CONTRACTOR’S LIST OF SUBCONTRACTORS/SUPPLIERS Contract No. Contractor’s Name, Address and Federal ID No.: Project Description/Location: Date Submitted: Bid Date: MWBE Goals MBE WBE Submittal No.: Contract Amount: Construction Contracts Exceeding $100,000 Commodity or Service Contracts Exceeding $25,000 Federal ID No. Subcontractor/ Sub/Supplier Subcontractor/Supplier MBE WBE General Description of Work Supplier OGS Use Only (Check One) Name, Address, Phone No. and Federal ID No. Dollar Value Sub Supplier (Do not list information previously submitted.) Federal ID No.: Federal ID No.: Federal ID No.: Federal ID No.: OGS Use Only Proposed Goal Attainments: Pursuant to Executive Law Article 15-A, my firm proposes to use the certified firms listed above. MBE % MBE $ WBE % WBE $ Accepted Accepted as Noted Not Accepted Contractor’s Signature Reason: Title OGS Authorized Signature Date Date
CONTRACTOR’S LIST OF SUBCONTRACTORS/SUPPLIERS Contract No. Contractor’s Name, Address and Federal ID No.: Project Description/Location: Date Submitted: Bid Date: MWBE Goals MBE WBE Construction Contracts Exceeding $100,000 Commodity or Service Contracts Exceeding $25,000 Submittal No.: Contract Amount: Federal ID No. Subcontractor/Supplier Name, Address, Phone No. and Federal ID No. (Do not list information previously submitted.) Sub/Supplier (Check One) MBE WBE General Description of Work Subcontractor/ Supplier Dollar Value OGS Use Only Sub Supplier Federal ID No.: Federal ID No.: Federal ID No.: Federal ID No.: Pursuant to Executive Law Article 15-A, my firm proposes to use the certified firms listed above. OGS Use Only Proposed Goal Attainments: MBE % MBE $ WBE % WBE $ Contractor’s Signature Accepted Accepted as Noted Not Accepted Title Reason: Date OGS Authorized Signature Date
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