HomeMy WebLinkAboutSchedule of Subcontractor06/29/06 10:08 FAX 904 630 1182 PROCUREMENT & SUPPLY
4 004/025
SCHEDULE OF SUBCONTRACTOR/SUBCONSULTANT
PARTICIPATION
NAME OF
BIDDER
PROJECT TITLE
BID
NUMBER
TOTAL BASE BID AMOUNT
*Plea a ist ali MBEs olr JSEBs first
NAME OF SUB ADDRESS OF TYPE TYPE OF TOTAL
FIRM FIRM OF SUB WORK TO BE CONTRACT •
(f ternaed) PERFORMED VALUE
CON SULTANT/S1JACONTRACTOR/$UPL1ER
TOTA LU
African -American Pariici ation Total Value:
$
Asian-Axnerican Partici ation Total Value:
$
Hi anic-American Partici ation Total Value:
$
Native -American Partici ation Total Value:
$
Women Partici alion Total Value:
$
The undersigned acknowledges and agrees that, if any of the above -listed MBEs and/or JSEBs are
not, for any reason, properly certified with the Ctty, in accordance with Ordinance 2004-602,
At the time of bid opening, the same will not be counted toward meeting the participation
percentage goal as defined herein.
The undersigned will enter into a formal Agreement with the MBE / JSEB
Suppliers/Consultants/Subcontractors identified herein for work listed in this schedule, as
well as any applicable alternates, conditioned upon execution of a contract with the City of
Jacksonville. Under penalties of perjury a declare that I have read the foregoing conditions
and instructions and the facts are true to the best of my knowledge and beliefs_
Signature:
Title Date:
Signature of Prim COntrli(:tOt
Print Name:
Attach additional list of subcontractora/subconsultants as needed
FORM i 10/04