1-Subcontractor Listing Form.pdf
PDF 140 KB Posted
- Attached to
- RFP - Telepsychiatry Services for Harris County Community Supervision & Corrections Department
- Solicitation number
- 26/0006
- Issued by
- Harris County, Texas
About this file
This is a Subcontractor Listing Form for Harris County, Texas, used to document proposed subcontractors, subconsultants, professionals, suppliers, and vendors for contract performance. The form requires submission of subcontractor information prior to contract award, with a final listing required before award is granted. The form accommodates multiple subcontractors with fields for company name, industry classification, DUNS number, principal name, approximate contract value, contract start and end dates, work description, and certification status. Harris County reserves the right to reject proposed subcontractors on any reasonable basis and must approve all actual subcontractors prior to their engagement on the project.
The contractor bears responsibility for verifying that all subcontractors are properly licensed, insured, and authorized to work under government contracts through verification of state, local, and federal debarment lists. Contractors must obtain and submit licenses for any subcontractors whose work requires state or federal licensing. The form includes a declaration option allowing contractors to indicate they will not be subcontracting any portion of work and will fulfill the entire contract with their own resources. If any subcontractor information changes during the contract term, the contractor must submit a revised form to Harris County for approval. This subcontractor listing requirement applies to the RFP for Telepsychiatry Services for the Harris County Community Supervision & Corrections Department.
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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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