DHEC Form 3591 "Prime Contractor's Subagreement Certification" - South Carolina

What Is DHEC Form 3591?

This is a legal form that was released by the South Carolina Department of Health and Environmental Control - a government authority operating within South Carolina. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2020;
  • The latest edition provided by the South Carolina Department of Health and Environmental Control;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of DHEC Form 3591 by clicking the link below or browse more documents and templates provided by the South Carolina Department of Health and Environmental Control.

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Download DHEC Form 3591 "Prime Contractor's Subagreement Certification" - South Carolina

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Prime Contractor’s
Subagreement Certification
SRF Project Number ________________________
Project Name ____________________________________________ Division___________________
Contractor’s Name and Address _______________________________________________________
__________________________________________________________________________________
Contractor’s Telephone ______________________
CERTIFICATION
I, as the authorized representative of the above named contracting firm, certify that we:
Plan to subcontract a portion of this project and will submit to SCDHEC evidence of the
positive steps taken to utilize minority and women’s businesses as required by Executive
Order 11246 prior to entering into any subagreement. We agree to submit MBE/WBE
utilization reports (U.S. EPA Form 5700-52A or equivalent). (Please fill out page 2 of this
form with each tentative subcontractor and/or any uncommitted work.)
Do not elect to subcontract any portion of this project. We understand that should we elect, at
a later date, to subcontract a portion of this project, we will be required to provide evidence of
the positive steps taken to utilize minority and women-owned businesses as required by
Executive Order 11246 prior to entering into any subagreement. Failure to do so may result
in costs associated with that subagreement declared ineligible for SRF assistance.
Printed Name and Title of Contractor’s Representative
Signature of Contractor’s Representative
Date
Submit by email to DHEC project manager or by mail to:
SRF Section - Water Facilities Permitting Division, S.C. DHEC, 2600 Bull Street, Columbia, SC 29201
PURPOSE / INSTRUCTIONS / REVIEW & RETENTION:
For SRF equivalency projects, prime contractors certify whether they plan to utilize subcontractors to
complete project construction using the Prime Contractor’s Subagreement Certification. The prime
contractor’s representative will enter the requested project information and indicate subcontracting
intentions. The representative will sign the certification and fill out page 2 with requested information as
needed. A revised DHEC 3591 must be submitted any time the information on page 1 or 2 changes.
The SRF Section will use this form to document the subcontracting intentions of the prime contractor.
The form will be kept in the DBE/EEO file for the named project and will be retained for three years
following the final SRF disbursement to the project’s Sponsor - per Retention Schedule 15795.
DHEC 3591 (1/2020)
S.C. Department of Health and Environmental Control
Page 1
Prime Contractor’s
Subagreement Certification
SRF Project Number ________________________
Project Name ____________________________________________ Division___________________
Contractor’s Name and Address _______________________________________________________
__________________________________________________________________________________
Contractor’s Telephone ______________________
CERTIFICATION
I, as the authorized representative of the above named contracting firm, certify that we:
Plan to subcontract a portion of this project and will submit to SCDHEC evidence of the
positive steps taken to utilize minority and women’s businesses as required by Executive
Order 11246 prior to entering into any subagreement. We agree to submit MBE/WBE
utilization reports (U.S. EPA Form 5700-52A or equivalent). (Please fill out page 2 of this
form with each tentative subcontractor and/or any uncommitted work.)
Do not elect to subcontract any portion of this project. We understand that should we elect, at
a later date, to subcontract a portion of this project, we will be required to provide evidence of
the positive steps taken to utilize minority and women-owned businesses as required by
Executive Order 11246 prior to entering into any subagreement. Failure to do so may result
in costs associated with that subagreement declared ineligible for SRF assistance.
Printed Name and Title of Contractor’s Representative
Signature of Contractor’s Representative
Date
Submit by email to DHEC project manager or by mail to:
SRF Section - Water Facilities Permitting Division, S.C. DHEC, 2600 Bull Street, Columbia, SC 29201
PURPOSE / INSTRUCTIONS / REVIEW & RETENTION:
For SRF equivalency projects, prime contractors certify whether they plan to utilize subcontractors to
complete project construction using the Prime Contractor’s Subagreement Certification. The prime
contractor’s representative will enter the requested project information and indicate subcontracting
intentions. The representative will sign the certification and fill out page 2 with requested information as
needed. A revised DHEC 3591 must be submitted any time the information on page 1 or 2 changes.
The SRF Section will use this form to document the subcontracting intentions of the prime contractor.
The form will be kept in the DBE/EEO file for the named project and will be retained for three years
following the final SRF disbursement to the project’s Sponsor - per Retention Schedule 15795.
DHEC 3591 (1/2020)
S.C. Department of Health and Environmental Control
Page 1
List all tentative subcontractors/vendors you plan to use for this project, identify any that are suppliers
and indicate whether the subcontractor/vendor is a minority business enterprise (MBE) or a women-
owned business enterprise (WBE). If more space is needed, attach additional sheets using the same
format.
1. Type of Work ____________________________________________
Subcontractor’s Name and Address __________________________________________________
_______________________________________________________________________________
Contact Person _________________________Telephone Number _________________________
Subcontract Amount _____________________Duration of Subcontract ______________________
MBE
WBE
Supplier
2. Type of Work ____________________________________________
Subcontractor’s Name and Address __________________________________________________
_______________________________________________________________________________
Contact Person _________________________Telephone Number _________________________
Subcontract Amount _____________________Duration of Subcontract ______________________
MBE
WBE
Supplier
3. Type of Work ____________________________________________
Subcontractor’s Name and Address __________________________________________________
_______________________________________________________________________________
Contact Person _________________________Telephone Number _________________________
Subcontract Amount _____________________Duration of Subcontract ______________________
MBE
WBE
Supplier
4. Type of Work ____________________________________________
Subcontractor’s Name and Address __________________________________________________
_______________________________________________________________________________
Contact Person _________________________Telephone Number _________________________
Subcontract Amount _____________________Duration of Subcontract ______________________
MBE
WBE
Supplier
5. Type of Work ____________________________________________
Subcontractor’s Name and Address __________________________________________________
_______________________________________________________________________________
Contact Person _________________________Telephone Number _________________________
Subcontract Amount _____________________Duration of Subcontract ______________________
MBE
WBE
Supplier
List of subcontract work yet to be committed with approximate price and duration of subcontract:
1. _______________________________________________________________________________
2. _______________________________________________________________________________
3. _______________________________________________________________________________
4. _______________________________________________________________________________
Submit by email to DHEC project manager or by mail to:
SRF Section - Water Facilities Permitting Division, S.C. DHEC, 2600 Bull Street, Columbia, SC 29201
DHEC 3591 (1/2020)
S.C. Department of Health and Environmental Control
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