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<br />EXHIBIT C <br /> <br />CONTRACTOR – SUBCONTRACTORDATA REPORTING SHEET <br /> <br />This form must be submitted to the City by the primary contractor and each subcontractor no later than ten <br />(10) days after receiving the award to comply with HUD Davis Bacon data reporting requirements and HUD <br />2516 <br /> <br />Re: Project Name: <br /> Project Address: <br /> <br /> <br /> <br />Contractor Sub Contractor <br />Name Name <br /> <br />Contractor Sub Contractor <br />Address Address <br /> The Contractor - Subcontractor certifies that: <br />a: Contractor - Subcontractors legal name and business address are as follows: <br /> <br />Name <br /> <br />Street Address: <br /> A street address <br />is required, but a PO Box may ALSO be <br /> <br />listed, if applicable <br /> <br />Employer or Tax ID <br /> <br />CCB Registration # <br /> <br />Phone Number <br />Trade Classification <br />(Ele, Plumbing, HVAC etc.) <br />Amount of Contract <br />$ <br />Effective Date Carrier: <br />Public Works Bond <br />b: The subcontractor is (check one) <br /> Single Proprietorship <br /> Partnership <br /> Corporation <br /> Other Entity or Association (describe) <br />c: List the name, title and address of each Owner, Partner or Officer (attach separate sheet as needed) <br />Name Title Home Address <br /> <br /> <br /> <br /> <br />Is this a Woman Owned Business? Yes or No <br />d: <br />e: Contractor Business Racial/Ethnic code :_________ <br />for owners & controllers of 51% of the business(options below) <br />1= White Americans; 2= Black Americans; 3= Native Americans; <br />4= Hispanic Americans 5= Asian/Pacific Americans; 6= Hasidic Jews <br /> <br />Contractor Signature Subcontractor Signature <br /> <br /> <br /> <br />Title: Title: <br />Phone: Date: Phone: Date: <br /> <br /> <br /> <br />