2025-581_Attachment_A-_First_Tier_Subcontractors_List.pdf
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- Attached to
- DNR RFB Warroad Area Power Shovel Contract
- Solicitation number
- 2000016663
- Issued by
- Beltrami County, Minnesota
About this file
This is a First-Tier Subcontractors List form (Attachment A) for Project Number 2025-581, the Warroad Area Power Shovel Contract. 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 requires certification under oath by an owner or officer that all listed subcontractors meet the minimum criteria to be a responsible contractor as defined in Minnesota Statute § 16C.285. The prime contractor must maintain signed verifications of compliance from all subcontractors and motor carriers, which must be provided to the contracting authority upon request. The form includes spaces for the authorized signature of the owner or officer, company name, printed name, date, and title of the signing official.
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Text version
ATTACHMENT A
FIRST-TIER SUBCONTRACTORS LIST
THIS FORM MUST BE COMPLETED PRIOR TO CONTRACT EXECUTION
PROJECT NUMBER 2025-581
PROJECT NAME Warroad Area Power Shovel Contract
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 .