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APPENDIX THREE

Attachment C

HUB SUBCONTRACTING PLAN HISTORICALLY UNDERUTILIZED BUSINESS LETTER OF INTENT (HUB-LOI)

(HUB-LOI IS USED BY POTENTIAL PROFESSIONAL/CONTRACTOR/VENDOR TO IDENTIFY SUBCONTRACTORS SELECTED FOR WORK ON THE CONTRACT)

Bidder: Vendor Identification Number:

_

Address:

P h o n e : _ _ _ _ - _ _ _ _ - _ _ _ _ Contract Amount: _

Bid Number:

______________

________________________

of Description _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

commodities/specifications:

Time _ _ _ _ _ _ _ _ _ _ _ _ _ _ period _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

covered:

Name of Subcontractor/Supplier:

_________________________________________________

Address: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Phone:

--

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Is the subcontractor a HUB? ____ No

____

Yes

____

No if yes, is the subcontractor certified?

____

Yes

GSC Certificate (VID) _______________________

D o l l a r a m o u n t o f c o n t r a c t w i t h t h i s s u b c o n t r a c t o r / s u p p l i e r : $ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Percentage amount of contract with this subcontractor/supplier: %

_ _ _ _ _ _ _ _ _ _ _ _ _ _

Description of work performed under agreement with the subcontractor for amount indicated above:

PLEASE SUBMIT A SEPARATE FORM FOR EACH SUBCONTRACTOR/SUPPLIER.

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