2025-628_Attachment_A-_First_Tier_Subcontractors_List.pdf
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- Attached to
- DNR RFB Sibley SP Cedar Hill Stairway Repair
- Solicitation number
- 2000016767
- Issued by
- Lac Qui Parle County, Minnesota
About this file
This document is an Attachment A First-Tier Subcontractors List for a Minnesota state project involving Sibley State Park Cedar Hill Stairway Repair, identified by project number 2025-628. The form is designed to capture detailed information about primary subcontractors participating in the project, including their legal business names, home office locations, percentage of contract value, and certification status for Targeted Group, Economically Disadvantaged, or Veteran-Owned businesses.
The form requires prime contractors to verify and certify that all first-tier subcontractors meet minimum responsible contractor criteria as defined under Minnesota Statute 16C.285. Contractors must be prepared to submit signed verification of compliance documentation from subcontractors and motor carriers upon request by the contracting authority. The document includes a certification section where an authorized company owner or officer must sign, print their name, provide their title, and date the form, which serves as an official attestation of the subcontractor information's accuracy and compliance with state procurement regulations.
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Text version
ATTACHMENT A
FIRST-TIER SUBCONTRACTORS LIST
THIS FORM MUST BE COMPLETED PRIOR TO CONTRACT EXECUTION
PROJECT NUMBER 2025-628
PROJECT NAME Sibley State Park Cedar Hill Stairway Repair
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 .