First Tier Subcontractor_designation_form-final 8-2023.pdf

PDF 84 KB Posted

Attached to
As-Needed Professional Engineering Services State and local contract opportunity
Solicitation number
37-25-048
Issued by
Wayne County, Michigan

About this file

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The document is a Wayne County Human Relations/Business Inclusion Division First Tier Subcontractor Designation Form, which is a mandatory compliance document for prime contractors bidding on county contracts exceeding $50,000 for supplies/services or $100,000 for construction. The form requires prime contractors to disclose detailed information about first-tier subcontractors, including company details, contract percentages, work to be performed, and any potential related party relationships between subcontractors and contract managers, regardless of whether subcontractors will actually be used.

The form is specifically designed to ensure transparency and documentation of subcontractor involvement in Wayne County contracts, with sections requiring prime contractors to provide comprehensive information such as federal tax ID, company address, contact information, subcontract amount, percentage of overall contract, and specific work to be performed. The document emphasizes that it must be completed even if no subcontractors will be utilized, and includes provisions for disclosing any potential conflicts of interest or related party connections. The form is part of Wayne County's business inclusion and oversight process, aimed at maintaining accountability and tracking subcontractor participation in county procurement activities.

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Other files for this state and local contract opportunity

Other files attached to As-Needed Professional Engineering Services, newest first.
File Type Posted
RFQu 37-25-048 As-Needed Professional Engineering Services FINAL DRAFT.pdf PDF
W-9 Form v10-18.pdf PDF
Appendix A - Scope of Services 37-25-048 FINAL DRAFT.pdf PDF
Appendix B - Sample Agreement-Contract 37-25-048 FINAL.pdf PDF
Ethics Form rev 8-16-21.pdf PDF

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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: _________ _______________________________

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