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, <br /> � <br /> Firm Name: 0 Certified SBE O Non SBE <br /> � Address: <br /> Phone Number: Fax Number: <br /> Services or Supplie� Provided: _.- . <br /> � Dollar Amount of their Contract: <br /> Firm Name: 0 CeRified SBE O Non SBE <br /> Address: <br /> � Phone Number: Fax Number: <br /> Services or Supplies Provided: <br /> Dollar Amount of their Contract: <br /> tFirm Name: O Certified SBE G Non SBE <br /> Address: <br /> Phone Number: Fax Number: <br /> � Services or Supplies Provided: <br /> Doilar Amount of their Contract: <br /> � Total Dollar Amount of Work Subcontracted to SBE Subcontractors/Suppliers $ <br /> Total Dollar Amount of Woiic Subcontracted to Non-SBE Subcontractors/Suppliers $ <br /> � Total Dotlar Amount of Work Self-PerFormed $ <br /> Total Bid/Contract $ <br /> � <br /> � Signature(s): <br /> � f Firm: <br /> Name o <br /> , Business Address: <br /> � E-Mail Address: <br /> � . <br /> � <br /> � <br /> � <br /> � Hennepin County Prlme Contradors Form HGTCS SBE6 tl <br />