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ADDITIONAL SUBCONTRACTOR NAMES Name of city where company home <br /> (Legal name of company as registered with the Secretary of State) office is located <br /> SUPPLEMENTAL CERTIFICATION <br /> By signing this document I certify that I am an owner or officer of the company,and I swear under oath that: <br /> All additional subcontractors listed on Additional Subcontractors List have verified through a signed statement under oath <br /> by an owner or officer that they meet the minimum criteria to be a responsible contractor as defined in Minn.Stat.§ <br /> 16C.285. <br /> Authorized Signature of Owner or Officer: Printed Name: <br /> Title: Date: <br /> Company Name: <br /> Additional Subcontractors List <br /> 004515-2 <br />