Firm Work, Supplier Percent Dollar (Name and Address) Material or Diversity/SEED (%) Amount Service Program Status (Of Total (Of This Firm's Work, Material (Provide Brief Proposal or Service) Description) Price) 1. PROPOSER/PRIME CONTRACTOR Name $_________ Address SEED % ___ City, State, Zip Amount of Qualified of Total Primary Contact Total Yes No Phone # Proposal Proposal License Number & Classification DIR # 2. SUBCONTRACTOR Name $_________ SEED % Address ___ Amount of Qualified City, State, Zip of Total Total Primary Contact Yes No Proposal Phone # Proposal License Number & Classification DIR # 3. SUBCONTRACTOR Name $_________ SEED % Address ___ Amount of Qualified City, State, Zip of Total Primary Contact Total Yes No Proposal Phone # Proposal License Number & Classification DIR # 4. SUBCONTRACTOR Name $_________ SEED % Address ___ Amount of Qualified City, State, Zip of Total Total Primary Contact Yes No Proposal Phone # Proposal License Number & Classification DIR # DESIGNATION OF PRIME CONTRACTOR, SUBCONTRACTORS, AND SUPPLIERS (Continuation Page ; may be duplicated as needed) SUBCONTRACTOR Name $_________ SEED % Address ___ Qualified Amount of City, State, Zip of Total Primary Contact Yes No Total Proposal Phone # Proposal License Number & Classification DIR #
Firm (Name and Address) Work, Material or Service (Provide Brief Description) Supplier Diversity/SEED Program Status Percent (%) (Of Total Proposal Price) Dollar Amount (Of This Firm's Work, Material or Service) 1. PROPOSER/PRIME CONTRACTOR Name Address City, State, Zip Primary Contact Phone # License Number & Classification DIR # SEED Qualified Yes No ___ % of Total Proposal $_________ Amount of Total Proposal 2. SUBCONTRACTOR Name Address City, State, Zip Primary Contact Phone # License Number & Classification DIR # SEED Qualified Yes No ___ % of Total Proposal $_________ Amount of Total Proposal 3. SUBCONTRACTOR Name Address City, State, Zip Primary Contact Phone # License Number & Classification DIR # SEED Qualified Yes No ___ % of Total Proposal $_________ Amount of Total Proposal 4. SUBCONTRACTOR Name Address City, State, Zip Primary Contact Phone # License Number & Classification DIR # SEED Qualified Yes No ___ % of Total Proposal $_________ Amount of Total Proposal DESIGNATION OF PRIME CONTRACTOR, SUBCONTRACTORS, AND SUPPLIERS (Continuation Page ; may be duplicated as needed) SUBCONTRACTOR Name Address City, State, Zip Primary Contact Phone # License Number & Classification DIR # SEED Qualified Yes No ___ % of Total Proposal $_________ Amount of Total Proposal
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