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700-010-36 <br />CONSTRUCTION <br />11/17 <br />Page 2 of 2 <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. <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 />a) Note: Notary not required when form is digitally signed. <br />00500-2 <br />