Jan. 2021

SUBCONTRACTOR REQUEST FORM

Prime Contractor:	Contract No.:
FEIN:	CR Vendor Registration #:

This is to request that the following subcontractor be authorized to perform work for the items listed below. It is clearly understood by both the prime contractor and the subcontractor that all items of the prime contract will apply. It is also clearly understood that the subcontractor is not a third-party beneficiary of the contract between the prime contractor and the City of Cedar Rapids.

Subcontractor:	FEIN:
Address:	Phone:

Subcontractor Representative:

Item No.	Item Description	Quantity	Unit Price	$ Amount	Part. Item?
Signature (Prime Contractor):	Total from back	$
Total (a)	$

Totals	Specialty Items	Total Less Specialty Items (b)	% sublet this form
Contract Amount	$	$	$	a/b x 100
% Prev. Sublet
Total % to date

Reviewed by:	Date:

Distribution:

Item No.	Item Description	Quantity	Unit Price	$ Amount	Part. Item?
Transfer to front side Totals this side	$