5-Attachment D - Subcontractor Listing Form.pdf
PDF 101 KB Posted
- Attached to
- RFO - Workers Compensation Claims Consultant
- Solicitation number
- KJ02122026
- Issued by
- Harris County, Texas
About this file
This is a Subcontractor Listing Form for Harris County, Texas, related to a Request for Offers (RFO) for Workers Compensation Claims Consultant services. The form requires contractors to provide detailed information for any potential subcontractors, subconsultants, professionals, suppliers, and vendors used in connection with the project. For each subcontractor, contractors must supply company name, industry classification, DUNS number, principal contact name, approximate contract value, start and end dates, work description, and certification status for HUB/MWBE and Section 3 programs. Harris County reserves the right to reject proposed subcontractors on any reasonable basis and must approve all actual subcontractors prior to their use. The form includes three blank entry sections for subcontractor information, with space for additional pages as needed.
Contractors are responsible for ensuring that any subcontractors used are properly licensed, insured, and authorized to work under government contracts, including verification against state, local, and federal debarment lists and submission of required licenses if the work requires licensing under state or federal law. A final Subcontractor Listing Form must be submitted prior to contract award, and any changes to subcontractor information throughout the contract term require written revision and County approval. The form includes a certification option for contractors who will not be subcontracting any portion of the work and will fulfill the entire contract with their own resources.
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Text version
Attachment D
SUBCONTRACTOR LISTING FORM
Contractor must provide information below for any potential subcontractors or subconsultants, professionals, suppliers, and vendors used in connection with the project. The County reserves the right to reject proposed subcontractors or subconsultants on any reasonable basis. Harris County must approve the actual subcontractors prior to their use (add additional pages if necessary):
Company Name:_______________________________ Industry: ______________________________________ DUNS #: _____________________________________Name of Principal: ______________________________ Approximate Contract Value $____________________ Start & End of Contract __________________________
Certified HUB / MWBE: ☐ Yes ☐ No Certified Section 3: ☐ Yes ☐ No Description of Work to be performed:
Company Name:_______________________________ Industry: ______________________________________ DUNS #: _____________________________________Name of Principal: ______________________________ Approximate Contract Value $____________________ Start & End of Contract __________________________
Certified HUB / MWBE: ☐ Yes ☐ No Certified Section 3: ☐ Yes ☐ No Description of Work to be performed:
Company Name:_______________________________ Industry: ______________________________________ DUNS #: _____________________________________Name of Principal: ______________________________ Approximate Contract Value $____________________ Start & End of Contract __________________________
Certified HUB / MWBE: ☐ Yes ☐ No Certified Section 3: ☐ Yes ☐ No Description of Work to be performed:
Contractor shall be responsible for ensuring any Subcontractors used are properly licensed, insured, and authorized to work under government contracts by checking state, local, and federal debarment lists and shall obtain and submit licenses for any subcontractors if the work being performed requires licensing in accordance with state or federal law. A final Subcontractor Listing Form will be required prior to contract award. If any of the required information changes throughout the term of the contract, Contractor must submit a revision to the County for approval.
☐ I will not be subcontracting any portion of the contract and will be fulfilling the entire contract with my own resources.
Signature of Contractor:
Print Name:
File details come from the government source that posted it. Updated .