IFB 161076 ATTACHMENT C Subcontracting Approval Request.pdf

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Attached to
IFB 161076 Crack Sealing Services
Solicitation number
IFB-126902
Issued by
Albemarle County, Chesapeake City, Virginia

About this file

This is a Subcontractor Approval Request form for the Virginia Department of Transportation (VDOT) related to IFB 161076 for crack sealing services on primary and secondary roadways throughout the Charlottesville Residency, which includes Albemarle, Greene, and Madison Counties. The form establishes the procedural requirements for contractors who wish to subcontract portions of the work under this contract. No work or equipment may be subcontracted without prior written consent from VDOT. Contractors seeking to subcontract must submit the names, qualifications, and experience of proposed subcontractors for agency approval. The form requires detailed information about each proposed subcontractor, including firm or individual name and address, contact person and phone number, type of work to be performed, and type of equipment proposed subcontractors will provide.

The primary contractor remains fully liable and responsible for all work performed by subcontractors and must ensure compliance with all contract requirements. Contractors must identify whether any proposed subcontractors are certified with the Department of Small Business and Supplier Diversity (DSBSD) as Small, Women Owned, or Minority Businesses and provide relevant certification numbers. An authorized VDOT representative must sign and date the form to approve and accept the proposed subcontractors under the contract terms and conditions, with the signature, date, and telephone number of the authorizing official required for validation.

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ATTACHMENT C

Solicitation #:

SUBCONTRACTOR APPROVAL REQUEST

No portion of the work (including equipment) shall be subcontracted to another firm or individual without prior written consent of Virginia Department of Transportation (herein referred to as VDOT). In the event that the contractor desires to subcontract some part of the work specified herein, the contractor shall furnish VDOT with the names, qualifications, and experience of their proposed subcontractors for agency approval. The primary contractor shall, however, remain fully liable and responsible for the work performed by its subcontractor(s) and shall assure compliance with all requirements of the contract.

List proposed subcontractor(s), including name, address, contact person, and type of work to be performed under this contract below.

FIRM INDIVIDUAL’S

NAME & ADDRESS

CONTACT PERSON AND

PHONE NUMBER

TYPE OF WORK TO BE

PERFORMED

TYPE OF EQUIPMENT PROPOSED SUBCONTRACTOR WILL PROVIDE

QUALIFICATIONS / EXPERIENCE LEVEL OF PROPOSED SUBCONTRACTOR

Please indicate which above proposed subcontractors are certified (with DSBSD) as Small, Women Owned or Minority Businesses.

Certification Number(s):

FOR VDOT USE ONLY:

The proposed subcontractor(s) listed above is/are approved and accepted under the terms and conditions of the contract requirements herein.

Signature of Authorized VDOT Representative Date Telephone Number

Solicitation #:
FIRM INDIVIDUAL’S
TYPE OF EQUIPMENT PROPOSED SUBCONTRACTOR WILL PROVIDE
FOR VDOT USE ONLY:
Solicitation: 161076
NAME ADDRESS 1:
NAME ADDRESS 2:
NAME ADDRESS 3:
NAME ADDRESS 4:
PHONE NUMBER 1:
PHONE NUMBER 2:
PHONE NUMBER 3:
PHONE NUMBER 4:
PERFORMED 1:
PERFORMED 2:
PERFORMED 3:
PERFORMED 4:
TYPE OF EQUIPMENT PROPOSED SUBCONTRACTOR WILL PROVIDE 1:
TYPE OF EQUIPMENT PROPOSED SUBCONTRACTOR WILL PROVIDE 2:
QUALIFICATIONS EXPERIENCE LEVEL OF PROPOSED SUBCONTRACTOR 1:
QUALIFICATIONS EXPERIENCE LEVEL OF PROPOSED SUBCONTRACTOR 2:
Certification Numbers 1:
Certification Numbers 2:
contract requirements herein:
The proposed subcontractors listed above isare approved and accepted under the terms and conditions of the:
Telephone Number:

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