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Miami -Dade County <br />SUBCONTRACTORISUPPLIER LISTING <br />- (Miaml County Code-SeStIgd%.R alfld$ 0 <br />Name of Bidder/Propos rlo. <br />Solicitation RTQ-00918 <br />In accordance with SecfidiK28.8 and 10.34 of the M®ade County Code, this form must be submitted as a condition of award by all Bidders/Proposers on County contracts for purchase of supplies, materials or services, <br />eluding professional services which involve expenditures of $100,000 or more, and all Proposers an County or Public Health Trust construction wntracts which involve expenditures of $100,000 or more. The Bidder/Proposer who is <br />warded this contract shall not change or substitute first tier 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 it <br />only. The Bidder/Proposer should enter the word "NONE" under the appropriate heading of this to= if no subcontractors or suppliers will be used on the contract and sign the form below. <br />In accordance with Ordinance g@ad Entity contracting with the County shall report the race, gender and ethnic o igin of the owners and employees of all first ger subcontractorslsupli ethe event that the recommended <br />idder/Pro Poser demonstrates to the Cou nty prior to award that the race ender and ethnic information is not reasonabl available at that time the Bidder/Pro oser shall be obligated to exercise diligent efforts to obtain that informati. <br />nd provide the same to the County not later than ten 10 da s after it becomes available and, in any event, prior to final ayment under the contract <br />(Please duplicate this form If additional space is needed.) <br />upp as <br />Principal Owner Employees) <br />Business <br />Mated <br />(Enter the number of male and female owners by race/ethnicity) (Enter the number of male and female employees and the number of <br />Name and <br />Principal <br />:Is/ <br />Services to b <br />mployees by racelathnicity) <br />Address of <br />Owner <br />Provided by <br />Native <br />Native <br />First Tier Dire <br />Supplier <br />M I F <br />Whale 1 Black I His cific American <br />panic Other M F White <br />Black Hispanic <br />American <br />Supplier <br />Islander Native <br />Islander Native Other <br />ken <br />F_ <br />F___= <br />I— (_ <br />principal Owner Employee(s) <br />Business <br />zcope o1 .01 <br />Name and <br />to be <br />(Enter the number of map and tamale owners by racelathnicity) (Enter the number of male and female employees and the number of <br />Address of <br />Principal <br />Performed by <br />employees by race/ethnleiry <br />Native <br />Native <br />First Tier <br />Owner <br />Subcontract <br />Subcontract <br />Subeonsulta <br />M F <br />-11. <br />Black <br />Hispania olFle <br />American Other M F <br />White <br />Black <br />Hispania <br />American <br />Other <br />Subconsulta <br />Islander <br />Native <br />Islander <br />Native <br />ken <br />=IMark here if race, gender and ethnicity information is not available and will be provided at a later date. This data maybe submitted to contracting department or on line to the Small Bus! heFYv&avao(6hgonbeaeisftwwsaemicas Department at <br />developmeebntractamaps a condition of final payment, BldderiProposer shall provide subcontractor Information on the Subcontractor Payment Report Sub 2001 UotwWehmardAa%wgdWbusinessilibrary/forms/subgafie.bk¢f <br />I certify that the representations contained in this SubcontractoNSuppliar listing are to the best of my knowledge true and accurate. <br />_. _. <br />Signature of Bidder/Proposer Print Name Print Title <br />5/3/2019 7:48 AM <br />p. 14 <br />