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1.riT"T]'sR pC• IAiTEN'C T(J PFRF012M AS A SUBCUNTRAC'1'OR <br />CONTRACT: ~,,/~': v NA~iH~~-~-o~F. B~iDiiER: -7~ <br />rW 4V C'~ edty"`/ ~/~'~ ~PP~.t ~~f~(.~Z VGK~~ _i/~(1 - <br />The undersigned intends to perform work in connection with the above contract upon execution of the bid <br />and subsequent award of contract by the Board of Transportation as: <br />Name ofMBENVBE/DBESubcontractor_G Yi.t2_ ~o"f~eos t^r~r~~.,~~. _T.~- <br />Address ~~? 2 ~EC~o~. d. ~ T '# ? 5 <br />City ~, ~G State ~L Zip 2 7 253 <br />Please check a!1 that apply: <br />Minority Business Enterprise (MBE} ~/ <br />Women iiusic~s Enterprise (WB8) <br />Disadvantaged easiness Enterprise (DBE) ~` <br />The MBE /WBE lDBE status of the above named subcontractor is certified by the North Carolina <br />Department of Transporiarion_ The above named subcontractor is prepared to perform the descrtbed work <br />listed on the attached MBE/WBE9DBE Commitment Items sheet, in connection with the above contract <br />upon execution of the bid and subsequent award of c:onitact by the Board of Transportation. The above <br />named subcomractor is prepared to perform the described work at the estimated Conunitment Total for <br />Subcontractor Price identified on the MBE/WBElDBE Commitment Items sheet and amoum indicated <br />below. <br />Commitment Total based on estimated Unit Prices and Quantities on the "attached" MBFJWBEfDBE <br />Commitment Items sheet. Amount $ 3S :_K`~ ? oO <br />The above gamed bidder and subcontractor mutually accepts the Commitment Totat estimated for the <br />Unit Prices and Quantities. This commitment total is based on estimated quantities only and most 1'kely <br />will vary up or down as the project is completed. Final c:ompertsation will be based on actual quantities of <br />work performed and accepted during the pursuance of work. The above listed amount represents the <br />entire dollar amount quoted based on these estimated quantities. No conversatsons, verbal agr+cements, <br />and/or other fomts ofnon-written r+epresentationsshgll serve to add, delete, or modify the terms as stated. <br />This document shalt not serve in any manner as an actual subcontract between the two parties_ A separate <br />subcontractor agreemerrt will describe in detail the cormractual obligations of the bidder and the <br />[v[BE/WBE/DBE subcontractor. <br />APIu-matiort <br />the above named MBE/ WBFJ DBE subcontractor affums that it will perform the potion(s) of the <br />contrail for the estimated dollar value as stated above. _ <br />GYtcz P~~n _~t~«~~ <br />Name of MBFJ WBEf DBE Saibcootr9ctor <br />~~ z PlB C~ Z rQS~c~un~- <br />Signistere lTitle <br />D9te <br />Date <br />6'd £lZtr6Lb 6L6 'aul uolpru;suo~ uaanrpw epp:Ll 60 !?6 ^oN <br />