HomeMy WebLinkAboutAttachment LPT-ZOtiIDER'S DISCLOSUPE OF SUL-'CONTPti-�CTORS �D SLI'I'LILI:S
'Fame of Orosnization:
ATTACHMENT L
.Address:
REQUIPED LISTINts OF �LIE CONTR4CTORS ON COUNTY CONTRACT
In compliance with A4iami-Dade County Ordinance 97-104, the Community Bascd Orcanizoil or,
must submit the list of first tier subcontractors or sub -consultants who v ,ill perform any part of the
Scone of Services Wort'•:, if this Agreement is for Sl 00,000 or more.
The Community Based Organization must complete this infomation. If the Community Based
Organization will not utilize subcont actors, then the Community Based Organization must state,
"No Subcontractors will be used", do not state "N/A".
ame of Subcontractor or Sub -Consultant Address City and State
REQUIRED LIST OF SUPPLIERS ON COUNTY CONTRACT
In compliance with Miami -Dade County Ordinance 97-104, the Community Based Organization
must attach a list of suppliers «ho twill supply materials for the Scope of Services to the Community
Based Organization, if this Contract .Agreement is $100,000 or more.
The Community Based Orgar ization must fill out tl is information. If the ConLmunity Based
Organization 1�i_J1 not use suppliers, the Conununity Based Organization must state, "No suppliers
I. -A11111 be used", do not state "NIA".
Name of Subcontractor or Sub -Consultant Address Cit -y and State
I hereby certify that the forego'm information is true, correct and complete:
Sibnature of Authorized Rep, esentat'
Title:
Firm Name:
Address:
T Bleph on e: Fax:
E-?17flil:
Datc:
Fed. ID No.:
Cite/State/Zip: