HomeMy Public PortalAboutSubcontractor Verification Form
This is to certify that I, has been contacted by
(Subcontractor) (General Contractor)
to provide the following services for Bid No. for
(Name of Project)
Utilization Category Bid Item
No.1
Scope of Work
to be Performed1
MBE
Amount WBE Amount
Advance
Payment
Amount2
Balance to be
Paid as Work
Progresses
Materials/Supplies including
Labor or Installation
Service Provider/Installer
Hauling Services
Supplier/Distributor
Broker/Dealer
Other (Specify)
1Indicate the Bid Item under which the MBE scope of work will be performed and provide a description of this work and the associated cost amount. If the scope of
work encompasses multiple pay items, please indicate all items and amounts. If necessary a second sheet may be attached to provide this information. 2Shall not exceed 5% of the stated utilization amount and will be subject to the withholding of retainage.
If the Advanced Payment Amount is “blank” or zero, Subcontractor must confirm by checking the box below that the Prime Contractor
did offer to make an advance payment in accordance with the Contract Documents and that Subcontractor declined this offer.
Offer of Advance Payment was Declined
Signature Date
Type or Print Name Email
MBE/WBE SUBCONTRACTOR/VENDOR VERIFICATION FORM