First Tier Subcontractor_designation_form-final 8-2023.pdf
PDF 84 KB Posted
- Attached to
- Truck Hailing Services
- Solicitation number
- 37-25-043
- Issued by
- Wayne County, Michigan
About this file
The document is a First Tier Subcontractor Designation Form issued by the Wayne County Human Relations/Business Inclusion Division, located in Detroit, Michigan. This form is mandatory for prime contractors receiving contracts over $50,000 for supplies/services or over $100,000 for construction projects, and must be completed even if no subcontractors will be used. The form is specifically associated with a Truck Hauling Services contract for the Wayne County Department of Public Services, Roads Division, which involves transporting materials such as ditch cleaning spoils, street sweepings, salt, and trash on an as-needed basis.
The form requires detailed documentation of any first-tier subcontractors, including their company information, contact details, federal tax ID, subcontract amount, percentage of total contract, and specific work to be performed. Contractors must also disclose any related parties between subcontractors and contract managers. The form emphasizes transparency by requiring prime contractors to provide comprehensive information about potential subcontractors and any potential conflicts of interest, ensuring accountability and proper business inclusion practices for Wayne County government contracts.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Appendix B - Truck hauling Services - IFB #37-25-043.xlsx | XLSX spreadsheet | |
| W-9 Form v10-18.pdf | ||
| APPENDIX for Consortium Agreement.pdf | ||
| Ethics Form rev 8-16-21.pdf | ||
| IFB 37-25-043 - Truck Hauling Services.pdf | ||
| Template Professional_Services_Agreement.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Human Relations/Business Inclusion Division 500 Griswold, Detroit, MI 48226 313 224-5021 rev 8/23
This form MUST be completed by all prime contractors receiving a contract, of more than $50,000 (supplies/services) or more than $100,000 (construction), from Wayne County regardless of the dollar amount at which the subcontractor participates.
**THIS FORM MUST BE COMPLETED EVEN IF NO SUBCONTRACTORS WILL BE USED**
1. CONTRACT NUMBER: - - (Number on Bid Announcement)
TCM NUMBER: _______-_______-_________ (Internal use only)
2. CURRENT AND/OR CUMULATIVE CONTRACT (Check one):
SUPPLIES/SERVICES contract (over $50,000? YES NO)
OR
CONSTRUCTION contract (over $100,000? YES NO)
3. WILL SUBCONTRACTORS BE USED FOR THIS CONTRACT? (Check one)
YES* NO
*If you answered “YES”, you must complete the next page.
4. Are there any related parties between the subcontractor(s) and any contract managers for this proposed contract? (Check one) YES* NO
*If you answered “YES”, you must complete the next page.
Prime Company Name: Fed Tax ID:
Address:
City: County: State: Zip:
Phone: ( )
Fax: ( )
Authorized Contact Person: Email:
I declare that all of the information contained in this form is complete and accurate to the best of my knowledge and, as signatory, am authorized to bind the contractor.
Print Name: _Title:
Signature: Date:
WAYNE COUNTY HUMAN RELATIONS/BUSINESS INCLUSION DIVISION
FIRST TIER SUBCONTRACTOR DESIGNATION FORM
*To be completed by Prime Contractors for “First Tier” Subcontractors Only*
Human Relations/Business Inclusion Division 500 Griswold, Detroit, MI 48226 313 224-5021 rev 8/23
SUBCONTRACTOR LIST
(MAKE ADDITIONAL COPIES OF THIS PAGE TO LIST ADDITIONAL SUBCONTRACTORS)
Prime Contractor Name
Subcontractor #
Contract #______-______-______
TCM#_____-_____-_____ (Internal use only)
Company Name: Fed Tax ID:
City: County: State: Zip:
Authorized contact: Phone:
Fax:
Subcontract Amount: $ % of Contract:
Work to be performed:
Are there any related parties between the subcontractor(s) and any contract managers for this proposed contract? (Check one) YES* NO
*If there are any related parties, please provide the name(s) and relevant relationship here:
(Attach additional pages as needed)
Name: ____________________________________ Relationship: __________________________________
Department: _______________________________ Title: ________________________________________
Subcontractor #
Company Name: Fed Tax ID:
City: County: State: Zip:
Authorized contact: Phone:
Fax:
Subcontract Amount: $ % of Contract:
Work to be performed:
Are there any related parties between the subcontractor(s) and any contract managers for this proposed contract? (Check one) YES* NO
*If there are any related parties, please provide the name(s) and relevant relationship here:
(Attach additional pages as needed)
Name: ____________________________________ Relationship: __________________________________
Department: _______________________________ Title: _________ _______________________________
File details come from the government source that posted it. Updated .