HomeMy WebLinkAboutexhibit1EATTACHMENT E
ATTACHMENT E
MIAMI-DADE DEPARTMENT OF HUMAN SERVICES
BYRNE GRANT ADMINISTRATION
PROVIDER'S DISCLOSURE OF SUBCONTRACTORS AND SUPPLIERS
(Ordinance 97-104)
Address:
Name of Organization:
REQUIRED LISTING OF SUBCONTRACTORS ON COUNTY CONTRACT
Miami -Dade County Ordinance 97-104, the Provider must submit the list of first ties
In compliance with M of the Sco a of Services Work, if thi;
subcontractors or sub -consultants who will perform any part
Contract is for $100,000 ormore.
The Provider must complete this information. If the Provider will notutilize subcontractors, then th
Provider must state "No subcontractors will be used"; do not state"N/A".D STATE
ADDRESS CITY AN
NA E OF SUBCONTRACTOR OR SUB -CONSULTANT
No subcontractors will be used.
REQUIRED LIST OF SUPPLIERS ON COUNTY CONTRACT
t a
uppli
will
compliance with Miami -
Dade County Ordinance 97-104, the Provider must submict ls ist of s 000E
who will supply materials for the Scope of Services to the Provider, if
more. pliers, the Provider m
The Provider must fill out this information. IN the Provider will not use su p
state "No suppliers will be used", do not state
ADDRESS
NAME OF SUPPLIER
No suppliers will be used.
herebycertify that the foregoing information is true, correct and complete:
I
Signature of Authorized Representative:
Date:
Title:
Fed. ID No.
Firm Name.
City/ State/Zip:
Address: E-mail:
Telephone:
Fax:
CITY AND STATE