Contractor Background Check Form (Page 3 of 4) in pdf

Contractor Background Check Form Page 3

Subcontractor Form

Undersigned shall employ, subject to the Owner's approval, the following subcontractor for the Request for Proposal. One (1)

form must be provided for each and every subcontractor employed. The prime Proposer shall bear the sole responsibility

for the successful completion of work performed by the below listed third party service provider(s).

Service provided by Subcontractor:

Name of Subcontractor:

Address:

City/State/Zip:

Telephone:

Fax Number:

E-Mail Address:

Point of Contact:

Business Days/Hours:

No. Years in Business Under This

Name:

No. Years at Location Listed:

No. Personnel Employed:

Subcontractor Name:

/Submitter’s Name/Title:

Address:

City, State and Zip Code:

Email Address:

Submitter’s Signature:

Telephone No.

Fax No.

800 # (if available)

Date:

Note: Due to provisions made to Contracted Services Criminal History by HB 2730, effective September 1, 2009, all subcontractors

must certify to the District, that the subcontractor complied and adheres to the Criminal History check requirements.

All subcontractors identified above, must complete the “Subcontractor Criminal Background Certification” form.

This sheet must be completed, signed, and returned with Prime Contractor’s submittal

Page 3 of 4

Contractor Background Check Form Page 3