Laserfiche WebLink
6.D. - Page 86 of 170 <br />Request for Qualifications: <br />General Park Building Construction, Retrofit, Maintenance, and/or Repairs <br />SCHEDULE B <br />TASK WORK ORDER LIST OF SUBCONSULTANTS <br />(NOTE: COPY THIS PAGE AND ADD ADDITIONAL SHEETS AS NECESSARY, SIGN ALL SHEETS) <br />Project Title Work Order Number <br />Contractor Address <br />Contact Person Phone/Fax <br />LIST OF ALL SUBCONSULTANTS (SERVICE PROVIDERS/SUPPLIERS/ETC.) <br />NAME, ADDRESS, TELEPHONE NO. OF <br />SUBCONSULTANT <br />DESCRIPTION OF <br />WORK OR SUPPLY <br />MBE/WBE/ <br />SBE/EBE/ <br />DVBE/OBE <br />CALTRANS/ <br />CITY/MTA <br />CERT. NO. <br />DOLLAR VALUE <br />OF <br />SUBCONTRACT <br />N6 r� <br />$ <br />TOTAL WBE AMOUNT <br />$ <br />% <br />TOTAL SBE AMOUNT <br />$ <br />% <br />Printed Name of Person Completing this Form <br />TOTAL EBE AMOUNT <br />$ <br />TOTAL DVBE AMOUNT <br />$ <br />TOTAL OBE AMOUNT <br />$ <br />Title Date <br />PERCENTAGE OF MBE/WBE/SBE/EBE/DVBE/OBE <br />PARTICIPATION <br />DOLLARS <br />PERCENT <br />Signature of Person Completing this Form <br />TOTAL MBE AMOUNT <br />$ <br />TOTAL WBE AMOUNT <br />$ <br />% <br />TOTAL SBE AMOUNT <br />$ <br />% <br />Printed Name of Person Completing this Form <br />TOTAL EBE AMOUNT <br />$ <br />TOTAL DVBE AMOUNT <br />$ <br />TOTAL OBE AMOUNT <br />$ <br />Title Date <br />BASE BID AMOUNT <br />$ <br />MUST BE SUBMITTED PRIOR TO THE ISSUANCE OF THE NOTICE TO PROCEED <br />IMPORTANT — RESPONDERS MUST SUBMIT ALL REQUIRED FORMS (COMPLETELY FILLED OUT) BY RFQ <br />SUBMITTAL DEADLINE. <br />Page 80 of 103 <br />169 <br />