Authorized Representatives Affidavit

Renewal of Regular Contractor's License Application (Sole Proprietorship)
PCAB-F-SVD-002a. Revision No. 00, 11/19/2018

This Form is NOT for sale. Reproduction is Allowed
Page 23 of 24
AUTHORIZED REPRESENTATIVES AFFIDAVIT

Note: To be accomilished b the AMO.
Republic of the Philippines )

Province of
City/Munic pality of S.S
Last Name First Name Ext. Name (Jr/Sr, if any) Middle Name
I,
Villamor Maytlor Celeste
mm dd YYYY Sinalq / Last Name First Name,. Middle Name
born on ilia nia
May 31 1980 Married to nia
and Room/Floor/unit/Bldg. Name, Lot/Block/Phase No., Street, Subdivision, Barangay, City/Municipality, Province, Zip Code
residing 462 Gorordo Ave., Lahug
Cebu City 6000
at
having duly sworn to in accordance with law depose and say:
That I am the Name of Firm
Authorized
Managing 1-mim'S CONSTRUCTION SERVICES
1. Officer of :
Room/Floor/Unit/Bldg. Name, Lot/Block/Ph. No., Street, Subdivision, Barangay, City/Municipality, Province, Zip Code
with office
462 Gorordo Ave., Lahug
address at: Cebu City 6000
That I appoint two (2) representatives, whose pictures and signatures appear below:
Name of Representatives and Signature of Representatives
Pictures (2x2) of Representatives
Positions in the Firm over Printed Name
Representative 1 Representative 1 Representative 1
2.
Representative 2 Representative 2 Representative 2
to transact business with PCAB; i.e, present for pre-screening my application for contractor's license or any
application related thereto, file/follow-up, submit documents, receive notices/license in connection with the said
application and the like.
That I am aware that I am responsible/liable for any or all acts/representation made by my representatives in
3.
connection with the functions stated herein.
4. That I undertake to notify PCAB in the event that this appointment is modified, amended cr revoked.
That I have read and fully understood and complied with the requirements of PCAB Bcar Resolution No. 515 s.
5.
2011 (copies of required documents are attached). _...--
MAYFLOR C TE VILLAMOR
Authorized M ging Officer (AMO)
(Signature er Printed Name)
SUBSCRIBED AND SWORN to before me this day of ,20 at

; affiant exhibited his/her Community Tax Certificate
No. issued at on 20
NOTARY PUBLIC
Until December 31, 20
Doc. No.
Page No.
Book No.
Series of 20
AMO must sign here:

Renewal of Regular Contractors License Application (Sole Proprietorship)
Page 5 of 24
AFFIDAVIT OF ATTESTATION
In behalf of I-MIM'S CONSTRUCTION SERVICES

(Name of Firm)
holder of Contractor's License No. 46155 , originally issued on May 10, 2019 , I hereby
request for Renewal of its Contractor's License for Contracting Fiscal Year 01 July 2019 to 30 June 2020.
I hereby request that its application for Contractor's License be approved.
I certify to the completeness of the information/documents contained in this application appertaining to the
category/classification the company is applying for and that the information/documents are true and correct.
I further certify that the business name and/or SEC registration of this firm is valid and existing.
I certify furthermore that the SSS, Pag-IBIG, and PhilHealth contributions were remitted in favor of the employees
of this firm.
I am fully aware that:
1. All documents submitted in support to this application are subject to verification before PCAB action;
2. Any discovered misrepresentation of information 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 the disapproval of my application,
denial/suspension/revocation of license and blacklisting of my firm and myself as its Authorized Managing
Officer; and
3. Unconfirmed information/documents submitted to support my firm's qualifications shall be excluded for

categorization/classification purposes.
4. The evaluation of my qualification shall be solely based on the document susmitted at the time the
application was filed/accepted by PCAB.
MAYFLO ELESTE VILLAMOR

Authorized M naging Officer (AMO)
(Signature ver Printed Name)
Republic of the Philippines

Province of
City/Municipality of ) S.S
SUBSCRIBED AND SWORN to before me this day of 20 at

; affiant exhibited to me his/her Community Tax Certificate
No. issued at on 20 .
NOTARY PUBLIC
Until December 31,20
Doc. No.
Page No.
Book No.
Series of 20
AMO must sign here:

Renewal of Regular Contractor's License Application (Sole Proprietorship)
Page 6 of 24
PCAB INTEGRITY PLEDGE

We believe that the construction industry is one of the most susceptible to all forms of corruption that hampers the
noble objectives towards national progress and global competitiveness.
As frontrunners of nation-building, we acknowledge our major role and responsibility in ensuring that we carry out
our tasks guided by ethical standards and equipped with the necessary capability for the successful prosecution of
our contracts.
In view thereof, we pledge the following:
• We will present only true qualifications to PCAB so that we may be evaluated properly and be given the
category and classification where we should rightfully belong;
• We will uphold the dignity of the license and not be instruments for unlicensed contractors to undertake
construction projects through license lending nor through false joint ventures/consortium or pseudo
combinations which is inimical to the public safety/interest;
• We will not employ unlicensed sub-contractors/specialty contractors which is a clear circumvention of the
requirement that all contractors must be licensed;
• We will absolutely shun away from any form of collusion that destroys the very essence and integrity of
biddings;
• We will not engage in bribery or do any act which constitutes graft or corrupt practice which is the root
cause of bloated contract amounts;
• We will not use sub-standard materials which will in any way compromise the safety, reliability and
performance of the built environment;
• We will not abandon our contracts and we will implement our projects faithfully in accordance with the
prescribed specifications thereof;
• We will provide the necessary resources, financial and technical capability in carrying out our contractual
obligations, and as far as possible, within the stipulated time of completion;
• We are aware that we will be imposed disciplinary action should we violate ny of the commitments hereof
or the PCAB Code of Ethics or be found to be a party to corruption.
MAYFLOR C LESTE VILLAMOR

Authorized Ma aging Officer (AMO)
(Signature • er Printed Name)
I-MIM'S CONST UCTION SERVICES

Name 1! Company
Republic of the Philippines

Province of
City/Municipality of ) S.S
SUBSCRIBED AND SWORN to before me this day of 20 at

; affiant exhibited to me his/her
Community Tax Certificate No. issued at on 20 .
NOTARY PUBLIC
Until December 31, 20
Doc. No.
Page No.
Book No.
Series of 20 .
AMO must sign here:

Authorized Representatives Affidavit

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Renewal of Regular Contractor's License Application (Sole Proprietorship)

PCAB-F-SVD-002a. Revision No. 00, 11/19/2018

AUTHORIZED REPRESENTATIVES AFFIDAVIT

Republic of the Philippines )

SUBSCRIBED AND SWORN to before me this day of ,20 at

AMO must sign here:

In behalf of I-MIM'S CONSTRUCTION SERVICES

I hereby request that its application for Contractor's License be approved.

I am fully aware that:

2. Any discovered misrepresentation of information and/or manifestations of fraud on the application

3. Unconfirmed information/documents submitted to support my firm's qualifications shall be excluded for

MAYFLO ELESTE VILLAMOR

Republic of the Philippines

SUBSCRIBED AND SWORN to before me this day of 20 at

AMO must sign here:

PCAB INTEGRITY PLEDGE

In view thereof, we pledge the following:

MAYFLOR C LESTE VILLAMOR

I-MIM'S CONST UCTION SERVICES

Republic of the Philippines

SUBSCRIBED AND SWORN to before me this day of 20 at

AMO must sign here:

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