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<br />'''----, <br /> <br />ATTACHMENT E <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: CliY of SvnoyIsle..s 'Be.afhress: ,7C7CJ eel/INs Ay~ '#F~SJ <br />. SC!nny x.sJe.S 8e.o.cJ.,/ Fe <br />33 "0 <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 />- <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 />- <br /> <br />Signature of Authorized Representative: <br /> <br /> <br />I hereby certify that the foregoing infor <br /> <br />Title: .MAy'OQ. Date: Nove..t\'\lo.e.r \~ \~ <br />Firm Name: c.;ty of SlJnoyJ:.sles Beo..c..h Fed.IDNo. as - 0784'-47 <br />Address: /7070 CblliNSAve, #a5Q City/State/Zip: Sunn'l.I.sfa BFAC.h.l f:L. 33/'0 <br />. <br /> <br />Telephone: (30.5) q47- 0<;,0 G Fax: (345) c!ff 7 - 3' 13 E-mail: NS€DELC0 p @. Ao L. COI"r) <br />