HomeMy WebLinkAboutAttachment lName of Organization:
Address:
REQUIRED LISTING OF SUBCONTRACTORS ON COUNTY CONTRACT
PROVIDER'S DISCLOSURE OF SUBCONTRACTORS AND -SUPPLIERS
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In compliance with Miami -Dade County Ordinance 97-104, the Community Based Orpanization
must submit the list of first tier subcontractors or sub -consultants who will perform any part of the
Scope of Services Work, if this Agreement is for $100,000 or more.
The Community Based Organization must complete this information. If the Community Based
Organization will not utilize subcontractors, then the Community Based Organization must state,
"No Subcontractors will be used", do not state "N/A".
Name 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 who will supply materials for the Scope of Services to the Community
Based Organization, if this Contract Agreement is $100,000 or more.
The Community Based Organization must fill out this information. If the Community Based
Organization will not use suppliers, the Community Based Organization must state, "No suppliers
will be used", do not state "N/A".
Name of Subcontractor or Sub -Consultant
Address City and State
I hereby certify that the foregoing information is true, correct and complete:
Signature of Authorized Representative:
Title: Date:
Firrn Name: Fed. ID No.:
Address: City/State/Zip:
Telephone: Fax:
E-Mail:
Liiami-Dade Cuunly, Florida
Firm Name of PI ;me Contractor/Proposer
SUB C ONTRACTO R/SUPPLILR. LISTING
(Ordinance 97-104)
RFP Name
RFP Number
This focal, or a comparable listing meeting the requirements of Ordinance No. 97-104, MUST be completed by all bidders and proposers on County contracts for purchase of
supplies, materials or services, including professional.services which involve expenditures of S100,000 or more, and all bidders and proposers on County or Public licalih Trust
construction contracts which involve expenditures of S100,000 or more: This form, or a comparable listing meeting the requirements of Ordinance No. 97-10.1, lutist lie
completed and submitted even though the bidder or proposer will not utilize subcontractor's or suppliers on the contract. The bidder or proposer should enter the
word "NONE" under the appropriate heading of Form A-7.1 in those instances where no subcontractors or suppliers will be used on the contract. A bidder or pi oposcr
who is awarded the contract shall not change or substitute first tier subcontractors or direct suppliers .or the portions of the contract work to be performed or maicrials to be
supplied from those identified except upon written approval of the CountYS;, • }
Business Name and Address of First Tier Prittcipbi Owner Scope of work to be Performed by (Principal Owner)
Subcontractor/Subcon51.1ltant Subcontractor/Subconsultant Gender Race
1Susiness Name and Address of Direct Supplier.
Supplies/l\'taterials/Services to be (Principal Oltucr)
Provided by Supplier Gentler R;tcc
I certify that tine representations contained in this Subcontractor/Supplier Listing are to the best of my knowledge true and accurate.
Signature of Proposer's
Authorized Iteprescntative
Print Name
(Duplicate if additional space is needed)
Print Title U:ate
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