First Tier Subcontractor Form.pdf

PDF 84 KB Posted

Attached to
Ecorse Sidewalk Replacement and Repairs
Solicitation number
37-25-065
Issued by
Wayne County, Michigan

About this file

Written by GovTribe AI ·

This document is a Wayne County Human Relations/Business Inclusion Division First Tier Subcontractor Designation Form, a mandatory compliance document for prime contractors receiving county contracts exceeding $50,000 for supplies/services or $100,000 for construction. The form requires prime contractors to disclose details about potential first-tier subcontractors, regardless of the subcontractor's dollar participation level, and must be completed even if no subcontractors will be used. The form includes sections for identifying the contract number, contract type, subcontractor usage, and potential related party relationships between subcontractors and contract managers.

The form provides space for prime contractors to list detailed information about subcontractors, including company name, federal tax ID, address, contact information, subcontract amount, percentage of total contract, specific work to be performed, and any potential conflicts of interest or related party connections. The document is designed to ensure transparency and accountability in the county's contracting process, requiring prime contractors to fully disclose subcontractor details and attest to the accuracy of the information through an authorized signature. The form is part of Wayne County's business inclusion and human relations oversight process, with contact information listed at the 500 Griswold, Detroit, MI address.

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Other files

File Type Posted
Appendix A - Price Sheet - IFB 37-25-065.xls XLS spreadsheet
Appendix J - DBE Form.pdf PDF
IFB 37-25-065 Ecorse Sidewalk Replacements.pdf PDF
Appendix I - Federal Labor Standards (HUD Form 4010) Information.pdf PDF
Appendix C - Example of Surety Forms (Performance and Payment Bonds).pdf PDF
Appendix G - Davis Bacon Wage Rates Determination.pdf PDF
Ethics Form rev 8-16-21.pdf PDF
W-9 Form v10-18.pdf PDF
Appendix H - Section 3 FAQ and Information.pdf PDF
Appendix E - Sidewalk Repair Locations.xlsx XLSX spreadsheet
Appendix D - Construction Documents.pdf PDF
Appendix F - Davis Bacon Act Information Sheet.pdf PDF
Appendix B - Sample Contract.pdf PDF
Show all 13

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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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