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ATTACHMENT A-1 <br />FIRST -TIER SUBCONTRACTORS LIST <br />SUBMIT PRIOR TO EXECUTION OF A CONSTRUCTION CONTRACT <br />STATE PROJECT NUMBER: <br />Minn. Stat. § 16C.285, Subd. 5. A prime contractor or subcontractor shall include in its verification of compliance <br />under subdivision 4 a list of all of its first -tier subcontractors that it intends to retain for work on the project. Prior to <br />execution of a construction contract, and as a condition precedent to the execution of a construction contract, the <br />apparent successful prime contractor shall submit to the contracting authority a supplemental verification under oath <br />confirming compliance with subdivision 3, clause (7). Each contractor or subcontractor shall obtain from all <br />subcontractors with which it will have a direct contractual relationship a signed statement under oath by an owner or <br />officer verifying that they meet all of the minimum criteria in subdivision 3 prior to execution of a construction contract <br />with each subcontractor. <br />FIRST TIER SUBCONTRACTOR NAMES* <br />(Legal name of company as registered with the Secretary of <br />State) <br />Name of city where company <br />home office is located <br />*Attach additional sheets as needed for submission of all first -tier subcontractors. <br />SUPPLEMENTAL CERTIFICATION FOR ATTACHMENT A-1 <br />By signing this document I certify that I am an owner or officer of the company, and I certify under oath <br />that: <br />All first -tier subcontractors listed on attachment A-1 have verified through a signed statement under <br />oath by an owner or officer that they meet the minimum criteria to be a responsible contractor as defined <br />in Minn. Stat. § 16C.285. <br />Authorized Signature of Owner or Officer: Printed Name: <br />Title: Date: <br />Company Name: <br />Revised 2/3/2021 Page 4 of 5 <br />