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[]
[]
[]
[]
["City of Seattle"]
["Seattle Public Utilities"]
[null,null,null,null,null,null,null,null,"Revision: 2/19/2014"]
["SUBCONTRACTOR APPROVAL APPLICATION"]
["Prior to a subcontractor beginning work, this form shall be completed and signed by Prime Contractor and submitted to and approved by the owner’s authorized representative."]
[]
[]
["SECTION A"]
["Project Name",null,null,null,null,null,"P.W. Project No.","Fed Aid No. \n(if applicable)","Spec. No. \n(if applicable)"]
[]
["Contractor Business Name (Prime)",null,null,null,null,null,null,null,"Telephone Number"]
[]
["Address ",null,null,null,null,null,"City","State","Zip"]
[]
["Approval is Requested to Sublet the Following Described Work to:"]
["Subcontractor Name              Lower Tier Sub? (complete box to the right)     ",null,null,null,null,null,"Lower Tier Subcontractor To: **"]
[]
["Address",null,null,"Telephone Number",null,null,"City","State","Zip"]
[]
["Federal Tax ID#",null,null,"State UBI#","Seattle Business License #                                               \n                                   Expires:",null,null,"Contractor's License #\n                                     Expires:"]
[]
["Has this Company ever been disbarred by L&I?"]
["No","Yes, Reason:"]
["Estimated Start Date",null,null,"Estimated Working Days ",null,"(A)         TOTAL CONTRACT AWARD\n**Lower Tier Subs: Enter Total Amount Sublet to First Tier Sub**"]
[]
[]
["Bid Item #","Bid Item Description\n          (also include description of partial work if applicable)",null,null,null,null,"Bid Item Amount","Amount Sublet","Partial Amount of Bid Item?"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,"(B)       Total Amount This Request (Less Contractually Excluded Work):",{"$f":"SUM(H32:H45)","v":0}]
[]
["SECTION B"]
["Is the company listed in the City of Seattle’s Vendor and Contractor Registration System?",null,null,null,null,null,null,null,"Yes           No"]
["(See http://web6.seattle.gov/fas/registration/)"]
[]
["Is the company listed in the WA State Office of Minority and Women’s Business Enterprises directory?",null,null,null,null,null,null,null,"Yes           No"]
["(See http://www.omwbe.wa.gov/certification/certification_directory.shtml)"]
["Is the company listed in the WMBE Contract Commitment Log section of the inclusion plan?"]
["         Yes (Go to Section C)"]
["         No, Is subcontracting to this company going to negatively affect the Total estimated percentage of the base bid to all MWBE subcontractors and suppliers in the inclusion plan or does it affect the work that is committed to the WMBE business’ listed on the commitment log in the inclusion plan?"]
[null,"No, Proceed to Section D."]
[null,"Yes, Provide a detailed explanation below for review by the owner’s representative (Note: Every attempt should be made to meet the \npercentage and to use the WMBE subcontractors/suppliers listed in the commitment log or substitute their work with another \napproved WMBE company.)"]
["SECTION C"]
["Does the dollar amount of the work match the dollar amount listed in the WMBE Contract Commitment Log?"]
["        Yes, the form is complete and you do not need to go any further."]
["        No, please provide an explanation below for review by the owner’s representative."]
["Explanation: (Sections B & C)"]
[]
[]
["SECTION D"]
["Is L&I Approved Intent to Pay Prevailng Wages for Subcontractor attached?",null,null,null,null,null,null,null,"Yes       "]
[]
["By signing this form I certify that the subcontractor listed above is in compliance with all of the responsible bidder requirements under RCW 39.04.350, including: having a certificate of registration under RCW 18.27; a UBI number; industrial insurance coverage if required under Title 51 RCW; an employment security number under Title 50; and a state excise tax registration number under Title 82.  I affirm that the subcontractor is not disqualified from working on any public works contract under RCW 39.06, or RCW 39.12.065(3) or on the Federal Excluded Parties List System (epls.gov)."]
[]
[]
[]
["I understand and will require that the subcontractor comply fully with the Contract under which this work is being performed."]
["Prime Contractor's Signature",null,null,null,null,null,null,"Date"]
[]
[]
["SECTION E                       For City of Seattle Administering Department Only"]
[]
["% of Total Contract Award, This Request (B)/(A):",null,null,{"$f":"H46/F29","v":{"$error":"#DIV/0!"}},"Cumulative % of all Work Subcontracted\n- OR -\n**Cumulative % of all Work Sublet to First Tier Sub**"]
[]
["Authorized CITY OF SEATTLE Signature",null,null,null,null,null,null,"Date:"]
[]
["Printed Name of Signature",null,null,null,null,null,null,"Title:"]
[]
["Approved",null,"Rejected, Reason:"]
[]
[]
["Instructions to the Contractor"]