. OR No. 1143467496 / CR No. 278413925, 2. 3 4. i. Local Government Units (LGUs) k. Other Government Agencies 1. Land Registration Authority (LRA) for the following Land Properties. 1. P-14710 » P1471) $ 7 fatterRenewal of Regular Contractors License Application PCAB-F-SVD:002b-1. Revision No. 00, 05/14/2020 This Form is NOT for sale. Reproduction is Allowed Page 2 of § 1. This firm's depository bank: Name of Bank : Eastwest Bank ~ Leviste Store Name of Manager Ginalyn D. Caberoy Bank Account Number : 200022130632 Name of Bank : China Bank Savings ~ Guiguinto RIS Name of Manager: Maita Dr De Guzman Bank Account Number : 612800001094 ~ Peso Account 612852000029 ~ Dollar Account ‘Name of Bank : BDO Unibank, Inc. ~ Ayala Avenue-People Support Name of Manager Evangeline T. Javier Bank Account Number : (This serves as a waiver on the confidentiality provision of the Bank Secrecy Law and your authorization to release any information that may be requested by PCAB in relation to the above-stated bank account) m. This firm’s clients/project owners as indicated in its statement of work accomplished /on-going. 6. [hereby certify to the truthfulness and authenticity of all information/documents encoded in PCAB's ONLINE RENEWAL SYSTEM and contained in this application that information/documents hereto attached and encoded are true and correct. 7. Lam fully aware that: a. Any discovered misrepresentation of information encoded or attached as a document and/or manifestations of fraud on the application documents submitted by my firm applicant or its ., Authorized Representative/Agent/Liaison Officer shall be subjected to investigation which may result to criminal charges and cases against me and my firm notwithstanding the disapproval of my firm’s application, denial/suspension/revocation of license and blacklisting of my firm and myself as its Authorized Managing Officer; b. Unconfirmed information/documents submitted to support my firm's qualifications shall be excluded for categorization classification purpose; and c. The evaluation of my firm's qualifications shall be solely based on the documents submitted at the time the application was filed accepted by PCAB. 8. I further certify that I prepared this document, fully understood every word of it and its meaning, and have affixed my signature hereunder voluntarily and freely with the full and complete knowledge of the meaning and intent of this document as well as of my rights under existing laws. yeah LEA“ \LERIE A. LAPANIETE (Name of. th signature and date) AFFIANT FURTHER SAYETH NAUGHT. Republic ofthe Philippines ) Province of __ — City/Municipality of )ss SUBSCRIBED AND SWORN to before me this day of ees 5 affiant exhibited to me his/her Government issued Identification Card issued at on ae LIS NOTARY PUBLIC 2 20-2Hitil December 31, 20 Dee. No. Page oH 510, ANGEL SUR, STA, CRUZ, LAGUNA io. PTR NO, 8323651/ STA.CRUZ LA alte Series of 20 4a. {SP LIFETIME NO, 21215/PASIG LK 7°] F 7 ALE COMPLIANCE NO. VI-00133: ORNEY'S ROLL NO, 29125