Free SF4351-IC730_R7.xls - Indiana

REQUEST FOR APPROVAL OF SUBCONTRACTOR
State Form 4351 (R7 / 11-07) / IC-730 INDIANA DEPARMENT OF TRANSPORTATION

CONTRACT NO. SHEET OF

(See reverse side for instructions) Name of Prime Contractor Name of Subcontractor Subcontractor Address (number and street, city, state, and ZIP code) CONTRACT BID / EWA DATA (A) BID / EWA ITEM (B) SPEC. REFERENCE (C) ITEM DESCRIPTION (D) BID / EWA QTY.

The Prime Contractor and proposed Subcontractor must complete the PRIME CONTRACTOR'S AND SUBCONTRACTOR'S SIGNATURES AND SUBCONTRACTOR'S CERTIFICATION OF UNEARNED WORK on the reverse side of the last sheet of this request. Subcontractor Federal Identification Number Subcontractor Phone No.

SUBCONTRACT DATA (E) ITEM UNITS (F) ITEM UNIT PRICE (G) QTY. SUBLET (H) % (I) SUBLET PRICE SUBLET / BID UNIT (J) EXTENSION (G) X (I)

TOTAL THIS SUBCONTRACT = APPROVAL (For Department Use Only) Request No. Date Received EEO Check Recommended by: Approved by (District Construction Engineer): The proposed subcontractor is prequalified. Prequalification is not required for this type of work. Prequalification is not required for $300,000 or less. Date (month, day, year) Date (month, day, year) ORIGINAL CONTRACT THIS SUBCONTRACT PREVIOUS SUBCONTRACTS TOTAL SUBCONTRACTS PRIME CONTRACTOR % % % %

INSTRUCTIONS FOR COMPLETING FORM IC-730 "REQUEST FOR APPROVAL OF SUBCONTRACTOR" 1. This form may be completed electronically, then printed, signed and submitted or it may be printed, then completed by hand, signed and submitted. If completed by hand, all entries must be printed or typed clearly. 2. Enter the Contract No. and Sheet __ of __. If the submittal contains multiple sheets, TOTAL THIS SUBCONTRACT and PRIME CONTRACTOR'S AND PROPOSED SUBCONTRACTORS SIGNATURES AND SUBCONTRACTOR'S CERTIFICATION OF UNEARNED WORK need only be completed on the last sheet. If multiple sheets, note in TOTAL THIS SUBCONTRACT to "See Page __ for Total". Complete the information for the name, Federal ID, phone number and address of the proposed Subcontractor. If the proposed Subcontractor does not have a Federal ID, the Social Security number of the company's owner must be given. 3. For each item to be subcontracted, enter (A) the 3 digit Bid or EWA Item No., (B) the 8 digit Spec. Reference No., (C) the Item Description, (D) the Bid or EWA Qty., (E) the Item Units and (F) the Item Unit Price. Columns (A) thru (F) must be exactly as bid by the Prime in the Itemized Proposal or as documented in an approved Change Order. 4. Enter (G), Qty. Sublet and (H), % Sublet. (G) is the quantity of the item, in the same units as (E), to be sublet. (H) is the estimated percentage of the work (labor, equipment & materials) the subcontractor will perform on the item. If the Subcontractor is performing all the work for the entire item quantity, then (G) = (D), and (H) = 100. If the Subcontractor is performing all the work for a portion of the item quantity, then (G) is a number less than (D), and (H) = 100. If the Subcontractor is performing part of the work on the entire quantity, then (G) = (D), and (H) is the estimated percentage of the work. If the Subcontractor is performing part of the work for a portion of the item quantity, then (G) is a number less than (D), and (H) is the estimated percentage of the work. The Sublet Price/Bid Unit, (I), is calculated as (F) x (H) / 100. The Extension, (J), is calculated as (G) x (I). When completed as an electronic spreadsheet, columns (I) and (J) will be calculated automatically. 5. The Prime Contractor must include an explanation on or with the IC-730 of who will perform the remainder of the work for all items for which the quantity and or percentage of work is partially sublet. 6. On all Federal Aid contracts, EEO Form CM 32-34, signed by the proposed Subcontractor, must be submitted with the request to sublet, as well as a copy of the notification to the Department of Labor (OFCCP) when the sublet is $10,000 or more. 7. On requests to sublet in excess of $300,000 or unearned work of more than $300,000, the proposed Subcontractor must be prequalified with the Department. Prequalification is not required for "Construction Engineering". Even if prequalification is not required, a request for approval, regardless of value, must be submitted for all subcontract work on the contract and must be approved prior to the proposed Subcontractor starting work. 8. The completed IC-730 must be submitted to the District Construction Office. PRIME CONTRACTOR'S AND PROPOSED SUBCONTRACTOR'S SIGNATURES AND SUBCONTRACTOR'S CERTIFICATION OF UNEARNED WORK The Prime Contractor and the proposed Subcontractor hereby certify: (1) that a written subcontract agreement has been made between the Prime Contractor and the proposed Subcontractor, that said agreement does physically contain all pertinent provisions and requirements of the prime contract; (2) that on Federal-Aid contracts, a set of the applicable Federal Wage Stipulations, Notice of Requirement for Affirmative Action, EEO Special Provisions, Form PR-1273 (Federal Contract Provisions) are physically attached to, and are part of the subcontract agreement; (3) that on state funded contracts, the State Wage Provisions and all applicable contract Special Provisions pertaining to the Subcontractor's operation are physically attached to, and are part of the subcontract agreement and (4) that a copy of the subcontract agreement is on file in the offices of the Prime Contractor and the Subcontractor and that the subcontract agreement is available for review by appropriate INDOT or FHWA personnel upon request. The proposed Subcontractor further certifies that as of the date signed the total amount of unearned work for which the proposed Subcontractor has been approved with any Owner, Contractor, or other party is $ . Unearned work is defined as any work to be performed under any contract or agreement wherein the undersigned is a general contractor, subcontractor, manufacturer or mining contractor which work has not been completed or accepted. The proposed Subcontractor may submit a separate Certification of Unearned Work. For this purpose, half-sized forms are available from the District Office.
Name of Prime Contractor Prime Contractor Signature Title Date (month, day, year) Name of Subcontractor Subcontractor Signature Title Date (month, day, year)