Letter Of Intent - Schedule Of Participation printable pdf download

Letter Of Intent - Schedule Of Participation

LETTER OF INTENT / SCHEDULE OF PARTICIPATION

DISADVANTAGED BUSINESS ENTERPRISE (DBE) PARTICIPATION*

(THIS FORM MUST BE COMPLETED IN FULL & SUBMITTED TO THE SPONSOR WITH DBE DOCUMENTATION)

PROJECT

NO.

PROJECT TITLE

NAME OF GENERAL CONTRACTOR

NAME OF DBE CONTRACTOR*

ADDRESS

CITY

STATE

ZIP CODE

PHONE

The undersigned DBE firm intends to perform work in connection with the above referenced project as:

Check one:

an individual

a partnership

a corporation

a joint venture with

other

attach extra sheets if necessary

The undersigned affirms that s/he is a duly authorized official representing the proposed Disadvantaged Business

Enterprise and affirms that its certification has not expired nor been revoked.

(Attach a copy of certification letter.)**

Check all that apply:

MBE

WBE

Other

Certification Agency

Certification Number

If awarded the contract, the undersigned intend to enter into a subcontract to perform the work described on the

following sheet for the prices indicated.

Use a separate form for each DBE firm to be utilized on the project.

Certification must be completed prior to contract award. See contract documents and "Instructions to Bidder."

H-GAC FORM A, PAGE 1 OF 2

Last Revised: May 2016

Letter Of Intent - Schedule Of Participation