First Tier Subcontractor_designation_form-final 8-2023.pdf
PDF 84 KB Posted
- Attached to
- Youth Assistance Program State and local contract opportunity
- Solicitation number
- 37-25-039
- 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 form for prime contractors receiving contracts over $50,000 for supplies/services or over $100,000 for construction from Wayne County. The form requires contractors to disclose whether they will use subcontractors and provide detailed information about any first-tier subcontractors, including their company details, contact information, subcontract amount, percentage of contract, and work to be performed.
The form is designed to ensure transparency in subcontracting relationships and requires disclosure of any related parties between subcontractors and contract managers. Contractors must complete the form even if no subcontractors will be used, and they must provide comprehensive information about each subcontractor, including federal tax ID, address, contact details, and the specific work they will perform. The form also includes a section for declaring any potential conflicts of interest or related party relationships, with space to detail the names, departments, titles, and nature of those relationships.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| Appendix A Price Sheet RFP 37-25-039.pdf | ||
| W-9 Form v10-18.pdf | ||
| Appendix C Sample Program Services RFP 37-25-039.pdf | ||
| Ethics Form rev 8-16-21.pdf | ||
| Appendix B Agreement FINAL RFP 37-25-039.pdf | ||
| RFP 37-25-039 Youth Assistance Providers FINAL.pdf |
On GovTribe
Work with this file on GovTribe
- 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 .