1-Subcontractor Listing Form.pdf
PDF 140 KB Posted
- Solicitation number
- 26/0053
- Issued by
- Harris County, Texas
About this file
This is a Subcontractor Listing Form required by Harris County, Texas for a project involving the design, provision, removal, and installation of playground equipment at Archbishop Fiorenza Park in Harris County Precinct 4. The form mandates that contractors provide detailed information for any potential subcontractors, subconsultants, professionals, suppliers, and vendors participating in the project. Required information includes company name, industry classification, DUNS number, principal contact name, approximate contract value, start and end dates, and a description of work to be performed. The form includes certification checkboxes for HUB/MWBE (Historically Underutilized Business/Minority Women Business Enterprise) and Section 3 status. Harris County reserves the right to reject proposed subcontractors on any reasonable basis and must provide prior approval before any subcontractor commences work.
Contractors bear full responsibility for verifying that all subcontractors are properly licensed, insured, and authorized to work on government contracts by conducting checks against state, local, and federal debarment lists. A final, completed Subcontractor Listing Form must be submitted prior to contract award, and contractors must notify the County of any changes to subcontractor information throughout the contract term. The form provides an alternative option for contractors to certify that they will perform the entire contract with their own resources and will not subcontract any portion of the work. Licenses for subcontractors must be obtained and submitted if the work requires licensing under state or federal law.
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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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