14._CCHCS-MC-392-_Non-Small_Business_Subcontractor_Request.pdf

Proposal Number: SD23-00097

CCHCS-MC-392 – Non-Small Business Subcontractor Preference Request Rev. 06/17/2019

Non-Small Business Subcontractor Preference Request

List each certified small business or microbusiness that will be subcontracted with. To be granted bidding preference, total small business or microbusiness subcontractor use must equal at least 25% of the total price or cost offered. Each named subcontractor must be actively certified as a small business or microbusiness by the bid submission due date and must acknowledge their participation. Attach the Small Business Subcontractor/Supplier Acknowledgement (CCHCS-MC-393) signed by an authorized representative of each named subcontractor acknowledging their proposed use as described herein.

Name of Certified Small Business or Microbusiness Subcontractor

Name of Subcontractor: Contact Person:

Street Address: City: State: Zip Code:

Telephone Number: Certification Number:

Certification Expiration Date: Participation Dollar Value: Committed Percentage of Total Bid:

Brief description of the commercially useful function(s) to be performed and provided:

Brief description of the commercially useful function(s) to be performed and provided:

Brief description of commercially useful function(s) to be performed and provided: