NYC DEPARTMENT OF EDUCATION
SUBCONTRACTOR APPLICATION
PRIME CONTRACTOR INFORMATION:
THE PRIME CONTRACTOR IS RESPONSIBLE FOR THE TIMELY SUBMISSION OF THIS APPLICATION PRIOR TO THE
START OF A SUBCONTRACTOR WORKING ON SITE. SUBCONTRACTOR APPROVAL STATUS IS TRADE SPECIFIC.
1. PRIME CONTRACTOR’S NAME __________________________________________________________
2. TEL. NO. _______________________ FAX___________________ EMAIL ________________________
3. FEDERAL TAX I.D. NUMBER ____________________________________________________________
4. CONTRACT DESCRIPTION ______________________________________________________________
5. BOE CONTRACT MANAGER _____________________________________________________________
6. CONTRACT NO. _____________________ SPECIFICATION NO. _______________________________
7. DESCRIPTION OF SUBCONTRACT WORK __________________________________________________
SUBCONTRACTOR BUSINESS INFORMATION:
1. NAME OF COMPANY _____________________________________________________________________
2. TEL. NO. _______________________ FAX__________________ EMAIL ____________________________
3. FEDERAL TAX I.D. NUMBER (FEIN) / SS NUMBER______________________________________________
[IF YOU DO NOT HAVE A FEDERAL TAX NUMBER ISSUED BY THE IRS, PROVIDE YOUR SOCIAL SECURITY NUMBER]
4. ADDRESS _______________________________________________________________________________
CITY _______________________________ STATE __________________ ZIP ________________________
5. OFFICER / OWNER NAME __________________________________________________________________
TITLE ___________________________________________________________________________________
6. TRADE(S) _____________________________________________ CURRENT LICENSE □ YES
[COPIES OF ALL APPLICABLE LICENSES AND CERTIFICATES MUST BE ATTACHED]
7. COMPANY IS ONE OR MORE OF THE FOLLOWING: PLEASE CHECK BOX AND ATTACH DOCUMENTATION
MBE LBE WBE SOLE PROPRIETORSHIP PARTNERSHIP CORPORATION
SUBCONTRACTOR CERTIFICATION:
I CERTIFY THE INFORMATION STATED IN THIS APPLICATION IS IN ALL RESPECTS TRUE
NAME OF BUSINESS ___________________________________________________________________________________________
BY _______________________________________________ ______________________________________________________
(SIGNATURE OF AUTHORIZED OFFICIAL) (TYPE OR PRINT NAME)
TITLE OF AUTHORIZED OFFICIAL ____________________________________
(TYPE OR PRINT)
DATE _______________________
SWORN TO ME THIS ________ DAY OF __________________ 20___________
____________________________________________
NOTARY PUBLIC
APPLY CORPORATE SEAL HERE
LABOR LAW CERTIFICATION:
I certify that I pay and will continue to pay the prevailing rate of wages including all supplemental benefits as required by the
New York State Labor Law Section 220 and /or Section 230 and as prescribed by the Comptroller of the City of New York to all
labor employed by me on New York City Department of Education contracts, and that I am ready to provide evidence on
prevailin
g wages and supplemental benefit payments at any time upon request from the New York City Department of
Education.
I certify that I will pay supplemental benefits to all labor employed by me in accordance with the category checked below.
1. Benefits paid through Union, Local Number ____________ (attach copy of agreement).
2. Approved welfare/pension plan (attach copy).
3. No work on site. Law not applicable.
4. Section 230 applies (check other appropriate category).
5. Cash payments in form of checks at Comptroller approved rates.
ALL CONTRACTORS AND SUBCONTRACTORS MUST SUBMIT A VENDEX BOOK TO THE MAYOR’S OFFICE OF CONTRACTS
AND A VENDEX MEMO TO THE DIVISION OF SCHOOL FACILITIES - GO TO WWW.NYC.GOV/VENDEX FOR INSTRUCTIONS
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