2011-204A - Laserfiche WebLink

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