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Instructlo" for Form: The. contractor Mott provide; anough'infotmation through `Schedule v'AWPpr9pdsheet to determine which pay-item(s). are bding'.subldt, the amounts; and cost. r subleicalculattonsthe amount Will 46 calculated based 6h the. actual contract u6ftprice(s.),unl,es-si6ere.lsapartitils!jblet For'paft'l;svOlOtg,.us6,tht3,un'dp;I pricessub-contract.. nc actual 1) Enter the Date of the. certification of sublet work Was prepared. -2) Enter thes6quential number of the request starting with number 1. 3) Enter the Feddr'al Aid project. number for the Prime Contractor if any, 4) Enter the Financial Project, Identification number ofthe �Contract 5) Enter the Qoptract, number of the Oontrapt I with the' Department. 6 - Enter the Countyname Where. thO work;is boingperformed. , . 7) enter the Nam'GL'o 'f the Pelme Contractor. 8) Enter the FEID number of the Prl` Me Contractor. 9) Enter the Original ContriactAbIlar.amolint (found :to nearest whole dollar). 1o) Enter a "r in the space Marked Change lf'any infbrmation on the, line has chang'e'd sin'ce.tho previous certification of - sublet workwatprepared. Qtherwlse, leave,blank. 11) Enter the Subcontractor names.: Enter all the stibcontr4dto(s) regardless of their tier, 42) Enter the tier number for the.subcontractor. If the, subwrittador, wicks directly e Prime di Wy� for th Contradtor, enter ak, I" , It Ile works one *level below,, enter a "2 and. so on. 13) Enter the f EID number f the Subcontractor(s). 14) Enter the -name of the pertinent,Contractor,or Subcontractor that. hired subcontractor. 15) Enter a shoo description of thework l to be performed. M Enterra TP I any 'pay item for the sublet ls;�A partial su.bleti M epterthe DBE, status for the subcontrac ND" for DB E, "NO for non -DBE. 18) The Department may require subcontractor to be prequalified with the Department at, described In the Special Provisions, Bid Notice: Whenever construction project's contain e s1OnqAndthdB. �§dhlcltat[o.n ofl certain classes. of-work-that-require-s'pe.,'cific-expertise: 19) One (1) dopy Of,this form s.hpil be submitted to the District Office by the contractor. 20) To be sl�ndd by ptin dipal-ol"the firm or someone with :the delegated authority and notarized .