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04/11/2002 23:24 9529300043 LASZLO FULOP PAGE 06;%21 ' Hennepin County Small Business Enterprise Program Contractors Participation Forrr� S.BE 6 Prime Contractor's/Suppiier's 0 Subcontractor's/Suppliec's ❑ lCheck One) Project Number: . . Contract Number: Project Name: Company Name: Phone Number: Fax Number: ' Cvntract SBE Goal: % Total SBE Participation: % Total Dollar Amount (lnitial NTE) of Cantract: Total Dollar Amount of Work Sslf-Performed: � (If entfre contract sum vvill be performed by the contractar or subcontractor listed above, you.may stop he�e atter signing and dating fhis form.) JOIN7 VENTURE PARTNER, (IF AN1�: CJ Certified SBE 0 Non SBE Acldress: City, State, Zip:. Phone Number: � � Fax Number: Services or Supplies Provided: Dollar Amount of their Contract: %,of Joint Venture's Based Bid: LtST ALL SUBG�NTRACTORS/SUPPLIERS AND THE DOLLAR VALUE OF TWE#R CONTRACTS Firm Name: C7 Certified SBE ❑ Non SBE Address: City, State, Zip: Phone Number: Fax Number: Services or Supplies Provided: Dollar Amount of their Contract: Firm Name: � Certified SBE ❑ Non SBE Address: City, State, Zip: Phone Number. Fax Number: Services or Supplies Provided: Dollar Amount of their Contract: Firm Name: � Certified SBE 0 Non SBE Address: � City, State, Zip: — Phone Number: F�x Number: Services or Supplies Provided: Dollar Amount of their Contract: Firm Name: 0 Certified SBE � Non SBE Address: City, State, Zip: Phone Number: Fax Number: � Services or Supplies Provided: Dollar Amount of their Contract: _.. . .. . . . . ......._ . ._.._ .... .. ..... .... _.. �irm Name: � Ce�tified SBE C] Non SB� Address: City, State, Zip: Phone Number: Fax Numbe�: Services o�Supplies Provided: Dollar Amount of their Contract: SBEB L. Rev. 3/4/02