2025_694_Attachment_A-_First_Tier_Subcontractors_List.pdf
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- Attached to
- DNR-RFB Tangnes Road Graveling
- Solicitation number
- 2000016879
- Issued by
- Scott County, Minnesota
About this file
This document is a First-Tier Subcontractors List form for Project Number 2025-694, titled "Tangnes Road Graveling". The form is designed to be completed prior to contract execution and requires prime contractors to list all first-tier subcontractors, including their legal names, home office locations, percentage of contract value, and whether they are certified as a Targeted Group Business, Economically Disadvantaged Business, or Veteran-Owned Business.
The form mandates that all listed first-tier subcontractors have verified through a signed statement that they meet the minimum criteria to be a responsible contractor as defined in Minnesota Statute 16C.285. The prime contractor must be prepared to submit verification copies to the contracting authority upon request. The document includes a certification section where an owner or officer of the company must sign, affirming the accuracy of the subcontractor information and their compliance with state requirements.
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Text version
ATTACHMENT A
FIRST-TIER SUBCONTRACTORS LIST
THIS FORM MUST BE COMPLETED PRIOR TO CONTRACT EXECUTION
PROJECT NUMBER 2025-694
PROJECT NAME Tangnes Road Graveling
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
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