ATTACHMENT FORM G - Leter of intent to perform as a subcontractor or subconsultant or to provide serivices-supplies.docx
DOCX document 33 KB Posted
- Solicitation number
- IFB-121333
- Issued by
- Portsmouth City, Virginia
About this file
This is Form G, a Letter of Intent to Perform as a Subcontractor or Subconsultant, used in Virginia state and local contracting processes. The form is submitted on the subcontractor or subconsultant company's official stationery and must be signed by an authorized officer. The document is associated with IFB 57-26-SKL for Sodium Hexametaphosphate (Glassy Plate Form) in Virginia. The form requires the subcontractor to identify the prime bidder, specify their certification status as a Minority Business Enterprise (MBE), Women's Business Enterprise (WBE), or Service-Disabled Enterprise (SDE), and provide their Virginia Department of Minority Business Enterprise (DMBE) certification number if applicable. The subcontractor must detail the specific work items, materials, or services they will perform or provide in connection with the project.
The form also functions as a payment authorization document that must be submitted with each pay request and final payment. It includes a payment section where the prime contractor or architect documents all payments to contractors, suppliers, and service providers for a given period, categorizing them by M/W/SBE status using designated codes (African American, Asian American, Hispanic, Native American, or Woman). The document requires approval and certification by an authorized representative of the prime contractor or architect and includes fields for the project name, bid number, pay application number, period, requested payment amount, and cumulative payment information. This form ensures proper documentation and tracking of subcontractor participation and payment throughout the contract execution period.
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Text version
FORM G
LETTER OF INTENT TO PERFORM AS A SUBCONTRACTOR OR SUBCONSULTANT OR TO PROVIDE SERVICES/SUPPLIES
Note: This form must be submitted to the Subcontractor/Subconsultant Company Official Stationery or Letterhead and signed by an authorized officer of the company or business Project Name: ____________________________________________ Bid # Name of Prime Bidder: ___________
| Address: | Street | City | State | Zip Code | |
| Telephone: | Email: |
Name of Certified Vendor The undersigned intends to perform work in connection with the above project as _____ Minority Business Enterprise ______ Women's Business Enterprise _____ Service-disabled Enterprise The M/WBE status of the undersigned is/is not certified by the Commonwealth of Virginia’s Department of Minority Business Enterprise (DMBE) Our SWAM certification number is _____________.
The undersigned is prepared to perform the following described work or provide materials or services in connection with the above project (specify in detail particular work items, materials or services to be performed or provided):
Note: This description is to be inserted in the submitted letter.
Date: __________________
| Name of Business: | ___________ | |||
| Address: | Street | City | State | Zip Code |
(Name & Title of Authorized Officer) ________________________________________ (Signature) Prime Contractor/Architect:
Address & Phone:
Project Name:
Pay Application #: P er iod:
Current Requested Payment Amount:
The following is a list of payments to be made to all contractors/suppliers & other providers on this project for the above-mentioned period.
| Firm Name and Address |
| *M/WBE |
Category
| Amount to be Paid form this pay Request |
| Total |
Payments to date Total Amount Committed
*M/W/SBE categories: African American (B), Asian American (A), Hispanic (H), Native American (N), Woman (W) Date: _ Approved/Certified By:
Name Title: _____________________
Signature: ___________________
**THIS DOCUMENT MUST BE SUBMITTED WITH EACH PAY REQUEST & FINAL PAYMENT**
File details come from the government source that posted it. Updated .