Attachment_A-1_Additional_Subcontractors_List.pdf
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- Solicitation number
- 2000017077
- Issued by
- Houston County, Minnesota
About this file
This document is an Attachment A-1 Additional Subcontractors List form for the Hibbing Area Forest Roads Resurfacing & Crushing project (Project Number 2025-916), which appears to be a Minnesota state transportation infrastructure project. The form is designed to be submitted within 14 days of retaining additional subcontractors during the project, and it requires prime contractors to verify and list first-tier subcontractors, including their legal names, home office locations, percentage of contract value, and whether they are certified as Targeted Group, Economically Disadvantaged, or Veteran-Owned businesses.
The document outlines specific legal requirements under Minnesota Statute § 16C.285, mandating that prime contractors obtain and submit verifications of compliance from each additional subcontractor with whom they have a direct contractual relationship. The form requires an authorized company owner or officer to certify that all listed subcontractors meet the minimum criteria to be considered responsible contractors, with the understanding that copies of signed verifications may be requested by the contracting authority. The form provides space for listing multiple first-tier subcontractors and includes a certification statement to be signed by the submitting company's representative.
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Text version
ATTACHMENT A-1
ADDITIONAL SUBCONTRACTORS LIST
SUBMIT WITHIN 14 DAYS OF RETAINING ADDITIONAL SUBCONTRACTORS DURING PROJECT
This form must be submitted to the Project Manager or individual as identified in the solicitation document.
PROJECT NUMBER 2025-916
PROJECT NAME Hibbing Area Forest Roads Resurfacing & Crushing
Minn. Stat. § 16C.285, subd. 5. Subcontractor Verification. If a prime contractor or any subcontractor retains additional subcontractors on the project after submitting its verification of compliance, the prime contractor or subcontractor shall obtain verifications of compliance from each additional subcontractor with which it has a direct contractual relationship and shall submit a supplemental verification confirming compliance with subdivision 3, clause (7), within 14 days of retaining the additional subcontractors…
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 additional subcontractors listed on Attachment A-1 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 .