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Instructions for Form : <br /> The contractor must provide enough information through a Schedule "A" spreadsheet to determine which pay-item (s ) are <br /> being sublet, the amounts , and cost. For sublet calculations, the amount will be calculated based on the actual contract <br /> unit price (s) unless there is a partial sublet. For partial sublets , use the unit prices from the actual sub-contract. <br /> 1 ) Enter the Date of the certification of sublet work was prepared . <br /> 2) Enter the sequential number of the request starting with number 1 . <br /> 3) Enter the Federal Aid Project number for the Prime Contractor if any . <br /> 4) Enter the Financial Project Identification number of the Contract . <br /> 5) Enter the Contract number of the Contract with the Department. <br /> 6) Enter the County name where the work is being performed . <br /> 7) Enter the Name of the Prime Contractor. <br /> 8) Enter the FEID number of the Prime Contractor. <br /> 9 ) Enter the Original Contract dollar amount (round to nearest whole dollar) . <br /> 10) Enter a "Y" in the space marked Change if any information on the line has changed since the <br /> previous certification of sublet work was prepared . Otherwise , leave blank . <br /> 11 ) Enter the Subcontractor names . Enter all the subcontractor(s ) regardless of their tier. <br /> 12 ) Enter the tier number for the subcontractor. If the subcontractor works directly for the Prime <br /> Contractor, enter a " 1 " . If he works one level below, enter a "2 and so on . <br /> 13) Enter the FEID number of the Subcontractor(s ). <br /> - 14) Enter the name of the pertinent Contractor or Subcontractor that hired subcontractor. <br /> 15) Enter a short description of the work to be performed . <br /> 16 ) Enter a " P" if any pay- item for the sublet is a partial sublet . <br /> 17 ) Enter the DBE status for the subcontractor: "D" for DBE , "N " for non-DBE . <br /> 18 ) The Department may require subcontractor to be prequalified with the Department as described <br /> in the Special Provisions and the Bid Solicitation Notice whenever construction projects contain <br /> certain classes of work that require specific expertise . <br /> 19) One ( 1 ) copy of this form shall be submitted to the District Office by the contractor. <br /> 20 ) To be signed by principal of the firm or someone with the delegated authority and notarized . <br /> In <br /> iLn <br /> 00500 - 2 <br />