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ATTACILMENT F <br /> JAG/BYRNE GRANT ADMINISTRATION <br /> PROVIDER'S DISCLOSURE OF SUBCONTRACTORS AND SUPPLIERS <br /> (Ordinance 97-104) <br /> Name of Organization: Address: <br /> REQUIRED LISTING OF SUBCONTRACTORS ON COUNTY CONTRACT <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 /> 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 /> NAME OF SUBCONTRACTOR OR SUB-CONSULTANT ADDRESS CITY AND STATE <br /> No subcontractors will be used. <br /> REQUIRED LIST OF SUPPLIERS ON COUNTY CONTRACT <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 /> 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 /> NAME OF SUPPLIER ADDRESS CITY AND STATE <br /> No suppliers will be used. <br /> I hereby certify that the foregoing information is true, correct and complete: <br /> Signature of Authorized Representative: <br /> Title: Date: <br /> Finn Name: Fed. ID No. <br /> Address: City/State/Lip: <br /> Telephone: ( ) Fax: ( 1 E-mail: <br />