PCAB FORM

PCAB-PAD-NEW-F01 Page 1 of 7
Effectivity Date 02/08/2013 Revision No. 04
This Form is NOT for sale. Reproduction is Allowed

SUSTAINING TECHNICAL EMPLOYEE AFFIDAVIT

Note: Please accomplish this affidavit properly. Refer to the next page for STE qualification requirements.
Recent
Republic of the Philippines ) Picture of STE
Passport size
Province of ______________) (4.5 cm x 3.5
City/Municipality of ________) S.S cm)

Last Name First Name Ext. Name (Jr/Sr, if any) Middle Name
I,
VALDEZ ABELARDO JR. GACUSAN
dd mm yyyy Single / Last Name First Name Middle Name
Born on Married to
17 06 1952 VALDEZ ROSALINA ABENOJA
Room/Floor/Unit/Bldg. Name, Lot/Block/Phase No., Street, Subdivision, Barangay, City/Municipality, Province, Zip Code
and
residing at: #52 South Central Aurora Hill, Baguio City 2600
having duly sworn to in accordance with law depose and say:
1. That I am a duly licensed CIVIL ENGINEER and holder of PRC License No. 0037083
(PROFESSION)
valid up to 6/17/2016.
Course / Profession
That I hold a Bachelor's Degree in
BS Civil Engineering
2. Name of School Inclusive Dates
Given at: Given on:
Baguio Colleges Foundation (now UC) 1982
That my Tax Identification Number is : 168 052 236
3.
and my Social Security System Number: 01-0526463-1
That I am employed on a regular and full-time Name of Firm
basis by: TRIPAROSF BUILDERS
4.
Position in the Firm CFY
With position of as a STE for
Project Engineer 2017-2018
5. That I am not presently employed by either a private company or any government office or government owned/controlled
corporation, nor a full time instructor, nor working abroad;
6. That I am not a holder of a valid contractor's license;
7. That I am not involved in any construction malperformance suggestive of negligence, incompetence or malpractice or any
act or 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 a Sustaining Technical Employee or an Authorized Managing Officer or an applicant for a contractors
license 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.

ABELARDO G. VALDEZ, JR.
Affiant

SUBSCRIBED AND SWORN to before me this _____ day of ___________________, 20___ at ___________________________;
affiant exhibited his/her Community Tax Certificate No. _____________ issued at __________________ on ______________ 20___.

Doc. No. NOTARY PUBLIC

Page No. Until December 31, 20 ___
Book No.
Series of 20 ___

PASTE PASTE

PROF. I.D. CARD PROF. I.D. CARD

VALID FOR VALID FOR

CURRENT YEAR CURRENT YEAR

(Front) (Back)
(photocopy) (photocopy)
 PCAB FORM
PCAB-PAD-NEW-F01 Page 2 of 7
Effectivity Date 02/08/2013 Revision No. 04
This Form is NOT for sale. Reproduction is Allowed

AFFIDAVIT OF STE CONSTRUCTION WORK EXPERIENCE

Note: Please use additional sheets if necessary.

Republic of the Philippines )

Province of ______________)
City/Municipality of ________) S.S

I, Abelardo G. Valdez, Jr., single/married, Filipino, of legal age, with postal address at #52 South Central Aurora
Hill, Baguio City, having been duly sworn in accordance with law depose and say that the projects enumerated below
constitute my full & complete construction experience.

Name and Work Nature/Scope of Work Project Duration

Complete Address of Employer/ Classification Assignment (mm/dd/yyyy)
Name & Location of Projects Undertaken (GE, GB, SP) (Proj. Engr.) From To
AYK Holdings
Palma St., Baguio City
Construction of commercial Signage GE Project Engineer Nov. 2014 Dec. 2014

Bernie Beray
Tam-Awan Village, Baguio City
Construction of 2-storey building with GE, GB Project Engineer Aug 2011 Feb 2012
3 basements with riprapping/slope
protection
Ringue Construction
Baguio City
Construction/Rehab of Roads at GE Project Engineer Mar. 2010 May 2010
Purok 14 and 15, Irisan, baguio City
Construction of Multi-purpose building, GB Project Engineer Mar. 2010 May 2010
P. Burgos Brgy., Baguio City
GE Project Engineer Aug 2009 Sept 2009
Rehab of Drainage Canal at Lower
Quirino Hill, Baguio City
GE Project Engineer Aug 2008 Sept 2008
Continuation of road widening at
Imelda Village, Brgy., Baguio City GB Project Engineer Mar 2008 June 2008
Construction of School Building at
Lower San Luis Village, baguio City
Repair and rewiring of Brgy Happy GB Project Engineer Nov 2007 Dec 2007
Hollow, Baguio City

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.

ABELARDO G. VALDEZ, JR.

Affiant

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 _____.
 PCAB FORM
PCAB-PAD-NEW-F01 Page 3 of 7
Effectivity Date 02/08/2013 Revision No. 04
This Form is NOT for sale. Reproduction is Allowed

AFFIDAVIT OF STE CONSTRUCTION WORK EXPERIENCE

Note: Please use additional sheets if necessary.

Republic of the Philippines )

Province of ______________)
City/Municipality of ________) S.S

I, Abelardo G. Valdez, Jr., single/married, Filipino, of legal age, with postal address at #52 South Central Aurora
Hill, Baguio City, having been duly sworn in accordance with law depose and say that the projects enumerated below
constitute my full & complete construction experience.

Name and Work Nature/Scope of Work Project Duration

Complete Address of Employer/ Classification Assignment (mm/dd/yyyy)
Name & Location of Projects Undertaken (GE, GB, SP) (Proj. Engr.) From To
Atheana Development Corporation
Badiwan, Tuba, Benguet
Land development of El Governor GE Project Engineer Feb 2005 Mar 2005
Subdivision, Lucnab, Baguio City
Construction of Sewage Plant of GB Project Engineer Jan 2005 Mar 2006
PEZA-Baguio, Loakan Rd., Bgo City
Const. of 12-storey Bldg., located at
GB Project Engineer Mar 2005 Dec 2006
Harrison Rd., Baguio City
AYK Holdings
Palma St., Baguio City
Site development and construction of GE, GB Project Engineer Jan 2003 June 2004
5-door apartment at Green Valley,
Baguio City GB Project Engineer Oct 1996 June 1997
Construction of Communication
Building by SMART, Palma St.,
Baguio City
Pockport Realty Service
Magsaysay Ave., Baguio City
Improvement/concreting along San GE Project Engineer Mar 1995 Oct 1996
Jacinto and Mangaldan, Pangasinan
Baguio Water District
Baguio City
Construction/Rehabilitation/Maintenan GE Project Engineer Mar 1978 June 1984
ce of reservoir, water systems,
concrete water tanks, other water
works

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.

ABELARDO G. VALDEZ, JR.

Affiant

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 _____.
 PCAB FORM
PCAB-PAD-NEW-F01 Page 4 of 7
Effectivity Date 02/08/2013 Revision No. 04
This Form is NOT for sale. Reproduction is Allowed

AFFIDAVIT OF STE CONSTRUCTION WORK EXPERIENCE

Note: Please use additional sheets if necessary.

Republic of the Philippines )

Province of ______________)
City/Municipality of ________) S.S

I, Abelardo G. Valdez, Jr., single/married, Filipino, of legal age, with postal address at #52 South Central Aurora
Hill, Baguio City, having been duly sworn in accordance with law depose and say that the projects enumerated below
constitute my full & complete construction experience.

Name and Work Nature/Scope of Work Project Duration

Complete Address of Employer/ Classification Assignment (mm/dd/yyyy)
Name & Location of Projects Undertaken (GE, GB, SP) (Proj. Engr.) From To
Yanbu Al-Singayah
Kingdom of Saudi Arabia
Pump operation controls for GE, GB Project Engineer Feb 1989 June 1990
desalination and chlorinating plant

Dynamic Enterprise
San Diego, California, USA
Construction and maintenance of GB Project Engineer Sept. 1990 Dec. 1992
Storage Building
Mechanical works (scud Missile
production)
Fitness Equipment

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.

ABELARDO G. VALDEZ, JR.

Affiant

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 _____.
 PCAB FORM
PCAB-PAD-NEW-F01 Page 5 of 7
Effectivity Date 02/08/2013 Revision No. 04
This Form is NOT for sale. Reproduction is Allowed

AFFIDAVIT OF STE CONSTRUCTION WORK EXPERIENCE

Note: Please use additional sheets if necessary.

Republic of the Philippines )

Province of ______________)
City/Municipality of ________) S.S

I, Abelardo G. Valdez, Jr., single/married, Filipino, of legal age, with postal address at #52 South Central Aurora
Hill, Baguio City, having been duly sworn in accordance with law depose and say that the projects enumerated
below constitute my full & complete construction experience.

Name and Work Nature/Scope of Work Project Duration

Complete Address of Employer/ Classification Assignment (mm/dd/yyyy)
Name & Location of Projects Undertaken (GE, GB, SP) (Proj. Engr.) From To

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.

ABELARDO G. VALDEZ, JR.

Affiant

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 _____.
 PCAB FORM
PCAB-PAD-NEW-F01 Page 6 of 7
Effectivity Date 02/08/2013 Revision No. 04
This Form is NOT for sale. Reproduction is Allowed

AFFIDAVIT OF STE CONSTRUCTION WORK EXPERIENCE

Note: Please use additional sheets if necessary.

Republic of the Philippines )

Province of ______________)
City/Municipality of ________) S.S

I, Abelardo G. Valdez, Jr., single/married, Filipino, of legal age, with postal address at #52 South Central Aurora
Hill, Baguio City, having been duly sworn in accordance with law depose and say that the projects enumerated below
constitute my full & complete construction experience.

Name and Work Nature/Scope of Work Project Duration

Complete Address of Employer/ Classification Assignment (mm/dd/yyyy)
Name & Location of Projects Undertaken (GE, GB, SP) (Proj. Engr.) From To

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.

ABELARDO G. VALDEZ, JR.

Affiant

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 _____.
 PCAB FORM
PCAB-PAD-NEW-F01 Page 7 of 7
Effectivity Date 02/08/2013 Revision No. 04
This Form is NOT for sale. Reproduction is Allowed

STE PERSONAL APPEARANCE

Note: To be accomplished by the STE

Name of STE
Last Name First Name Ext. Name (Jr/Sr, if any) Middle Name
VALDEZ ABELARDO JR. GACUSAN
Profession PRC ID No. Expiration Date
CIVIL ENGINEER 0037083 6/17/2016
Present Employer
FEJAN CONSTRUCTION

I hereby confirm the following:

1. The veracity of the information reflected on the STE Affidavit and Affidavit of Construction Experience
that I executed in favor of the above present employer;

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 and disassociated therefore:

Date of Date of
Previous Employers Position
Employment Resignation
Ringue Construction, Baguio City Nov 2007 May 2010 Project Engineer
Atheana Development Corporation, Tuba, Benguet Feb 2005 March 2006 Project Engineer

AYK Holdings, Baguio City Oct. 1996 June 2004 Project Engineer

Pockport Realty Service, Baguio City Mar 1995 Oct 1996 Project Engineer

Baguio Water District Mar 1978 June 1984 Project Engineer

Yanbu Al-Singayah, Saudi Arabia Feb 1989 June 1990 Project Engineer

Dynamic Enterprise, USA Sept 1990 Dec 1992 Project Engineer

4. Other Remarks:
_____________________________________________________________________________________

_____________________________________________________________________________________
Valid I.D.(s) Presented:

1. ________________ No: ______________ ________________________

STEs Signature
2. ________________ No: ______________
________________________
Date Signed

-----------------------------------------------------------------------
To be filled out by PCAB/DTI Personnel

____________________________ STEs Specimen Signature (during interview):

Signature over Printed Name
PCAB / DTI Office:_______________ ____________________________
Date :__________________________