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<br />SCHEDULE OF SUBCONTRACTOR/SUB CONSUL T ANT <br />PARTICIPATION <br /> <br />~(k <br /> <br />NAME OF <br />BIDDER <br />PROJECT TITLE <br />BID <br />NUMBER <br /> <br />f~p-e()or <br />SG ~ (XU ~66 <br /> <br />*Please list all MBEs or JSEBs first <br /> <br />NAME OF SUB <br />FIRM <br /> <br />ADDRESS OF <br />FIRM <br /> <br />,)YS1EJ1-\f> SnC. <br /> <br />TOTAL BASE BID AMOUNT <br /> <br />TYPE <br />OFSUB <br />(if certified) <br /> <br />TYPE OF <br />WORK TO BE <br />PERFORMED <br /> <br />TOTAL <br />CONTRACT <br />VALUE <br /> <br />CONSUL T ANT/SUBCONTRACTOR/SUPPLIER <br />TOTAL VALUES <br />African-American Participation Total Value: $ <br />Asian-American Participation Total Value: $ <br />Hispanic-American Participation Total Value: $ <br />Native-American Participation Total Value: $ <br />Women Participation Total Value: $ <br /> <br />The undersigned acknowledges and agrees that, if any of the above-listed MBEs and/or JSEBs are <br />not, for any reason, properly certified with the City, in accordance with Ordinance 2004-602, <br />at the time of bid opening, the same will not be counted toward meeting the participation <br />percentage goal as defined herein. <br /> <br />The undersigned will enter into a formal Agreement with the MBE / JSEB <br />Suppliers/Consultants/Subcontractors identified herein for work listed in this schedule, as <br />well as any applicable alternates, conditioned upon execution of a contract with the City of <br />Jacksonville. Under penalties of perjury I declare that I have read the foregoing conditions <br />and instructions and the facts are true to the best of my knowledge and beliefs. <br /> <br />Signature: <br /> <br /> <br />Print Name: <br /> <br />IV) ;-t L- \\eJ <br /> <br />Le;rnf_~ <br /> <br />Title <br /> <br />. P / ,\ J, <br />V. ~e(/(~tt.,,-~ <br /> <br />'1/;7/0] <br /> <br />Date: <br /> <br />" <br /> <br />Attach additionullisl of subcontraclors/subconsultants as nceded <br />FORIvI I 10/04 <br />