Prime Contractor: Email Address:
Subcontractor: Email Address:
Address: City: State: Zip Code:
Contact Person: Phone Number: () Fax Number: ()
Contract Amount: Federal I.D. Number: ______
B2G Officer: ______Email: ______
Subcontractor must submit this “Subcontractor’s Background Information form" to the prime contractor. Submit updated forms to reflect any changes made to the original contract award amount.
1. First list your firm’s name and dollar amount, etc, then list your firm’s direct suppliers. If any other Subcontractor will be utilized, list them as well.
The total dollar amount of your subcontract agreement with the prime must be accounted for in this detail.
2. Identify each firm as either a Subcontractor (SUB) or supplier (SUP).
3. Identify if any of the Subcontractors or suppliers listed is a Minority, Woman, Small, Emerging or Disadvantaged Business Enterprise (M/W/S/E/DBE) certified by DSBO.
4. Provide Federal ID# for Subcontractor and suppliers
5. Identify type of work to be performed by Subcontractors, or type of material to be provided by suppliers.
6. Indicate the dollar value of each firm subcontract or supplier agreement.
Check Applicable Columns
( √ ) / Federal I.D. # / Work or Supplies to be Furnished / Company Name, Address (City, State, Zip Code)
Telephone & Fax Number, Contact Person & E-mail / Dollar Amount
Subcontractor / Supplier / M/W/S/E/DBE
Subcontractor / Supplier / M/W/S/E/DBE
SUBCONTRACTOR’S BACKGROUND INFORMATION FORM
(Copy this page if needed)
Check Applicable Columns( √ ) / Federal I.D. # / Work or Supplies to be Furnished / Company Name, Address (City, State, Zip Code)
Telephone & Fax Number, Contact Person & E-mail / Dollar Amount
Subcontractor / Supplier / M/W/S/E/DBE
Subcontractor / Supplier / M/W/S/E/DBE
Subcontractor / Supplier / M/W/S/E/DBE
Subcontractor / Supplier / M/W/S/E/DBE
Subcontractor / Supplier / M/W/S/E/DBE
Rev 03242015 JE