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<br />ATTACHMENT F <br /> <br />JAGIBYRNE GRANT ADMINISTRATION <br /> <br />PROVIDER'S DISCLOSURE OF SUBCONTRACTORS AND SUPPLIERS <br />(Ordinance 97-104) <br /> <br />Name of Organization: C"ry Or S'-'nny roSlErS ~W\ddress: J~O(O C.o\\;N.S AVG <br />$u (\ny .xsL~s SEA-c.h, Fl."331'-0 <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 ST ATE <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 />Title: <br /> <br />/v'l A 0 <br /> <br /> <br />Date: <br /> <br />I hereby certify that the foregoing infor <br /> <br />Signature of Authorized Representative: <br /> <br />Firm Name: <br /> <br />h . Fed. ID No. '5 w 078 4G,4..7 <br /> <br />Address: /8070 Coll,'l\is, AvE:. City/ State/Zip: ~ntllY IsLEoS "!.eAc.h I FL. 33('-0 <br />Telephone: (JoSj ~47-0"OG, Fax: (30S 7ct2.-/SG..\ E-mail: N~d~c.up @ s\ b-PL. ,\le..1" <br />