24YS0017_-_Subcontractor_Consultant_List_for_SB-DVBE_Option.pdf

State of California Solicitation Number: 24YS0017 Department of Veterans Affairs

SUBCONTRACTOR/CONSULTANT LIST

I will NOT use any subcontractors or consultants in the performance of this Agreement.

The following information MUST be provided for ALL subcontractors or consultants used by the contractor to perform any labor or render any services under this Agreement. In addition, if known, please indicate whether the subcontractor/consultant is a Small or Micro business or Disabled Veteran Business Enterprise (DVBE) by placing an “X” in the appropriate column and include their Department of General Services (DGS) Reference Number. If a subcontractor(s)/consultant(s) will be used, but no selection has been made, identify the service and estimate the dollar amount of services. If additional space is needed, supplementary sheets in the format below may be attached to this list.

SUBCONTRACTOR OR CONSULTANT

NAME, ADDRESS AND PHONE NUMBER SERVICES TO BE PERFORMED

ESITEMATED

DOLLAR AMOUNT

OF SERVICES

CHECK IF A:

DGS REFERENCE

NUMBER SMALL

BUSINESS

MICRO

BUSINESS DVBE N/A

NAME:

STREET ADDRESS:

CITY, STATE, ZIP:

PHONE NUMBER:

NAME:

STREET ADDRESS:

CITY, STATE, ZIP:

PHONE NUMBER:

NAME:

STREET ADDRESS:

CITY, STATE, ZIP:

PHONE NUMBER:

NAME:

STREET ADDRESS:

CITY, STATE, ZIP:

PHONE NUMBER:

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