Common use of Required Licenses Clause in Contracts

Required Licenses. Check the box if the nature of the subcontract requires the subcontractor to be licensed and you are required to review those licenses. PIN: Contract Description: Name: EIN/SSN: Name: PIP Vendor #: *Phone: *Fax: *Address: *City: *State/Zip: *EIN/SSN: *E-Mail: Subcontract Description: Approx Subcontract Value:$ Approx Start Date / / Approx End Date / / YES Application Pending Intends to Apply NO Prime Contractor Certification: I hereby affirm that the information supplied is true and correct. Signature Title Print Name Date Email Phone AGENCY AGENCY PRELIMINARY REVIEW PLEASE SEE PAGE 2 FOR INSTRUCTIONS Agency Preliminary Review Completed By: Date

Required Licenses. Check the box if the nature of the subcontract requires the subcontractor to be licensed and you are required to review those licenses. PIN: Contract Description: Name: EIN/SSN: Name: PIP Vendor #: *Phone: *Fax: *Address: *City: *State/Zip: *EIN/SSN: *E-Mail: Subcontract Description: Approx Subcontract Value:$ Approx Start Date / / Approx End Date / / YES Application Pending Intends to Apply NO Prime Contractor Certification: I hereby affirm that the information supplied is true and correct. Signature Title Print Name Date Email Phone AGENCY AGENCY PRELIMINARY REVIEW PLEASE SEE PAGE 2 FOR INSTRUCTIONS Agency Preliminary Review Completed By: Date 1. VENDEX 2. Employment 3. References 4. PLA 5. Apprenticeship 6. Licenses