Awarded_Contractor_|_Contract_Forms_-List_of_Designated_Subcontractors_06.29.23_Fillable.pdf

List of Designated Subcontractors

LIST OF DESIGNATED SUBCONTRACTORS

Per California Public Contract Code Section 4104(a) & (b)

Project Name: Prime Contractor:

Address: Phone No.: ( )

E-mail Address: Is Prime Contractor MBE/WBE owned?: Yes No

DIR Public Works Registration No.: Contractor License No.: License Type(s):

SUBCONTRACTOR INFORMATION

Subcontractor Name Email License Type

Trade/Description of Work

DIR Public

Works

Registration

Number

State

Contractor's

License #

Indicate if

Section 3 or MWBE

Section 3 Yes

M/WBE Yes

CONTINUED ON NEXT PAGE

List of Designated Subcontractors

SUBCONTRACTOR INFORMATION (continued)

Subcontractor Name Email License Type

Trade/Description of Work

DIR Public

Works

Registration

Number

State

Contractor's

License #

Indicate if

Section 3 or M/WBE

No subcontracting. All work to be completed by bidder.

The "Subletting and Subcontracting Fair Practices Act" (Public Contract Code Section 4100-4113, inclusive), with regard to public works requires subcontractors, if used and whose portion of the work will be in excess of one-half of 1 percent of the prime contractor’s total bid, be listed in the prime contractor's bid or offer. The prime contractor may list only one subcontractor for each portion of the work.

The undersigned bidder hereby gives assurance that if contract is awarded to bidder; all subcontractors listed above are licensed by the State of

California to perform the proposed work/trade. Bidder assures that no subcontractor shall be deleted or substituted for without the prior written approval of the SHRA Contracting Officer. Bidder further certifies, under penalty of perjury, that they and all subcontractors are registered with the

California Department of Industrial Relations (DIR) pursuant to Labor Code 1771.1(a).

Signature of Contractor/Title Date Place (City) Signed

THIS FORM MUST BE SUBMITTED WITH BID