Addendum 4 _ Contractor_Subcontractor Informa.pdf

City of Norcross – PWUP Department 345 Lawrenceville Street, Norcross GA 30071 Office: 678-421-2069 Fax: 770-255-2335 www.norcrossga.net

Addendum 4 – Contractor & Subcontractor Information

CDBG 2023 – RESURFACING & STORMWATER PROJECTS

ITB PWUP 23-25

The following changes and clarifications to the ITB are provided based on questions received and must be added/considered when completing your proposal:

Minority and female-owned firms are encouraged to participate in this federally funded project.

http://www.norcrossga.net/

EXHIBIT G - CONTRACTOR/SUBCONTRACTOR INFORMATION FORMS

Contractor Information Form

Name of Project: Award Amount:

DUNS #: SAM/CCR #:

E-Verify #: Date of Contract Award:

1) Minority-owned Business:

Yes No Note: Please answer “YES” if the owner(s) and controller(s) share(s) 51% of the business. When 51% or more is not owned and controlled by any single minority/racial/ethnic/gender/category, choose the most appropriate category.

2) Identify Race/Ethnicity:

White Americans Black Americans Native Americans Hispanic Americans Asian/Pacific Americans Multi-Racial/Other

3) Female-owned Business:

Contractor

Name of Firm:

Address:

FED I.D. #:

Name of Main Contact:

Phone #:

Fax #:

Email:

Cell Phone #:

4) Identify if you are a Section 3 Business:

Note: A Section 3 Business is one that can provide evidence that they meet one of the following criteria: 1) 51% or more of the business is owned by Section 3 residents (public housing resident or low- or very low-income person);

2) At least 30% of full time employees include current Section 3 residents, or residents that were section 3 residents within three years of the date of hire; or 3) The business can provide evidence of a commitment to subcontract to businesses that meet one of the first two qualifications.

Sub-Contractor Information Form

Name of Project: Award Amount:

DUNS #: SAM/CCR #:

E-Verify #: Date of Contract Award:

Note: Please answer “YES” and indicate in the minority/racial/ethnic/gender character, if the owner(s) and controller(s) share(s) 51% of the business. When 51% or more is not owned and controlled by any single minority/racial/ethnic/gender/category, choose the most appropriate category.

1) Minority-owned Business:

2) Identify Race/Ethnicity:

White Americans Black Americans Native Americans Hispanic Americans Asian/Pacific Americans Multi-Racial/Other

3) Female-owned Business:

Sub-Contractor

Name of Firm:

Address:

FED I.D. #:

Name of Main Contact:

Phone #:

Fax #:

Email:

Cell Phone #:

4) Identify if you are a Section 3 Business:

Note: A Section 3 Business is one that can provide evidence that they meet one of the following criteria: 1) 51% or more of the business is owned by Section 3 residents (public housing resident or low- or very low-income person);

2) At least 30% of full time employees include current Section 3 residents, or residents that were section 3 residents within three years of the date of hire; or 3) The business can provide evidence of a commitment to subcontract to businesses that meet one of the first two qualifications.