First Tier Subcontractor_designation_form-final 8-2023.pdf
PDF 84 KB Posted
- Attached to
- Air Compressors & Dryers
- Solicitation number
- 37-25-042
- Issued by
- Wayne County, Michigan
About this file
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 projects. The form requires prime contractors to disclose detailed information about any subcontractors they intend to use, including the subcontractor's company name, federal tax ID, address, contact information, subcontract amount, percentage of contract, and specific work to be performed. Contractors must also indicate whether there are any related parties between subcontractors and contract managers.
The form is specifically designed to ensure transparency and compliance in the subcontracting process, with a requirement that it must be completed even if no subcontractors will be used. The document provides space for listing multiple subcontractors and requires prime contractors to declare the completeness and accuracy of the information provided. While the form is part of a larger procurement process for air compressors and dryers at various Wayne County locations, this specific document focuses on the administrative reporting of subcontractor involvement and potential conflicts of interest in the contract execution.
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Other files
| File | Type | Posted |
|---|---|---|
| IFB 37-25-042 - Air Compressor.pdf | ||
| W-9 Form v10-18.pdf | ||
| APPENDIX for Consortium Agreement.pdf | ||
| Appedix B Professional_Services_Agreement 37-25-042.pdf | ||
| Addendum #1 - IFB 37-25-042 Air Compressors.pdf | ||
| Ethics Form rev 8-16-21.pdf | ||
| APPENDIX A - Price Sheet 37-25-042.xlsx | XLSX spreadsheet | |
| APPENDIX A - Revised Price Sheet 37-25-042.xlsx | XLSX spreadsheet |
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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 .