1-Subcontractor Listing Form.pdf
PDF 140 KB Posted
- Attached to
- ITB - Histology Slide Stainer and Related Items for the Harris County Institute of Forensic Science
- Solicitation number
- 25/0237
- Issued by
- Harris County, Texas
About this file
This is a Subcontractor Listing Form from Harris County that contractors must complete to provide information about any potential subcontractors, subconsultants, professionals, suppliers, and vendors used in connection with their projects. The form requires contractors to list company names, industries, DUNS numbers, principal names, approximate contract values, contract start and end dates, and detailed descriptions of work to be performed for each subcontractor. Harris County reserves the right to reject proposed subcontractors on any reasonable basis and must approve all actual subcontractors prior to their use, with a final subcontractor listing required before contract award.
The form includes checkboxes for contractors to indicate whether subcontractors are certified as HUB/MWBE (Historically Underutilized Business/Minority and Women-Owned Business Enterprise) or Section 3 businesses, demonstrating the county's commitment to utilizing diverse suppliers. Contractors are responsible for ensuring all subcontractors are properly licensed, insured, and authorized to work under government contracts by checking state, local, and federal debarment lists. The form also provides an option for contractors to certify that they will fulfill the entire contract with their own resources without subcontracting, and requires contractors to submit revisions to the county for approval if any required information changes throughout the contract term.
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Text version
SUBCONTRACTOR LISTING FORM
Contractor must provide information below for any potential subcontractors or subconsultants, professionals, suppliers, and vendors used in connection with the project. The County reserves the right to reject proposed subcontractors or subconsultants on any reasonable basis. Harris County must approve the actual subcontractors prior to their use (add additional pages if necessary):
Company Name:_______________________________ Industry: ______________________________________
DUNS #: _____________________________________Name of Principal: ______________________________
Approximate Contract Value $____________________ Start & End of Contract __________________________
Certified HUB / MWBE: ☐ Yes ☐ No Certified Section 3: ☐ Yes ☐ No
Description of Work to be performed:
Company Name:_______________________________ Industry: ______________________________________
DUNS #: _____________________________________Name of Principal: ______________________________
Approximate Contract Value $____________________ Start & End of Contract __________________________
Certified HUB / MWBE: ☐ Yes ☐ No Certified Section 3: ☐ Yes ☐ No
Description of Work to be performed:
Company Name:_______________________________ Industry: ______________________________________
DUNS #: _____________________________________Name of Principal: ______________________________
Approximate Contract Value $____________________ Start & End of Contract __________________________
Certified HUB / MWBE: ☐ Yes ☐ No Certified Section 3: ☐ Yes ☐ No
Description of Work to be performed:
Contractor shall be responsible for ensuring any Subcontractors used are properly licensed, insured, and authorized to work under government contracts by checking state, local, and federal debarment lists and shall obtain and submit licenses for any subcontractors if the work being performed requires licensing in accordance with state or federal law. A final
Subcontractor Listing Form will be required prior to contract award. If any of the required information changes throughout the term of the contract, Contractor must submit a revision to the County for approval.
☐ I will not be subcontracting any portion of the contract and will be fulfilling the entire contract with my own resources.
Signature of Contractor:
Print Name:
| Company Name: |
| Industry: |
| DUNS: |
| Name of Principal: |
| Approximate Contract Value: |
| Start End of Contract: |
| Certified HUB MWBE: Off |
| Description of Work to be performed 1: |
| Description of Work to be performed 2: |
| Description of Work to be performed 3: |
| Company Name_2: |
| Industry_2: |
| DUNS_2: |
| Name of Principal_2: |
| Approximate Contract Value_2: |
| Start End of Contract_2: |
| Certified HUB MWBE_2: Off |
| Description of Work to be performed 1_2: |
| Description of Work to be performed 2_2: |
| Company Name_3: |
| Industry_3: |
| DUNS_3: |
| Name of Principal_3: |
| Approximate Contract Value_3: |
| Start End of Contract_3: |
| Certified HUB MWBE_3: Off |
| Description of Work to be performed 1_3: |
| Description of Work to be performed 2_3: |
| I will not be subcontracting any portion of the contract and will be fulfilling the entire contract with my own: Off |
| Print Name: |
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