2025-979_Attachment_A-_First_Tier_Subcontractors_List.pdf
PDF 84 KB Posted
- Attached to
- DNR RFB Interstate SP Lift Station Control Panel
- Solicitation number
- 2000017170
- Issued by
- Carver County, Minnesota
About this file
This document is a First-Tier Subcontractors List form for Project Number 2025-979, involving the Interstate State Park Lift Station Control Panel and Pumps Upgrade. The form is designed to be completed prior to contract execution and requires contractors to list all first-tier subcontractors, including their legal names, home office locations, percentage of contract value, and whether they qualify as a Targeted Group Business, Economically Disadvantaged Business, or Veteran-Owned Business.
The form includes a certification statement requiring the prime contractor to verify that all listed first-tier subcontractors meet the minimum criteria to be a responsible contractor as defined in Minnesota Statute 16C.285. The document provides space for the authorized owner or officer to sign, print their name, list their company name, and include the date and title. Additional sheets can be attached if more subcontractors need to be listed, and the form emphasizes the importance of submitting signed verifications of compliance upon request by the contracting authority.
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Text version
ATTACHMENT A
FIRST-TIER SUBCONTRACTORS LIST
THIS FORM MUST BE COMPLETED PRIOR TO CONTRACT EXECUTION
PROJECT NUMBER 2025-979
PROJECT NAME Interstate State Park Lift Station Control Panel and Pumps Upgrade
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 .