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ATTACHMENT F <br />JAGBYRNE GRANT ADMINISTRATION <br />PROVIDER'S DISCLOSURE OF SUBCONTRACTORS AND SUPPLIERS <br />(Ordinance 97 -104) <br />Name of Organization: OJT l �� Su��n� ZsLS at4t1- Address: I Xe70 to11►oir Avt <br />5 unr•y -Ltl.r s 11tAt L, <br />REQUIRED LISTING OF SUBCONTRACTORS ON COUNTY CONTRACT <br />In compliance with Miami -Dade County Ordinance 97 -104, the Provider must submit the list of first tier <br />subcontractors or sub - consultants who will perform any part of the Scope of Services Work, if this <br />Contract is for $100,000 or more. <br />The Provider must complete this information. If the Provider will not utilize subcontractors, then the <br />Provider must state "No subcontractors will be used "; do not state "N /A ". <br />NAME OF SUBCONTRACTOR OR SUB - CONSULTANT ADDRESS CITY AND STATE <br />No subcontractors will be used. <br />REQUIRED LIST OF SUPPLIERS ON COUNTY CONTRACT <br />In compliance with Miami -Dade County Ordinance 97 -104, the Provider must submit a list of suppliers <br />who will supply materials for the Scope of Services to the Provider, if this Contract is $100,000 or <br />more. <br />The Provider must fill out this information. If the Provider will not use suppliers, the Provider must <br />state "No suppliers will be used ", do not state "N /A ". <br />NAME OF SUPPLIER ADDRESS CITY AND STATE <br />No suppliers will be used. <br />I hereby certify that the foregoing info <br />✓� <br />Signature of Authorized Representative <br />Title: !-44Jo r- <br />is true, corn ct an complete: <br />Date: <br />Firm Name: �.i'� suH�y L�4 s 4cG� Fed. ID No. iJi�'- 07g4V `-7 <br />Address: I g070 6olliv4S five . City /State /Zip: S41,10y rays _64aci~ 331L0 <br />Telephone: (10<) 947- ObO(.o Fax: (ias' ) 7 9 I S'le3 E -mail: i►edaic�c�t9s�F�h "l.nl� <br />