(Sealed Bid) As specified in the DBE Participation Section included in the Solicitation Documents, the Proposer must furnish to SEPTA the details of non-DBE subcontractor participation. PROJECT NAME: SEALED BID NO.: WORK/SERVICES TO BE PERFORMED BY SUBCONTRACTORS MATERIAL/SUPPLIES TO BE PURCHASED FROM SUPPLIERS NAME OF FIRM DESCRIPTION OF TOTAL WORK/SERVICES TO BE CONTACT PERSON, BUSINESS ADDRESS, TELEPHONE NUMBER SUBCONTRACT/PURCHASE PERFORMED / ORDER AMOUNT MATERIAL TO BE SUPPLIED Firm Name: Contact: $ Address: Tele. No.: Firm Name: Contact: $ Address: Tele. No.: Firm Name: Contact: $ Address: Tele. No.: Firm Name: Contact: $ Address: Tele. No.: Firm Name: Contact: $ Address: Tele. No.: (Type or Print all information) Name of Bidder: Tele. No.: ( ) (type or print) Email: Contact: Title: (type or print) Signature: Date:
(Sealed Bid) As specified in the DBE Participation Section included in the Solicitation Documents, the Proposer must furnish to SEPTA the details of non-DBE subcontractor participation. PROJECT NAME: SEALED BID NO.: WORK/SERVICES TO BE PERFORMED BY SUBCONTRACTORS MATERIAL/SUPPLIES TO BE PURCHASED FROM SUPPLIERS NAME OF FIRM CONTACT PERSON, BUSINESS ADDRESS, TELEPHONE NUMBER DESCRIPTION OF WORK/SERVICES TO BE PERFORMED / MATERIAL TO BE SUPPLIED TOTAL SUBCONTRACT/PURCHASE ORDER AMOUNT Firm Name: $ Contact: Address: Tele. No.: Firm Name: $ Contact: Address: Tele. No.: Firm Name: $ Contact: Address: Tele. No.: Firm Name: $ Contact: Address: Tele. No.: Firm Name: $ Contact: Address: Tele. No.: (Type or Print all information) Name of Bidder: Tele. No.: ( ) (type or print) Email: Contact: Title: Signature: (type or print) Date:
03-2016-stateconstructionrev-16-00043-ARIB.docx