Laserfiche WebLink
<br />^.I. .I. ^'-nJ.YU!.ol"ll. I!. <br /> <br />MIAMI-DADE DEPARTMENT OF HUMAN SERVICES <br />BYRNE GRANT ADMINISTRATION <br /> <br />PROVIDER'S DISCLOSURE OF SUBCONTRACTORS AND SUPPLIERS <br />(Ordinance 97-104) <br /> <br />Name of Organization: <br /> <br />~1I/J!J / des fucJy Address: <br /> <br />REQUIRED LISTING OF SUBCONTRACTORS ON COUNTY CONTRACT <br /> <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 /> <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 /> <br />NAME OF SUBCONTRACTOR OR SUB-CONSULTANT <br /> <br />ADDRESS <br /> <br />CITY AND STATE <br /> <br />No subcontractors will be used. <br /> <br />REQUIRED LIST OF SUPPLIERS ON COUNTY CONTRACT <br /> <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 /> <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 /> <br />NAME OF SUPPLIER <br /> <br />ADDRESS <br /> <br />CITY AND STATE <br /> <br />No suppliers will be used. <br /> <br />I hereby certify that the foregoing information is true, correct and complete: <br /> <br />~#-naie: /0'- /o-t}ef( <br />of 511/)1) . IsJe~ &rich Fed IDNo. 05- 67fL./6'17 <br /> <br />Address: /7076 CoJI/fjJ IJv~ 1dSD City/ State/Zip: SMfJ!} Is~eJ 'BetJchl fl. 33160 <br />Telephone: 0<6) 9l{7- yl/llD Fax: (,M '1'17 -'/lJb E-TflQi/: m'!JZ.rCin(/ @ <br />(}1/f) 'SpOIljI Urn <br /> <br />Title: <br />Firm Name: (!i <br /> <br />