Fillable MBE/ESB Change in Subcontractors Form

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MBE/ESB Change in Subcontractors Form

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Minority Business Development
900 East Broad Street
City Hall, 16th Floor
Richmond, VA 23219
Office: (804) 646-5947
Fax: (804) 646-0136
http://www.richmondgov.com/MBD
MBE/ESB Change in Subcontractors Form
All firms listed in this directory have registered with the City of Richmond as a minority owned
business (MBE) or certified as an Emerging Small Business (ESB). It should be noted, that
there are MBE businesses listed in this directory that are not certifi ed. Therefore, any prime
contractor/vendor desiring to use a registered MBE firm that is not certified, must be aware,
that the registered MBE firm has 180 days to get certified or before the completion of the
contract, whichever is less, or the prime con tractor/vendor risks not receiving credit toward the
minority participation goal for the said project.
MBE/ESB – 6 Change in Subcontractors Form – Revised Date 9/1/2015
Prime Contractor:
Project Name:
Contract No.
Original MBE/ESB Contractor
Contact Person
Phone Number
Release Date
Current MBE/ESB
Contractor/Vendor(s)
Hire Date
Contact Person
Phone/Fax
Number
Address
Reason for Change
ABC Co., Inc.
Joe Johns
(804) xxx-xxxx
00/00/0000
Richmond City Inc.
00/00/0000
Mike Richmond
804-xxx-xxxx
804-xxx-xxxx
1234 Broad Street
Richmond, VA
23219
MBE Subcontractor unable to
commit
Signature OF AUTHORIZED OFFICIAL: Date:
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MBEESB Change in Subcontractors Form

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Completed 16 July 2020

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