Request For Specialty Subcontract Labor Only Classification(S) Based On Experience And Contractor Reference (Page 5 of 5) in pdf

Request For Specialty Subcontract Labor Only Classification(S) Based On Experience And Contractor Reference Page 5

Affidavit of Subcontractor Applying for Subcontract Labor Only Classification(s)

State of Louisiana, Parish of __________________________________________________________ personally

appears ______________________________________________ who being duly sworn, deposes and saith that:

I understand that approval for the subcontract labor only license classification(s) that I have requested on

this form neither permits me to enter into contracts directly with a project owner or awarding authority, nor

to buy materials for contracts for which this subcontractor labor only classification has been used and

required. I further understand and agree that my license may be immediately suspended or revoked if it is

determined by the compliance section of the Louisiana State Licensing Board for Contractors that I have used

the subcontractor labor only license classification(s) requested on this form to contract directly with anyone

other than a licensed contractor, or if I have purchased materials for contracts signed using the subcontractor

labor only license classification(s) requested herein, where a state contractors license is required by law for

such contracts.

I affirm that the forgoing statements and all statements contained on this form are true and correct and the

answers of the foregoing are true to the best of my knowledge under penalties of perjury.

Sworn or affirmed before me this ____________ date of _________________________________,______________.

Name of Subcontractor’s Firm:_____________________________________________________________________

Signature of Subcontractor: _______________________________________________________________________

Address of Subcontractor’s Firm ____________________________City________________ State_____ Zip________

Signature of Notary Public

Print Name and Address of Notary Public

_________________________________

Request For Specialty Subcontract Labor Only Classification(S) Based On Experience And Contractor Reference Page 5