"Certification (Exhibit 1) - Small Contractor (Sc) or Small Contractor Minority Business Enterprise (Scmbe) as Subcontractors for State Funded Projects" - Connecticut

Certification (Exhibit 1) - Small Contractor (Sc) or Small Contractor Minority Business Enterprise (Scmbe) as Subcontractors for State Funded Projects is a legal document that was released by the Connecticut Department of Transportation - a government authority operating within Connecticut.

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Download "Certification (Exhibit 1) - Small Contractor (Sc) or Small Contractor Minority Business Enterprise (Scmbe) as Subcontractors for State Funded Projects" - Connecticut

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STATE OF CONNECTICUT
DEPARTMENT OF TRANSPORTATION
2800 BERLIN TURNPIKE, P.O. BOX 317546
NEWINGTON, CONNECTICUT 06131-7546
Phone:
CERTIFICATION (EXHIBIT 1)
Small Contractor (SC) or
Small Contractor Minority Business Enterprise (SCMBE)
as Subcontractors for State Funded Projects
Project Description & Number
PRIME CONSULTANT
Firm Name:
Street:
City/State:
SC/SCMBE CONSULTANT
Firm Name:
Street:
City/State:
The following is a description of the project function the above SC or SCMBE will perform on the subject project,
which represents a dollar amount of $
The contractor is required, should there be a change in the originally named SC or SCMBE, to submit documentation to the
initiating unit to substantiate and justify the change, (i.e. documentation to provide a basis for the change for review and approval by
CONNDOT officials) prior to the implementation of the change. The contractor must demonstrate that the originally named SC or
SCMBE is unable to perform in conformity to specifications, unwilling to perform, is in default of its agreement, is overextended on other
jobs, etc.
Please submit a copy of the SC's or SCMBE's Certificate of Eligibility from the Department of Administrative Services with your
completed form.
We, the below signed, do hereby certify and concur with the above stated conditions.
Further, the SC or SCMBE consultant by signing below, is certifying that for the current state fiscal year the SC's or
SCMBE's volume of contracts and/or subcontracts awarded have not exceeded $10,000,000.
PRIME CONSULTANT:
Name:
signature
Name typed:
Date:
Title:
SC or SCMBE:
Name:
signature
Name typed:
Date:
Title:
An Equal Opportunity Employer
Printed on Recycled or Recovered Paper
STATE OF CONNECTICUT
DEPARTMENT OF TRANSPORTATION
2800 BERLIN TURNPIKE, P.O. BOX 317546
NEWINGTON, CONNECTICUT 06131-7546
Phone:
CERTIFICATION (EXHIBIT 1)
Small Contractor (SC) or
Small Contractor Minority Business Enterprise (SCMBE)
as Subcontractors for State Funded Projects
Project Description & Number
PRIME CONSULTANT
Firm Name:
Street:
City/State:
SC/SCMBE CONSULTANT
Firm Name:
Street:
City/State:
The following is a description of the project function the above SC or SCMBE will perform on the subject project,
which represents a dollar amount of $
The contractor is required, should there be a change in the originally named SC or SCMBE, to submit documentation to the
initiating unit to substantiate and justify the change, (i.e. documentation to provide a basis for the change for review and approval by
CONNDOT officials) prior to the implementation of the change. The contractor must demonstrate that the originally named SC or
SCMBE is unable to perform in conformity to specifications, unwilling to perform, is in default of its agreement, is overextended on other
jobs, etc.
Please submit a copy of the SC's or SCMBE's Certificate of Eligibility from the Department of Administrative Services with your
completed form.
We, the below signed, do hereby certify and concur with the above stated conditions.
Further, the SC or SCMBE consultant by signing below, is certifying that for the current state fiscal year the SC's or
SCMBE's volume of contracts and/or subcontracts awarded have not exceeded $10,000,000.
PRIME CONSULTANT:
Name:
signature
Name typed:
Date:
Title:
SC or SCMBE:
Name:
signature
Name typed:
Date:
Title:
An Equal Opportunity Employer
Printed on Recycled or Recovered Paper