SCHEDULE A-1:

DESIGNATION of ALL SUBCONTRACTORS, INCLUDING SUBCONTRACTORS/SUBCONSULTANTS/VENDORS/SERVICE PROVIDERS

Company Name: Project Name: Date: Change Order # : _____

Contact name: Phone# Water Authority Project Manager: Contract # Amendment #:_____

NAME AND CONTACT OF
SUBCONTRACTOR(S) / SUBCONTRACTOR(S) LICENSE NUMBER / 2nd Tier Sub?
YES TO:____/NO / ADDRESS, TELEPHONE NUMBER, E-MAIL OF PLACE OF BUSINESS.
Headquarters or Local Office? / SPECIFIC WORK TO BE DONE BY SUBCONTRACTOR (1) / Small Business
Yes / No / MINORITY- OWNED YES / NO / WOMAN- OWNED YES / NO / VETERAN-OWNED YES / NO / ORIGINAL DOLLAR
AMOUNT (2) / Changes Per This Change Order/
Amendment / Cumulative Change Orders/ Amendment Dollars / % OF
TOTAL
FEE / LIST ANY CERTIFICATIONS (3)

Note: San Diego County Water Authority reserves the right to verify contents of this report by contacting subcontractors, including subcontractors, subconsultants, vendors and service providers.

(1) If 100 percent of item will NOT be performed or furnished by listed small contractor, describe exact portion of the item that will be performed or furnished by the small contractor.

(2) Must show total price for specific work by subcontractor, subconsultant, vendor, service provider, or broker. For Material Brokers, show Broker Fee for Service.

(3) For a complete description of Small Business certifications and criteria, visit: http://www.sdcwa.org/opps/scoop-aboutus.phtml#FAQ

\\Seal\data\PA\FullAccess\SCOOP\Forms & Templates\NEW Scoop A1.doc Revised 07/14 SCHEDULE A-1