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<br />.- <br /> <br />A TT ACHMENT F <br /> <br />JAG/BYRNE GRANT ADMINISTRATION <br /> <br />PROVIDER'S DISCLOSURE OF SUBCONTRACTORS AND SUPPLIERS <br />(Ordinance 97-104) <br /> <br />Name of Organization: CI;-'I 0 F 5 uon'j.:rsLe BeQ.ch <br /> <br />Address: /8'07CJ eollrl'{~ ~V'F <br />SuN t-J y .xs L{;~ '8'E'"Act,( FL- <br />33/bO <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 inform tion is true, correct and complete: <br />o '/ <br />Signature of Authorized Representative: fI!I111/ . <br /> <br />Title: t/f If 0 f2.. <br /> <br /> <br />Date: <br /> <br />Firm Name: C I r- <br /> <br />~ <br /> <br />Fed. IDNo. 65 . G7~4ro4] <br /> <br />Address: I go 76 Cut {, N. S 4Vb; City/ State/Zip: S Vi'" y' .rs! p s D eCc:c ~, r-t 3 J I fDO <br />Telephone: (3C(f) 9 f7-orooG, Fax: (3CUJ 7j2-( ~-6 '3 E-mail: NE&e{ccJO ~ S~bFl. tlJe1 <br />