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SECTION 00516 - RESPONSIBLE CONTRACTOR - SUPPLEMENTAL <br />ADDITIONAL SUBCONTRACTORS LIST <br />PRIME CONTRACTOR TO SUBMIT AS SUBCONTRACTORS ARE ADDED TO THE PROJECT <br />PROJECT TITLE: Riverdale Drive Extension Improvements <br />This form must be submitted to the Project Manager or individual as identified in the solicitation document. <br />Minn. Stat. § 16C.285, Subd. 5.... If a prime contractor or any subcontractor retains additional subcontractors on the <br />project after submitting its verification of compliance, the prime contractor or subcontractor shall obtain verifications of <br />compliance from each additional subcontractor with which it has a direct contractual relationship and shall submit a <br />supplemental verification confirming compliance with subdivision 3, clause (7), within 14 days of retaining the additional <br />subcontractors. <br />ADDITIONAL SUBCONTRACTOR NAMES Name of city where company <br />(Legal name of company as registered with the Secretary of State) home office is located <br />Additional Subcontractors List - Riverdale Drive Extension Improvements <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 this form have been verified through a signed statement under oath by an owner or officer <br />that they meet the minimum criteria to be a responsible contractor as defined in Minn. Stat. § 16C.285. <br />Authorized Signature of Owner or Officer: Printed Name: <br />Title: Date: <br />Company Name: <br />City of Ramsey - R16.111092 RESPONSIBLE CONTRACTOR - SUPPLEMENTAL <br />April 5, 2017 PAGE 00516 -1 <br />© Bolton & Menk, Inc. 2016, All Rights Reserved <br />