project manual-salt storage bldg-2002

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, ~ � in ount . Hennep C y � Smali Business Enterprise Program Subcontractor's/Supplier's Participation Form � Project Name: Project Number: Prime Contractor's Name: Prime's Phone Number: Subcontractor's Name: Sub's Phone Number: � Doliar Amount of Subcontractor's Contract: Total Dollar Amount of Work Seif-PerFormed by 1$ Tier Sub: (If entire dollar amounf of contract,as indicated on Prime's/Suppliers SBE Participation Form,wiH be se/f- � performed by the subconfracto�/supplier in question,you may stop here after signing and dating the form.) Joint Venture Partner(if any): G Certified SBE O Non SBE � Address: Phone Number: Fax Number: Services or Supplies Provided: � Dollar Amount of their Contract: %of Joint Venture's Based Bid: List all 2'�tier subcontractors/suppliers and the dollar value of their contracts, along with the � percentage of the 1�`tier subcontract each 2"�tier subcontract represents: Firm Name: � Certified SBE G Non SBE � Address: Phone Number: Fax Number: Services or Supplies Provided: Dollar Amount of their Contract: � Firm Name: G Certified SBE 0 Non SBE Address: � Phone Number: Fax Number: Services or Supplies Provided: Dollar Amount of their Contract: , Firm Name: O Certified SBE G Non SBE Address: Phone Number: Fax Number: � Services or Supplies Provided: Dollar Amount of their Contract: Firm Name: O Certified SBE O Non SBE � Address: Phone Number: Fax Number: Services or Supplies Provided: � Dollar Amount of their Contract: FiRn Name: 0 Certified SBE G Non SBE Address: � Phone Number: Fax Number: Services or Supplies Provided: Dollar Amount of their Contract: � � Hennepin County Subc�ntractors Fom� HCrTCS S8E7 9/O�;R