INPUT FORM NO 26: SUBCONTRACTOR`S DECLARATION

The Ohio School Facilities Commission
10 West Broad Street
14th Floor
Columbus, Ohio 43215
Phone : 614-466-6290
Fax: 614-466-7749
INPUT FORM NO 26: SUBCONTRACTOR'S DECLARATION
Contractor's Contract No.
Your Federal ID Number:
Project Name and Location:
School District Name/County:
Prime Contractor's Name:
Prime Contractor's Address:
Phone Number:
Please Estimate the Following:
1. Your job duration (in weeks)
2. Your starting work date (month/year)
3. Your peak activity at construction site (month/year)
4. Your total combined work force, including all subcontractors
Complete for all subcontractors, specify brand name of their material:
Name:
Type Work:
Address:
Brand Name:
City:
Phone:
State:
Zip:
Name:
Type Work:
Address:
Brand Name:
City:
Phone:
State:
Zip:
Name:
Type Work:
Address:
Brand Name:
City:
Phone:
State:
Zip:
The Contractor listed above certifies that the subcontractors listed on this form are enrolled in the Bureau of Workers'
Compensation's (BWC) Drug-Free Workplace Program (DFWP) or Drug-Free EZ program for small employers (DF-EZ). To verify
DFWP enrollment for a subcontractor, go to BWC's website at: http//www.ohiobwc.com
Reviewed By:
Date
Prime Contractor Signature
Prime Contractor Name
Date
Construction Manager Signature
(Please type or print)
Construction Manager Name
(Please type or print)
Revision Date/Number: 5/16/06 (5)
The Ohio School Facilities Commission
10 West Broad Street
14th Floor
Columbus, Ohio 43215
Phone : 614-466-6290
Fax 614-466-7749
INSTRUCTIONS FOR COMPLETING INPUT FORM 26: SUBCONTRACTOR’S DECLARATION
PLEASE PRINT
• Please complete the following: Project/Contract No., Federal Tax ID#, Project Name and
Location, Prime Contractor’s Name and Address, Phone No. and Fax No.
• Your job duration in weeks: enter the prime contractor’s estimate of the job duration in weeks.
• Your estimated starting work date: enter the prime contractor’s estimated work date (even if this is before
the actual on-site date). Use a two-digit number for the month, followed by a four-digit number for the year.
• Your peak activity at the construction site: enter the prime contractor’s estimated beginning of peak activity
at the construction site. Use a two-digit number for the month, followed by a four-digit number for the year.
• Your total work force, including subcontractors: enter the prime contractor’s estimated total combined work
force for this project, including all subcontractors.
• There are three (3) columns for entering information relating to your subcontractors. DO NOT include material
material suppliers on this form, a separate form is furnished for suppliers. Complete one column for each
subcontractor. If additional sheets are necessary, make copies of this form.
Name:
Address:
City/State/Zip:
Telephone #:
Fax #:
Federal Tax I.D.#:
Name of President:
Contact Person:
Award Date of Contract:
Amount of Contract:
Name of subcontractor
Address of subcontractor
City/State/Zip of subcontractor
Telephone number of subcontractor
Fax number of subcontractor
FTID# for subcontractor
President of subcontractor’s company
Name of your contact person with the subcontractor
Date of executed contract between prime and subcontractor
Amount of subcontractor’s contract with prime