Common use of STATEMENT OF SUBCONTRACTORS Clause in Contracts

STATEMENT OF SUBCONTRACTORS. Please provide the names and information for all subcontractors used in the performance of the proposed contract, and what portion of work will be assigned to each subcontractor. Subcontractors may not be substituted without the written consent of the City. Use Attachment “A” if additional pages are necessary. If no subcontractors will be used, please write “Not Applicable.” Company Name: Contact Name and Phone Number: Contact Email: Address: Contract Date Sub-Contract Dollar Amount: Requirements of Contract: What portion of work will be assigned to this subcontractor: Is the Subcontractor a certified SLBE, ELBE, MBE, DBE, DVBE, or OBE? (Circle One) YES NO If YES, Contractor must provide valid proof of certification with the response to the bid or proposal. Company Name: Contact Name and Phone Number: Contact Email: Address: Contract Date Sub-Contract Dollar Amount: Requirements of Contract: What portion of work will be assigned to this subcontractor: Is the Subcontractor a certified SLBE, ELBE, MBE, DBE, DVBE, or OBE? (Circle One) YES NO If YES, Contractor must provide valid proof of certification with the response to the bid or proposal.

STATEMENT OF SUBCONTRACTORS. Please provide the names and information for all subcontractors used in the performance of the proposed contract, and what portion of work will be assigned to each subcontractor. Subcontractors may not be substituted without the written consent of the City. Use Attachment “A” if additional pages are necessary. If no subcontractors will be used, please write “Not Applicable.” Company Name: Xxxx Xxxx Associates, Inc. Contact Name and Phone Number: Xxxxxxx Xxxxxx (000)000-0000 Contact Email: xxxxxxx@xxxxxxxxxxxxxxxx.xxx Address: 0000 0xx Xxxxxx, Xxxxx 000, Xxx Xxxxx, XX 00000 Contract Date TBD Sub-Contract Dollar Amount: :_ TBD Requirements of Contract: Traffic Control Design Services What portion of work will be assigned to this subcontractor: 25% Is the Subcontractor a certified SLBE, ELBE, MBE, DBE, DVBE, or OBE? (Circle One) YES X NO If YES, Contractor must provide valid proof of certification with the response to the bid or proposal. Company Name: Contact Name and Phone Number: Contact Email: Address: Contract Date Sub-Contract Dollar Amount: :_ Requirements of Contract: What portion of work will be assigned to this subcontractor: Is the Subcontractor a certified SLBE, ELBE, MBE, DBE, DVBE, or OBE? (Circle One) YES NO If YES, Contractor must provide valid proof of certification with the response to the bid or proposal.

STATEMENT OF SUBCONTRACTORS. Please provide the names and information for all subcontractors used in the performance of the proposed contract, and what portion of work will be assigned to each subcontractor. Subcontractors may not be substituted without the written consent of the City. Use Attachment “A” if additional pages are necessary. If no subcontractors will be used, please write “Not Applicable.” Company Name: _Not applicable Contact Name and Phone Number: Contact Email: Address: Contract Date Sub-Contract Dollar Amount: Requirements of Contract: What portion of work will be assigned to this subcontractor: Is the Subcontractor a certified SLBE, ELBE, MBE, DBE, DVBE, or OBE? (Circle One) YES NO If YES, Contractor must provide valid proof of certification with the response to the bid or proposal. Company Name: Contact Name and Phone Number: Contact Email: Address: Contract Date Sub-Contract Dollar Amount: Requirements of Contract: What portion of work will be assigned to this subcontractor: Is the Subcontractor a certified SLBE, ELBE, MBE, DBE, DVBE, or OBE? (Circle One) YES NO If YES, Contractor must provide valid proof of certification with the response to the bid or proposal.