| Name: | RUBBERFORM RECYCLED PRODUCTS LLC |
| Jurisdiction: | New York |
| Legal type: | DOMESTIC LIMITED LIABILITY COMPANY |
| Status: | Active |
| Date of registration: | 06 Apr 2005 (20 years ago) |
| Entity Number: | 3187243 |
| ZIP code: | 14094 |
| County: | Monroe |
| Place of Formation: | New York |
| Address: | 75 MICHIGAN STREET, LOCKPORT, NY, United States, 14094 |
| Unique Entity ID | Expiration Date | Physical Address | Mailing Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| S7JCZ6NMMR77 | 2025-03-15 | 75 MICHIGAN ST, LOCKPORT, NY, 14094, 2629, USA | 75 MICHIGAN ST, LOCKPORT, NY, 14094, 2629, USA | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Doing Business As | RUBBERFORM RECYCLED PRO LLC |
| URL | https://rubberform.com/ |
| Division Name | RUBBERFORM RECYCLED PRODUCTS, LLC |
| Congressional District | 24 |
| State/Country of Incorporation | NY, USA |
| Activation Date | 2024-03-15 |
| Initial Registration Date | 2007-02-27 |
| Entity Start Date | 2005-04-06 |
| Fiscal Year End Close Date | Dec 31 |
Service Classifications
| NAICS Codes | 326299 |
| Product and Service Codes | 9320, 9905 |
Points of Contacts
| Electronic Business | |
|---|---|
| Title | PRIMARY POC |
| Name | WILLIAM J ROBBINS |
| Role | PRESIDENT |
| Address | 75 MICHIGAN STREET, LOCKPORT, NY, 14094, 2629, USA |
| Title | ALTERNATE POC |
| Name | WILLIAM J ROBBINS |
| Role | PRESIDENT |
| Address | 75 MICHIGAN STREET, LOCKPORT, NY, 14094, 2629, USA |
| Government Business | |
|---|---|
| Title | PRIMARY POC |
| Name | JACOB D ROBBINS |
| Role | VICE PRESIDENT OF BUSINESS DEVELOPMENT |
| Address | 75 MICHIGAN ST, LOCKPORT, NY, 14094, 2629, USA |
| Past Performance | |
|---|---|
| Title | PRIMARY POC |
| Name | WILLIAM J ROBBINS |
| Role | PRESIDENT |
| Address | 75 MICHIGAN STREET, LOCKPORT, NY, 14094, USA |
| CAGE number | Status | Type | Established | CAGE Update Date | CAGE Expiration | SAM Expiration | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 4P5K5 | Active | U.S./Canada Manufacturer | 2007-02-27 | 2024-03-15 | 2029-03-15 | 2025-03-15 | |||||||||||||||
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| POC | JACOB D. ROBBINS |
| Phone | +1 716-478-0404 |
| Fax | +1 716-478-0408 |
| Address | 75 MICHIGAN ST, LOCKPORT, NY, 14094 2629, UNITED STATES |
Ownership of Offeror Information
| Highest Level Owner | Information not Available |
|---|
| Immediate Level Owner | Information not Available |
|---|
| List of Offerors (0) | Information not Available |
|---|
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RUBBERFORM RECYCLED PRODUCTS, LLC 401(K) PLAN | 2023 | 202632537 | 2024-04-23 | RUBBERFORM RECYCLED PRODUCTS, LLC | 14 | |||||||||||||||||||||||||||||
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| Administrator’s EIN | 621874769 |
| Plan administrator’s name | TAG RESOURCES, LLC |
| Plan administrator’s address | 6501 DEANE HILL DRIVE, KNOXVILLE, TN, 37919 |
| Administrator’s telephone number | 8656701844 |
Signature of
| Role | Plan administrator |
| Date | 2024-04-23 |
| Name of individual signing | TARA EVANS, FOR TAG RESOURCES |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 326200 |
| Sponsor’s telephone number | 7164780404 |
| Plan sponsor’s address | 75 MICHIGAN ST., LOCKPORT, NY, 14094 |
Plan administrator’s name and address
| Administrator’s EIN | 621874769 |
| Plan administrator’s name | ADMINISTRATIVE GROUP, LLC DBA TAG RESOURCES |
| Plan administrator’s address | 6501 DEANE HILL DRIVE, KNOXVILLE, TN, 37919 |
| Administrator’s telephone number | 8656701844 |
Signature of
| Role | Plan administrator |
| Date | 2024-04-24 |
| Name of individual signing | TARA EVANS, FOR TAG RESOURCES |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 326200 |
| Sponsor’s telephone number | 7164780404 |
| Plan sponsor’s address | 75 MICHIGAN ST., LOCKPORT, NY, 14094 |
Plan administrator’s name and address
| Administrator’s EIN | 621874769 |
| Plan administrator’s name | ADMINISTRATIVE GROUP, LLC DBA TAG RESOURCES |
| Plan administrator’s address | 6501 DEANE HILL DRIVE, KNOXVILLE, TN, 37919 |
| Administrator’s telephone number | 8656701844 |
Signature of
| Role | Plan administrator |
| Date | 2024-04-23 |
| Name of individual signing | TARA EVANS, FOR TAG RESOURCES |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 326200 |
| Sponsor’s telephone number | 7164780404 |
| Plan sponsor’s address | 75 MICHIGAN ST., LOCKPORT, NY, 14094 |
Plan administrator’s name and address
| Administrator’s EIN | 621874769 |
| Plan administrator’s name | ADMINISTRATIVE GROUP, LLC DBA TAG RESOURCES |
| Plan administrator’s address | 6501 DEANE HILL DRIVE, KNOXVILLE, TN, 37919 |
| Administrator’s telephone number | 8656701844 |
Signature of
| Role | Plan administrator |
| Date | 2023-09-08 |
| Name of individual signing | TARA EVANS, FOR TAG RESOURCES |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 326200 |
| Sponsor’s telephone number | 7164780404 |
| Plan sponsor’s address | 75 MICHIGAN ST., LOCKPORT, NY, 14094 |
Plan administrator’s name and address
| Administrator’s EIN | 621874769 |
| Plan administrator’s name | TAG RESOURCES, LLC |
| Plan administrator’s address | 6501 DEANE HILL DRIVE, KNOXVILLE, TN, 37919 |
| Administrator’s telephone number | 8656701844 |
Signature of
| Role | Plan administrator |
| Date | 2022-09-23 |
| Name of individual signing | TARA EVANS |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 326200 |
| Sponsor’s telephone number | 7164780404 |
| Plan sponsor’s address | 75 MICHIGAN ST., LOCKPORT, NY, 14094 |
Plan administrator’s name and address
| Administrator’s EIN | 621874769 |
| Plan administrator’s name | ADMINISTRATIVE GROUP, LLC DBA TAG RESOURCES |
| Plan administrator’s address | 6501 DEANE HILL DRIVE, KNOXVILLE, TN, 37919 |
| Administrator’s telephone number | 8656701844 |
Signature of
| Role | Plan administrator |
| Date | 2024-04-23 |
| Name of individual signing | TARA EVANS, FOR TAG RESOURCES |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 326200 |
| Sponsor’s telephone number | 7164780404 |
| Plan sponsor’s address | 75 MICHIGAN ST., LOCKPORT, NY, 14094 |
Plan administrator’s name and address
| Administrator’s EIN | 621874769 |
| Plan administrator’s name | ADMINISTRATIVE GROUP, LLC DBA TAG RESOURCES |
| Plan administrator’s address | 6501 DEANE HILL DRIVE, KNOXVILLE, TN, 37919 |
| Administrator’s telephone number | 8656701844 |
Signature of
| Role | Plan administrator |
| Date | 2023-09-07 |
| Name of individual signing | TARA EVANS, FOR TAG RESOURCES |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 326200 |
| Sponsor’s telephone number | 7164780404 |
| Plan sponsor’s address | 75 MICHIGAN ST., LOCKPORT, NY, 14094 |
Plan administrator’s name and address
| Administrator’s EIN | 621874769 |
| Plan administrator’s name | TAG RESOURCES, LLC |
| Plan administrator’s address | 6501 DEANE HILL DRIVE, KNOXVILLE, TN, 37919 |
| Administrator’s telephone number | 8656701844 |
Signature of
| Role | Plan administrator |
| Date | 2021-09-24 |
| Name of individual signing | PHIL TISUE |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 326200 |
| Sponsor’s telephone number | 7164780404 |
| Plan sponsor’s address | 75 MICHIGAN ST., LOCKPORT, NY, 14094 |
Plan administrator’s name and address
| Administrator’s EIN | 621874769 |
| Plan administrator’s name | TAG RESOURCES, LLC |
| Plan administrator’s address | 6501 DEANE HILL DRIVE, KNOXVILLE, TN, 37919 |
| Administrator’s telephone number | 8656701844 |
Signature of
| Role | Plan administrator |
| Date | 2021-11-19 |
| Name of individual signing | PHIL TISUE |
| Name | Role | Address |
|---|---|---|
| RUBBERFORM RECYCLED PRODUCTS, LLC | DOS Process Agent | 75 MICHIGAN STREET, LOCKPORT, NY, United States, 14094 |
| Start date | End date | Type | Value |
|---|---|---|---|
| 2023-04-27 | 2025-04-01 | Address | 75 MICHIGAN STREET, LOCKPORT, NY, 14094, USA (Type of address: Service of Process) |
| 2015-04-06 | 2023-04-27 | Address | 75 MICHIGAN STREET, LOCKPORT, NY, 14094, USA (Type of address: Service of Process) |
| 2007-04-20 | 2015-04-06 | Address | 75 MICHIGAN STREET, LOCKPORT, NY, 14094, USA (Type of address: Service of Process) |
| 2005-04-06 | 2007-04-20 | Address | 12 BARRINGTON HILLS, PITTSFORD, NY, 14534, USA (Type of address: Service of Process) |
| Filing Number | Date Filed | Type | Effective Date |
|---|---|---|---|
| 250401031437 | 2025-04-01 | BIENNIAL STATEMENT | 2025-04-01 |
| 230427003246 | 2023-04-27 | BIENNIAL STATEMENT | 2023-04-01 |
| 220819000652 | 2022-08-19 | BIENNIAL STATEMENT | 2021-04-01 |
| 190409060360 | 2019-04-09 | BIENNIAL STATEMENT | 2019-04-01 |
| 170405006909 | 2017-04-05 | BIENNIAL STATEMENT | 2017-04-01 |
| 150406006041 | 2015-04-06 | BIENNIAL STATEMENT | 2015-04-01 |
| 130410006408 | 2013-04-10 | BIENNIAL STATEMENT | 2013-04-01 |
| 110609002820 | 2011-06-09 | BIENNIAL STATEMENT | 2011-04-01 |
| 090324002233 | 2009-03-24 | BIENNIAL STATEMENT | 2009-04-01 |
| 070420002085 | 2007-04-20 | BIENNIAL STATEMENT | 2007-04-01 |
| Inspection Nr | Report ID | Date Opened | Site Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 347720922 | 0213600 | 2024-08-28 | 75 MICHIGAN ST., LOCKPORT, NY, 14094 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Type | Inspection |
| Activity Nr | 1707607 |
| Safety | Yes |
| Inspection Type | Planned |
| Scope | Partial |
| Safety/Health | Safety |
| Close Conference | 2023-11-01 |
| Emphasis | N: AMPUTATE, P: AMPUTATE |
Violation Items
| Citation ID | 01001 |
| Citaton Type | Serious |
| Standard Cited | 19100147 C06 I |
| Issuance Date | 2023-11-27 |
| Abatement Due Date | 2023-12-28 |
| Current Penalty | 2000.0 |
| Initial Penalty | 6641.0 |
| Contest Date | 2023-12-19 |
| Final Order | 2024-03-01 |
| Nr Instances | 1 |
| Nr Exposed | 4 |
| Gravity | 5 |
| FTA Current Penalty | 0.0 |
| Citation text line | 29 CFR 1910.147(c)(6)(i): The employer did not conduct an annual or more frequent inspection of the energy control procedure to ensure that the procedure and requirements of this standard were followed: a) On or about 11/02/2023, throughout establishment; Employer did not conduct periodic inspections of the Lockout/Tagout procedures for employees who performed servicing/maintenance activities such as, but not limited to: Changing molds on Press #1 and Press #2 - custom built shells (motor by Lincoln model # 9C AF4P20TC61 L), cleaning the ribbon blender on Mixer 1 Paul O. Abbe and Mixer 2 Aaron Process Model 06015010756IMB, and changing the blade on Hyd-Mech band saw, to verify that the procedures and requirements of the standard were adequate and used properly by employees. ABATEMENT CERTIFICATION REQUIRED |
| Citation ID | 01002 |
| Citaton Type | Serious |
| Standard Cited | 19100147 F03 I |
| Issuance Date | 2023-11-27 |
| Abatement Due Date | 2023-12-28 |
| Current Penalty | 2000.0 |
| Initial Penalty | 6641.0 |
| Contest Date | 2023-12-19 |
| Final Order | 2024-02-29 |
| Nr Instances | 2 |
| Nr Exposed | 3 |
| Gravity | 5 |
| FTA Current Penalty | 0.0 |
| Citation text line | 29 CFR 1910.147(f)(3)(i): When servicing and/or maintenance is performed by a crew, craft, department or other group, they shall utilize a procedure which affords the employees a level of protection equivalent to that provided by the implementation of a personal lockout or tagout device. a) On or about 11/02/2023, in the Press area, when maintenance mechanic and production employee changed the molds on Press number 1 and number 2, a group lock-out procedure was not followed to ensure every employee performing this maintenance task applied their own lock to the group lockout device. b) On or about 11/02/2023, in the Production area, when maintenance mechanic and production employee cleaned the ribbon blender on Mixer #2 Aaron Process model 06015010756IMB, a group lock-out procedure was not followed to ensure every employee performing this maintenance task applied their own lock to the group lockout device. ABATEMENT CERTIFICATION REQUIRED |
| Citation ID | 01003 |
| Citaton Type | Serious |
| Standard Cited | 19100212 A03 II |
| Issuance Date | 2023-11-27 |
| Abatement Due Date | 2023-12-28 |
| Current Penalty | 2000.0 |
| Initial Penalty | 6641.0 |
| Contest Date | 2023-12-19 |
| Final Order | 2024-03-01 |
| Nr Instances | 2 |
| Nr Exposed | 2 |
| Gravity | 5 |
| FTA Current Penalty | 0.0 |
| Citation text line | 29 CFR 1910.212(a)(3)(ii):Point(s) of operation of machinery were not guarded, or guards were not designed and constructed, to prevent employee(s) from having any part of their body in the danger zone(s) during operating cycle(s): a) On or about 11/02/2023, the Press area; while operating Press 1 and Press 2 - custom built shells (motor by Lincoln model # 9C AF4P20TC61 L), without proper guarding, employees were exposed to amputation hazards. b) On or about 11/02/2023, in the Production area; while operating Mixer 1 Paul O. Abbe and Mixer 2 Aaron Process Model 06015010756IMB, when the ribbon blender was not guarded, employees were exposed to amputation hazards. ABATEMENT DOCUMENTATION REQUIRED |
| Citation ID | 02001 |
| Citaton Type | Other |
| Standard Cited | 19100147 C07 IV |
| Issuance Date | 2023-11-27 |
| Abatement Due Date | 2023-12-28 |
| Current Penalty | 0.0 |
| Initial Penalty | 0.0 |
| Contest Date | 2023-12-19 |
| Final Order | 2024-03-01 |
| Nr Instances | 1 |
| Nr Exposed | 4 |
| FTA Current Penalty | 0.0 |
| Citation text line | 29 CFR 1910.147(c)(7)(iv):The employer did not certify that employee training had been accomplished and kept up to date: a) On or about 11/02/2023; throughout establishment, when employees had lockout/Tagout authorized employee training, the employer did not certify that employee training had been accomplished and kept up to date. ABATEMENT CERTIFICATION REQUIRED |
| Status | User ID | Name of Firm | Trade Name | UEI | Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Active | P0844411 | RUBBERFORM RECYCLED PRODUCTS LLC | RUBBERFORM RECYCLED PRO LLC | S7JCZ6NMMR77 | 75 MICHIGAN ST, LOCKPORT, NY, 14094-2629 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Name | William Robbins |
| Role | President |
| Name | Deborah Robbins |
| Role | Vice-President |
SBA Federal Certifications
| HUBZone Certified | No |
| Women Owned Certified | No |
| Women Owned Pending | No |
| Economically Disadvantaged Women Owned Certified | No |
| Economically Disadvantaged Women Owned Pending | No |
| Veteran-Owned Small Business Certified | No |
| Veteran-Owned Small Business Joint Venture | No |
| Service-Disabled Veteran-Owned Small Business Certified | No |
| Service-Disabled Veteran-Owned Small Business Joint Venture | No |
Bonding Levels
| Description | Construction Bonding Level (per contract) |
| Level | $0 |
| Description | Construction Bonding Level (aggregate) |
| Level | $0 |
| Description | Service Bonding Level (per contract) |
| Level | $0 |
| Description | Service Bonding Level (aggregate) |
| Level | $0 |
NAICS Codes with Size Determinations by NAICS
| Primary | Yes |
| Code | 326299 |
| NAICS Code's Description | All Other Rubber Product Manufacturing |
| Small | Yes |
Export Profile (Trade Mission Online)
| Exporter | No |
| Export Business Activities | (none given) |
| Exporting to | (none given) |
| Desired Export Business Relationships | (none given) |
| Description of Export Objective(s) | (none given) |
| USDOT Number | Carrier Operation | MCS-150 Form Date | MCS-150 Mileage | MCS-150 Year | Power Units | Drivers | Operation Classification | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 3608815 | Interstate | 2023-03-07 | 60547 | 2022 | 1 | 1 | Private(Property) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Total Number of Inspections for the measurement period (24 months) | 1 |
| Driver Fitness BASIC Serious Violation Indicator | No |
| Vehicle Maintenance BASIC Acute/Critical Indicator | No |
| Unsafe Driving BASIC Acute/Critical Indicator | No |
| Driver Fitness BASIC Roadside Performance measure value | 0 |
| Hours-of-Service (HOS) Compliance BASIC Roadside Performance measure value | 7 |
| Total Number of Driver Inspections for the measurment period | 1 |
| Vehicle Maintenance BASIC Roadside Performance measure value | 2 |
| Total Number of Vehicle Inspections for the measurement period | 1 |
| Controlled Substances and Alcohol BASIC Roadside Performance measure value | 0 |
| Unsafe Driving BASIC Roadside Performance Measure Value | 0 |
| Number of inspections with at least one Driver Fitness BASIC violation | 0 |
| Number of inspections with at least one Hours-of-Service BASIC violation | 1 |
| Total Number of Driver Inspections containing at least one Driver Out-of-Service Violation | 0 |
| Number of inspections with at least one Vehicle Maintenance BASIC violation | 1 |
| Total Number of Vehicle Inspections containing at least one Vehicle Out-of-Service violation | 0 |
| Number of inspections with at least one Controlled Substances and Alcohol BASIC violation | 0 |
| Number of inspections with at least one Unsafe Driving BASIC violation | 0 |
Inspections
| Unique report number of the inspection | 3298171395 |
| State abbreviation that indicates the state the inspector is from | OH |
| The date of the inspection | 2023-10-18 |
| ID that indicates the level of inspection | Full |
| State abbreviation that indicates where the inspection occurred | OH |
| Time weight of the inspection | 1 |
| Number of Out-Of-Service violations related to Driver | 0 |
| Number of Out-Of-Service violations related to vehicle | 0 |
| Number of violations related to Hazardous Materials | 0 |
| Total number of Out-Of-Service violations | 0 |
| Total number of Out-Of-Service violations related to Hazardous Materials | 0 |
| Description of the type of the main unit | STRAIGHT TRUCK |
| Description of the make of the main unit | INTL |
| License plate of the main unit | 3172818 |
| License state of the main unit | IN |
| Vehicle Identification Number of the main unit | 3HAEUMMN0NL854158 |
| Unsafe Driving BASIC inspection | Y |
| Hours-of-Service Compliance BASIC inspection | Y |
| Driver Fitness BASIC inspection | Y |
| Controlled Substances/Alcohol BASIC inspection | Y |
| Vehicle Maintenance BASIC inspection | Y |
| Total number of BASIC violations | 2 |
| Number of Unsafe Driving BASIC violations | 0 |
| Number of Hours-of-Service Compliance BASIC violations | 1 |
| Number of Driver Fitness BASIC violations | 0 |
| Number of Controlled Substances/Alcohol BASIC violations | 0 |
| Number of Vehicle Maintenance BASIC violations | 1 |
| Number of Hazardous Materials Compliance BASIC violations | 0 |
Violations
| The date of the inspection | 2023-10-18 |
| Code of the violation | 3958E |
| Name of the BASIC | Hours-of-Service Compliance |
| The violation is identified as Out-Of-Service violation | N |
| The weight that is assigned to a violation if it's identified as an Out-Of-Service violation | 0 |
| The severity weight that is assigned to a violation | 7 |
| The time weight that is assigned to a violation | 1 |
| The description of a violation | False report of drivers record of duty status |
| The description of the violation group | False Log |
| The unit a violation is cited against | Driver |
| The date of the inspection | 2023-10-18 |
| Code of the violation | 393203B |
| Name of the BASIC | Vehicle Maintenance |
| The violation is identified as Out-Of-Service violation | N |
| The weight that is assigned to a violation if it's identified as an Out-Of-Service violation | 0 |
| The severity weight that is assigned to a violation | 2 |
| The time weight that is assigned to a violation | 1 |
| The description of a violation | Cab/body improperly secured to frame |
| The description of the violation group | Cab Body Frame |
| The unit a violation is cited against | Vehicle main unit |
Date of last update: 29 Mar 2025
Sources: New York Secretary of State
