12-Prime Contractor Use Form.pdf

PDF 235 KB Posted

Attached to
Ballard Park Fitness Equipment Purchase and Installation
Solicitation number
IFB260040
Issued by
Jefferson County, Kentucky

About this file

Written by GovTribe AI ·

This is a Prime Contractor Use Form for state and local contracting, specifically associated with Louisville Metro Revenue Commission based on the required tax identification numbers. The form is designed to collect comprehensive information from prime contractors including business details, project specifications, contractor certifications (minority-owned, female-owned, handicapped-owned businesses, and Section 3 business concerns), estimated project timeline, contract amount, employee count, and various required identification numbers including Federal EIN, Kentucky Tax Remittance Number, Kentucky Unemployment Insurance Number, Louisville Metro Revenue Commission Number, and UEI Number.

The form includes a dedicated section requiring prime contractors to list all subcontractors and suppliers planned for the project, with specific identification of their minority business enterprise (MBE), female business enterprise (FBE), handicapped business enterprise (HBE), and Section 3 business status, along with individual contract amounts. The document emphasizes compliance with diversity and inclusion requirements by mandating that all subcontractors complete a separate Subcontractor Use Form. The form serves as a regulatory compliance tool to track business participation demographics and ensure adherence to local contracting requirements, though specific project details, contract values, timelines, or submission deadlines are not pre-populated in this template version.

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PRIME CONTRACTOR USE FORM

Prime Contractor Information:

Business Name:

Business Address:

City: State: Zip Code:

Phone Number: Fax Number:

Email Address:

Project Name:

Project Bid Number:

Is your company certified minority? Yes No Female Owned? Yes No

If yes, list certification:

Are you a Section 3 Business Concern (as defined by 24CFR75.38)? Yes No

Type of work to be performed:

Estimated Start Date: Estimated End Date:

Contract Amount: $ Federal EIN:

Number of Employees (include all full-time, part-time and leased employees):

Kentucky Tax Remittance Number

Kentucky Unemployment Insurance Number

Louisville Metro Revenue Commission Number

UEI Number

Please return to:

ATTN:

Phone:

EMAIL:

PRIME CONTRACTORS –

In the space below, please list all subcontractors and suppliers that will be used on this project. Please indicate which subcontractors and suppliers are minority owned businesses (MBE), female owned businesses (FBE), handicapped owned businesses (HBE) and Section 3 businesses. Please have all subcontractors must complete the Subcontractor Use Form, as seen on the following page.

Name Subcontractor or Supplier?

Contract Amount

MBE? FBE? HBE? Section 3

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Dropdown49:
0: [Subcontractor]
1: [Supplier]
2: [Other]
3: [Subcontractor]
4: [Subcontractor]
5: [Subcontractor]
6: [Subcontractor]
7: [Subcontractor]
8: [Subcontractor]
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0: [Yes]
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2: [Yes]
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0: [No]
1: [No]
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