Please list the full name of any subcontractor used to complete the project. The Grantee certifies that they have checked the federal debarment/suspension list, at the Web site , for the agents and/or subcontractors listed below. Submit this form to your State Contact listed on the cover page of the Agreement. Grantee:___________________________________________________________________ Project Name:____________________________________________________________________ Contractor Name: Address: Not on Debarment Suspension List Contractor Name: Address: Not on Debarment Suspension List Contractor Name: Address: Not on Debarment Suspension List
Please list the full name of any subcontractor used to complete the project. The Grantee certifies that they have checked the federal debarment/suspension list, at the Web site , for the agents and/or subcontractors listed below. Submit this form to your State Contact listed on the cover page of the Agreement. Grantee:___________________________________________________________________ Project Name:____________________________________________________________________ Contractor Name: Address: Not on Debarment Suspension List Contractor Name: Address: Not on Debarment Suspension List Contractor Name: Address: Not on Debarment Suspension List
CONTRACTORS_QUALIFICATIONS_FORM_635202_7.docx