2-25-035 LIS form 2025.pdf
PDF 67 KB Posted
- Attached to
- County Shredding Services
- Solicitation number
- 25-035
- Issued by
- Jackson County, Missouri
About this file
This document is a List of Intended Subcontractors form from the Office of the County Auditor's Compliance Review Office in Kansas City, Missouri, specifically for Invitation to Bid (ITB) No. 25-035. The multi-page form provides a template for contractors to list potential subcontractors, with spaces for detailed information about each subcontractor including company name, address, contact information, certification status (MBE, WBE, VBE, or DBE), scope of work, and percentage of contract award.
The form is designed to track and verify subcontractor information for compliance purposes, with sections for internal review by the Compliance Office. Each section allows for recording certification details, such as the certifying agency (KCMO, State of MO, or Other), approval status, and certification type. The bottom of the document includes space for the Chief of Compliance to receive, approve, or reject the List of Intended Subcontractors, with a signature line for final authorization. The form appears to be part of a standardized process to ensure diversity and transparency in subcontractor selection for county contracts.
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Other files
| File | Type | Posted |
|---|---|---|
| 1-Attachment B Forms.pdf | ||
| 3-25-035 Specifications.pdf | ||
| 4-25-035 Addendum 1.pdf |
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Text version
Harry S. Truman, Presiding Judge 1927-1934
LIST OF INTENDED SUBCONTRACTORS
Complete this form and return to the Compliance Office. Attach additional pages as needed.
Contractor Name: _______________________ Bid Number: ITB. No. 25-035
Description Bidder Response
Company Name: INTERNAL USE ONLY
A. Address line 1: Certifying Agency:
Address line 2 : ________ KCMO Telephone Number : ________ State of MO Contact Name: ________ Other
Email Address: Approved: Y N
Certified ( Check One) : __ MBE __ WBE __ VBE __DBE Approved By: _______
Expiration Date of Certification:
Scope of Work : Contract Value :
Percentage of Contract Award: $ __________________
B. Address line 1: Certifying Agency:
Address line 2 : ________ KCMO Telephone Number : ________ State of MO Contact Name: ________ Other
Email Address: Approved: Y N
Certified ( Check One) : __ MBE __ WBE __ VBE __DBE Approved By: _______
Expiration Date of Certification:
OFFICE OF THE COUNTY AUDITOR
COMPLIANCE REVIEW OFFICE
415 E 12TH STREET, 2ND FLOOR
KANSAS CITY, MISSOURI 64106
(816) 881-3302
FAX (816) 881-3340
COMPLIANCE@JACKSONGOV.ORG
WWW.JACKSONGOV.ORG/AUDITOR
C. Address line 1: Certifying Agency:
Address line 2 : ________ KCMO Telephone Number : ________ State of MO Contact Name: ________ Other Email Address: Approved: Y N Certified ( Check One) : __ MBE __ WBE __ VBE __DBE Approved By: _______ Expiration Date of Certification:
D. Address line 1: Certifying Agency:
Address line 2 : ________ KCMO Telephone Number : ________ State of MO Contact Name: ________ Other
Email Address: Approved: Y N
Certified ( Check One) : __ MBE __ WBE __ VBE __DBE Approved By: _______
Expiration Date of Certification:
E. Address line 1: Certifying Agency:
Address line 2 : ________ KCMO Telephone Number : ________ State of MO Contact Name: ________ Other Email Address: Approved: Y N Certified ( Check One) : __ MBE __ WBE __ VBE __DBE Approved By: _______ Expiration Date of Certification:
F. Address line 1: Certifying Agency:
Address line 2 : ________ KCMO Telephone Number : ________ State of MO Contact Name: ________ Other Email Address: Approved: Y N Certified ( Check One) : __ MBE __ WBE __ VBE __DBE Approved By: _______ Expiration Date of Certification:
INTERNAL USE ONLY
LIS RECEIVED: _________________________
LIS APPROVED:_______________ LIS NOT APPROVED: ______________
REASON LIS NOT APPROVED:_______________________________________
CHIEF OF COMPLIANCE X_____________________________________________
SIGNATURE
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