PCAB Form No. 108 Passport size Picture of STE Republic of the Philippines ) Province of _____________ ) Municipality of ___________) S.S. STE AFFIDAVIT TALENS RONNIE RAMOS I,____________________________________________________________________, Filipino, of legal age, LAST NAME FIRST NAME COMPLETE MIDDLE NAME born on residing atMAHARLIKA HIGHWAY, ZULUETA DIST., CABANATUAN CITY ____________________________________________________________________ having duly sworn in accordance with law depose and say: M M / D D/ Y Y Y Y 0 9 0 4 1 9 8 3 single/married to __________________________________________and CIVIL ENGINEER 103822 1. That I am a duly licensed __________________________ and holder of PRC registration no. ___________ 2. That I hold aNEW ERA UNIVERSITY Bachelor's Degree in BACHELOR OF SCIENCE IN CIVIL ENGINEERING _________________________________________________________ at MARCH 2005 ______________________________________________________ given on _____________________; (NAME OF SCHOOL) 3. That my Tax Identification Number (TIN) and Social Security No. are 2 4 2 - 4 3 1 - 0 1 0 and 0 2 - 2 2 9 9 1 8 2 - 9 respectively; 4. valid up toSEPT 04, 2012 (copy of my PRC is attached at the back hereof); _______________ (PROFESSION) R. D. TALENS CONSTRUCTION AND TRADING 5. That I am employed by _________________________________________________________________ (NAME OF FIRM) That I am not presently employed in any government office or government owned/controlled corporation, nor a full time instructor, nor working abroad; on regular and full-time basis with the position PROJECT ENGINEER / ME 1 of _________________________________and 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 in any construction malperformance suggestive of negligence, incompetence or malpractice or any act of omission liable for disciplinary action by myself or in collaboration with any other person; 8. That I have not been convicted by a court of competent jurisdiction of any offense involving moral turpitude; 9. That I am fully aware that my failure to 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 any or all information in this affidavit from whatever sources PCAB may consider appropriate; 11. That I am executing this affidavit to attest to the truth of the foregoing. FURTHER AFFIANT SAYETH NAUGHT. RONNIE R. TALENS _________________________________ 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) X New Upgrading Renewal Others, pls. specify _____________________ Revised 03/31/04 INSTRUCTIONS ON FILLING UP PCAB FORM NO. 108 QUALIFICATION REQUIREMENTS OF SUSTAINING TECHNICAL EMPLOYEE 1. A technology professional, such as engineer or architect, duly licensed by the Professional Regulation Commission. 2. Holder of a Professional I.D. valid for current year. 3. Possesses at least three (3) years of experience in implementation of construction to which he is to be nominated 4. A full-time employee of the nominating contractor, not associated professionally or by employment with any other party, particularly a party engaged in construction or construction-related activities 5. Have none of the following disqualifications: a) Involvement, in any capacity, in any construction malperformance of grave consequence, suggestive of his negligence, incompetence and/or malpractice; b) Involvement, by himself or in collaboration with any other person or firm, in any act or omission liable for disciplinary action of which he is or the other person or firm was found guilty by the Board; c) Conviction by a court of competent jurisdiction of any offense involving moral 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 holder of a Contractor’s License. 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 PROF. I.D. CARD VALID FOR CURRENT YEAR (Front) (xerox copy) PASTE PROF. I.D. CARD VALID FOR CURRENT YEAR (Back) (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: _______________________ __________________________________________ RONNIE R. TALENS 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 R. D. TALENS CONSTRUCTION and TRADING Maharlika Highway, Zulueta Dist. (Pob.), Cab. City NE Cakes And Restaurant Waltermart, Sta. Maria, Bulacan Const of One-Storey Bldg. w/ Attic Kapt. Pepe, Cabanatuan City Extension of NE Crossing Supermarket Cabanatuan City Renovation of One-Storey Residential Kapt. Pepe, Cabanatuan City Const. of Prep & Grade School Building Sumacab Este, Cabanatuan City NE Cakes and Restaurant / Supermarket Victory Norte, Santiago City SUMITOMO MITSUI CONST. CORP. PHIL. Paseo De Roxas, Makati City Design and Analysis of Sakamoto Office Bldg. To GB GB GB GB GB GB Project Engineer Project Engineer Project Engineer Project Engineer Project Engineer Project Engineer 03 / 05 / 09 02 / 24 / 09 02 / 19 / 09 01 / 30 / 09 07 / 10 / 08 10 / 10 / 07 05 / 05 / 09 04 / 10 / 09 05 / 19 / 09 03 / 31 / 09 06 / 22 / 09 01 / 30 / 08 02 / 01 / 2008 GB GB GB GB GB GB GB GB GB GB Structural Engineer 10 / 10 / 2008 Brgy. Aplaya, Bauan, Batangas Design and Analysis of Sakamoto RG Filling Bldg. Brgy. Aplaya, Bauan, Batangas Design and Analysis of HOGP Factory FPIP, Sto. Tomas, Batangas Design and Analysis of Covered Bagasse Yard Structural Engineer Structural Engineer Structural Engineer Structural Engineer Structural Engineer Structural Engineer Structural Engineer Brgy. Labuagon, Kibawe, Bukidnon Design and Analysis of Power House Bldg. Brgy. Labuagon, Kibawe, Bukidnon Design and Analysis of Men’s and Ladies’ Dorm Surigao Design and Analysis of Vendor’s Dormitory Surigao Design and Analysis of R&D Project Rio Tuba, Bataraza, Palawan Various Foundation Design, Ethanol & Cogeneration Power Plant Brgy. Labuagon, Kibawe, Bukidnon Design of Sheet Pile Surigao Structural Engineer Structural Engineer SUMITOMO MITSUI CONST. CORP. SINGAPORE Wafer Factory Tuas, Singapore GB QA/QC Engineer 10 / 31 / 08 01 / 09 / 09 R.D. TALENS CONSTRUCTION and TRADING Maharlika Highway, Zulueta, Cabanatuan City Two Storey Res. Bldg. Lakewood, Cabanatuan City Repair of School Bldg. San Vicente, Jaen, Nueva Ecija GB GB Project Engineer Project Engineer 06 / 26 / 07 05 / 10 / 07 12 / 2007 06 / 15 / 07 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 Two-Storey Residential Bldg. San Mariano, San Antonio, Nueva Ecija Construction of Multi-Purpose Bldg. Marawa, Jaen, Nueva Ecija Construction of Multi-Purpose Bldg. Antonio, Jaen, Nueva Ecija Concreting of Barangay Road Pamacpacan, Jaen, Nueva Ecija Concreting of Barangay Road Marilao, Gapan City Construction of Multi-Purpose Bldg. Sapang, Jaen, Nueva Ecija Gymnasium Entablado, Cabiao, Nueva Ecija Concreting of Barangay Road Alua, San Isidro, Nueva Ecija Concreting of Barangay Road San Fernando Sur, Cabiao, Nueva Ecija Commercial Bldg. w/ Mezzanine (Royce) Bucana, Gapan City Construction of 2 – Door Apartment Kapt. Pepe Subd., Cabanatuan City Drainage St. Niño, Gapan City Construction of Multi-Purpose Bldg. Malimba, Gapan City Concreting of Barangay Road Polilio, Cabiao, Nueva Ecija Const. ERY FY 06 Barracks Building Fort Magsaysay, Palayan City Gymnasium Jaen, Nueva Ecija 4 – Bedrooms Split Level Residence Rio Chico, Gen. Tinio, Nueva Ecija Construction of H.E. Building Sta. Rita, Cabiao, Nueva Ecija NE Cakes & Restaurant / Supermarket Abar 2nd, San Jose City Construction of Barangay Hall Peñaranda, Nueva Ecija Construction of Multi-Purpose Bldg. Bagong Buhay, Cabiao, Nueva Ecija Duplex Residence w/ Attic Room Golden Ville Subd., Cabanatuan City NE Village Bakod Bayan, Cabanatuan City Gen. Natividad Breeding Farm Phase I Brgy. Bravo, Gen. Natividad, Nueva Ecija Various Renovation/Restoration Projects In N.E. Pacific Mall Various Renovation/Restoration Projects In N.E. Outlets GB GB GB GE GE GB GB GE GE GB GB GE GB GE GB GB GB GB GB GB GB GB GB GB GB GB Project Engineer Project Engineer Project Engineer Project Engineer Project Engineer Project Engineer Project Engineer Project Engineer Project Engineer Project Engineer Project Engineer Project Engineer Project Engineer Project Engineer Project Engineer Project Engineer Project Engineer Project Engineer Project Engineer Project Engineer Project Engineer Project Engineer Project Engineer Project Engineer Project Engineer Project Engineer 05 / 04 / 07 05 / 03 /07 04 / 21 / 07 04 / 18 / 07 04 / 11 / 07 03 / 27 / 07 03 / 19 / 07 03 / 14 / 07 03 / 02 / 07 02 / 16 /07 02 / 06 /07 02 / 05 / 07 02 / 03 / 07 01 / 31 / 07 12 / 2006 09 / 2006 05 /16 / 06 03 / 11 / 06 02 / 2006 01 / 27 / 06 01 / 08 / 06 12 / 2005 12 / 2004 02 / 2004 Continuous Proj. Continuous Proj. To 09 / 2007 06 / 25 / 07 06 / 15 / 07 05 / 01 / 07 04 / 28 / 07 04 / 25 / 07 04 / 27 / 07 03 / 27 / 07 03 / 19 / 07 09 / 2007 06 / 03 / 07 03 / 15 / 07 03 / 03 / 07 02 / 15 / 07 05 / 2007 12 / 2006 12 / 2006 05 / 02 / 06 12 / 2006 03 / 25 / 06 03 / 22 / 06 04 / 2006 11 / 2005 09 / 2004 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. RONNIE R. TALENS _________________________________ 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 ___________________ Type of Application: (Pls. check) X Notary Public Until December 200 ___ Company Name ____________________________ PCAB License No. __________________________ New Upgrading Renewal Others, pls. specify ___________________________ Revised 03/31/04 PCAB Form No. 110 SUSTAINING TECHNICAL EMPLOYEE (STE) PERSONAL APPEARANCE FORM (To be accomplished fully by the STE) MALE RONNIE RAMOS TALENS Name: ______________________________________________ Sex: __________________ Address: MAHARLIKA HIGHWAY, ZULUETA DIST., CABANATUAN CITY ____________________________________________________________________ 103822 CIVIL ENGINEER Profession: __________________________________ PRC Reg. :_____________ Nominating Firm: ____________________________________________________________ Contractor's License No.: ______________________ I hereby confirm the following: 1. The veracity of the information reflected on the STE Affidavit and Affidavit of Construction Experience (PCAB Form Nos. 107 & 108, copies attached) that I executed in favor of the above firm; 2. That I am fully aware that my failure to notify the PCAB of my disassociation from the above-stated nominating firm and any misrepresentation in the attached forms shall cause my disqualification 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 been previously connected with the following companies: Previous Employers Date of Employment Date of Resignation Position 4. Other Remarks: ___________________________________________________________________________ ___________________________________________________________________________ ______________________________ STE's Signature Date Signed: _______________________ Identification Documents Presented: PRC ID No. 103822 ____________________ valid until ______________________ DRIVERS LICENSE NO. C05-02-019054 SEPT 04, 2012 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: ____________________________ Republic of the Philippines ) Province of _____________ ) Municipality of ___________) S.S. AFFIDAVIT OF STE CONSTRUCTION EXPERIENCE RONNIE RAMOS TALENS I, _________________________________, of legal age, with postal address at Maharlika Highway, Zulueta Dist. (Pob.), Cab. Citysingle/married, Filipino,sworn in accordance with law depose and ________________________________________________, having been duly 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 R. D. TALENS CONSTRUCTION and TRADING Maharlika Highway, Zulueta Dist. (Pob.), Cab. City Four (4) Bedroom Residential Bldg. La Fuente, Sta. Rosa, Nueva Ecija Construction of the NEECO II-AREA 1 ZONE 1 Talavera District Office Bldg. Calipahan, Talavera, Nueva Ecija Renovation of Renato Talens Residence Andal Aliño, Talavera, Nueva Ecija AVON Cabanatuan 2nd Floor NE Mall, Zulueta, Cabanatuan City Renovation and Retrofitting of Existing Nursing Building Dagupan City, Pangasinan Pagkakaisa NE-Primary Multi-Purpose Cooperative Murcon, Llanera, Nueva Ecija Multi – Purposed Building Camp. Tinio, Cabanatuan City To GB GE Project Engineer Project Engineer 03/01/2010 05/06/2010 08/27/2010 08/19/2010 GB GB GB Project Engineer Project Engineer Project Engineer 04/04/2010 04/14/2010 11/18/2009 08/12/2010 06/10/2010 05/15/2010 GB Project Engineer 12/23/2009 05/08/2010 GE GE Project Engineer Project Engineer 11/27/2009 10/15/2009 01/09/2010 12/22/2009 Road Improvements ( Drainage, Sidewalk, Curb & Gutter Gen. M. Natividad, Nueva Ecija Covered Court Las Piñas Elementary School, Peñaranda, GE Project Engineer 11/02/2009 12/17/2009 Nueva Ecija Hotel Sogo Cabanatuan ( Steel Trusses) Circumferential Rd., Cabanatuan City Hotel Sogo Cabanatuan ( Masonry Works) Circumferential Rd., Cabanatuan City Renovation of Commercial Stall ( Dickies) GB GB Project Engineer Project Engineer 10/2009 11/2009 09/2009 11/2009 GB GB GB GB Project Engineer Project Engineer Project Engineer Project Engineer 08/25/2009 08/25/2009 08/17/2009 07/29/2009 10/15/2009 09/25/2009 11/20/2009 09/07/2009 Mega Center The Mall, Cabanatuan City CIC – Grilles and Gate Sumacab Este, Cabanatuan City Renovation of 2- Storey Residential Bldg. La Fuente, Sta. Rosa, Nueva Ecija Renovation and Extension of ZAPP’S Jet Bldg. H. Concepcion, Cabanatuan City