Common use of 16C Clause in Contracts

16C. 285. A prime contractor shall submit to the contracting authority upon request copies of the signed verifications of compliance from all subcontractors of any tier and motor carriers, pursuant to subdivision 3, clause (7). Authorized Signature of Owner or Officer Company Name Print Name Date Title FIRST TIER SUBCONTRACTOR NAMES (Legal name of company as registered with the Secretary of State) Name of city where company home office is located % of value of Contract *Is the First Tier Subcontractor a TG/ED/VO? *TG/ED/ VO = Certified Targeted Group Business, Economically Disadvantaged Business, and Veteran-Owned Business

16C. 285. A prime contractor shall submit to the contracting authority upon request copies of the signed verifications of compliance from all subcontractors of any tier and motor carriers, pursuant to subdivision 3, clause (7). _ _ Authorized Signature of Owner or Officer Company Name _ _ Print Name Date _ Title FIRST TIER SUBCONTRACTOR NAMES (Legal name of company as registered with the Secretary of State) Name of city where company home office is located % of value of Contract *Is the First Tier Subcontractor a TG/ED/VO? *TG/ED/ VO = Certified Targeted Group Business, Economically Disadvantaged Business, and Veteran-Owned Business

16C. 285. A prime contractor shall submit to the contracting authority upon request copies of the signed verifications of compliance from all subcontractors of any tier and motor carriers, pursuant to subdivision 3, clause (7). Authorized Signature of Owner or Officer Company Name Print Name Date Title FIRST TIER SUBCONTRACTOR NAMES (Legal name of company as registered with the Secretary of State) Name of city where company home office is located % of value of Contract *Is the First Tier Subcontractor a TG/ED/VO? *TG/ED/ VO = Certified Targeted Group Business, Economically Disadvantaged Business, and Veteran-Owned BusinessBusiness All additional subcontractors listed above verified through a signed statement under oath by an owner or officer that they me et the

16C. 285. A prime contractor shall submit to the contracting authority upon request copies of the signed verifications of compliance from all subcontractors of any tier and motor carriers, pursuant to subdivision 3, clause (7). _ _ Authorized Signature of Owner or Officer Company Name _ _ Print Name Date Title FIRST TIER SUBCONTRACTOR NAMES (Legal name of company as registered with the Secretary of State) Name of city where company home office is located % of value of Contract *Is the First Tier Subcontractor a TG/ED/VO? *TG/ED/ VO = Certified Targeted Group Business, Economically Disadvantaged Business, and Veteran-Owned Business