2025-537_Attachment_A-_First_Tier_Subcontractors_List.pdf

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Attached to
DNR_RFB Le Sueur County Dora Lake Observation Well
Solicitation number
2000016588
Issued by
Lake of the Woods County, Minnesota

About this file

This is an Attachment A First-Tier Subcontractors List form for Le Sueur County's Dora Lake WMA Observation Well Drilling project (Project Number 2025-537). The form must be completed prior to contract execution and requires listing all first-tier subcontractors, including their legal company names as registered with the Secretary of State, the city where their home office is located, the percentage value of the contract they will perform, and whether they qualify as a Targeted Group Business, Economically Disadvantaged Business, or Veteran-Owned Business (TG/ED/VO).

The form includes a certification section requiring the prime contractor's owner or officer to sign under oath, confirming that all listed subcontractors have verified through signed statements that they meet the minimum criteria to be responsible contractors as defined in Minn. Stat. § 16C.285. The prime contractor must be prepared to submit signed verifications of compliance from all subcontractors and motor carriers to the contracting authority upon request.

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ATTACHMENT A

FIRST-TIER SUBCONTRACTORS LIST

THIS FORM MUST BE COMPLETED PRIOR TO CONTRACT EXECUTION

PROJECT NUMBER 2025-537

PROJECT NAME Le Sueur County Dora Lake WMA Observation Well Drilling

FIRST TIER SUBCONTRACTOR NAMES

(Legal name of company as registered with the Secretary of State)

Name of city where company home office is located

% of value of Contract

*Is the First Tier Subcontractor a

TG/ED/VO?

Attach additional sheets as needed for submission of all first-tier subcontractors.

*TG/ED/ VO = Certified Targeted Group Business, Economically Disadvantaged Business, and Veteran-Owned Business

I certify by signing this form under oath that I am an owner or officer of the company, and that:

All first-tier subcontractors listed above have verified through a signed statement under oath by an owner or officer that they meet the minimum criteria to be a responsible contractor as defined in Minn. Stat. § 16C.285. A prime contractor shall submit to the contracting authority upon request copies of the signed verifications of compliance from all subcontractors of any tier and motor carriers, pursuant to subdivision 3, clause (7).

Authorized Signature of Owner or Officer Company Name

Print Name Date

Title

File details come from the government source that posted it. Updated .