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Miami -Dade County <br />Solicitation RTQ-00918 <br />SUBCONTRACTORISUPPLIER LISTING <br />(MiamDadeCounty CodeSeStkal.RaiNi O <br />Name of Bidder/Propos '10. <br />n accordance with Sectiodlt,88.8 and 10.34 of the M®ade County Code, this form must be submitted as a condition of award by all Biddenu?naposers on County contracts for purchase of supplies, materials or services, <br />Winding professional services which Involve expenditures of $100,000 or more, and a0 Proposers an County, or Public Health Trust consliucfion contracts which Involve expenditures of $100,000 ormore. The Bidder/Proposerwho is <br />warded this contract shall not change or substitute first bar subcontractors or direct suppliers or the portions of the contract work to be performed or materials to be supplied from those Identified, except upon written approval of tl <br />�Dturty. The Bidder/Proposershould enter the word NONE' under the appropriate heading of this form if no subcontractors or suppress will be used on the contract and sign the form below. <br />In accordance with Ordinance BDladEntity contracting with the County shall report the race, gender and elhnloorigin of the owners and employees of ad first der subconlractomleupiffiethe event that the recommended <br />idder Pr000serd monslmtea to the Coun rior to award that the race nder and ethnic Information is not reasonablyavailable a he time the Bidder/Pro user shall be obligated to exercise diligent efforts to obtain that Informed. <br />nd rovide the same to me Coun not latermlin ten 10 des after it becomes available and, in en event, rierto fine ayment under the contract <br />(Please duplicate this form If additional space is needed.) <br />3uppliest <br />Principal Owner <br />Emp oyea(s) <br />Business <br />Materials/ <br />(Enter the number of male and female owners by racalethnlcity) <br />(Enter the number of male and female employees and the number of <br />Name and <br />Principal <br />Services to Ic <br />mployeas by racelefhnicity) <br />Native <br />Native <br />Address of <br />Owner <br />Provided by <br />First Tter Dire <br />Supplier <br />M <br />F <br />White <br />Black <br />Hispanic <br />01rtc <br />Americo <br />Other <br />M <br />F <br />Whim <br />Black <br />Hispanic <br />Other <br />Supplier <br />Iaiander <br />Native <br />Islander <br />Nativeart <br />Native <br />ken <br />i <br />F- <br />� <br />F-.-F_F__F_F__� <br />F__F <br />F_ F_ <br />mployae(a) <br />(Enter the number of male and <br />F___ <br />female employees <br />— <br />F__ F__I (. <br />and the number of <br />Business <br />ocope or wo <br />to he <br />Principal Owner <br />No sand <br />Address <br />Performed by <br />(Enhrthanumberef-li end/emdeowners byracdathnidty) <br />em to ass b <br />racalethnldly <br />of <br />First Tier <br />Principal <br />Owner <br />Subcontract <br />Native <br />Native <br />Subcontract <br />Subeonsulta <br />M <br />F <br />White <br />Black <br />Hispanle <br />chic <br />Islander <br />American <br />Native <br />Omer <br />M <br />F <br />White <br />Black <br />Hlspsnte <br />lalandar <br />American <br />NaBve <br />Omar <br />Subconsulta <br />kan <br />j <br />t <br />Midark hen if rag, gender and ethnicity Infmmatlon is not available and will be provided at a later data. Tha data may be aubmitled to centractlng department or on line to the Small Bueihtlpgv0aveigWiagaatMYietlrdlmlmssarvtces Department at <br />developmmalantracts.ceps a condition of final payment,Bidder/Proposer shall provide subcontractor Information on the Subcontractor Payment Report Sub 200Hd4olwkh&rdmn*A lmgddbusines.Ilibmryl(orms/subgayra*64Wf <br />I certify that the representations contained in this Subcontractor/Suppharllsting are to the best of my knowledge true and accurate. <br />Signature of Bidder/Proposer Print Name Print Title <br />5/312019 7:48 AM p. 14 <br />