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i, <br /> 1 <br /> 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. II <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. i <br /> 9) Enter the Original Contract dollar amount(round to nearest whole dollar). i <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"11". If he works one level below,enter a"2"and so on. <br /> 13) Enter the FEID number of the Subcontractor(s). r <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 /> 00500-2 <br />