Project Contact List/Subcontractor List



|[pic] |Facilities Planning and Management |

| |Construction Services |

| |200 General Services Building |

| |Ames, IA 50011-4021 |

| |Phone: (515) 294-0563 |

| |Fax: (515) 294-2764 |

| |E-Mail: construc@iastate.edu |

Project Information & Contact List

|Name of Project: |      |

Use project title as exactly on award letter or contract

|Bid Package Number or Phase: |      |

Iowa Sales Tax Exemption Certificates will be prepared by the Owner for the Contractor and Subcontractor(s) listed on this form. Include parties who will be purchasing material for this project. The Owner will generate the Certificate(s). The Certificate(s) will be sent to the Prime Contractor for distribution.

An explanation of deviations to the Subcontractor List must be provided.

Return this form by mail, fax or e-mail at the address above

|Prime Contractor: | |      |

|Iowa Contractor Registration #: | |      |

|Federal ID #: | |      |

|Street Address: | |      |

|City, State, Zip: | |      |

|Office Phone #: | |      |

|Fax #: | |      |

|Project Manager: | |      |

|Project Manager E-Mail Address: | |      |

|Superintendent: | |      |

|Superintendent E-Mail Address: | |      |

|Superintendent Cellular Phone #: | |      |

|Site Phone #: | |      |

|Primary Emergency Contact: | |      Phone #:       |

|Secondary Emergency Contact: | |      Phone #:       |

|(Not required if Primary is answered 24 | | |

|hours) | | |

Check here if no subcontractors will be used:

ISU uses an electronic pay application system that utilizes digital signatures called eznetpay®. Please provide a primary representative of your company who will be responsible for signing pay applications. A digital signature is required to keep the pay application process moving. It is recommended that at least one backup representative is provided.

|Primary Representative: | |      E-mail:       |

|Backup Representative (1): | |      E-mail:       |

|Backup Representative (2): | |      E-mail:       |

|Backup Representative (3): | |      E-mail:       |

|Backup Representative (4): | |      E-mail:       |

Comments:      

• Do not follow-up with hard copy by mail.

|ISU Use Only: |Tax| |

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|Section & Description: | |      |

|Iowa Contractor Registration #: | |      |

|Federal ID #: | |      |

|Street Address: | |      |

|City, State, Zip: | |      |

|Office Phone #: | |      |

|Fax #: | |      |

|Emergency Contact: | |      Phone #:       |

|Primary Contact & Title: | |      E-mail Address:       |

| | |(Required for access to Centric Project) |

Type of work:

Brickwork / Masonry Carpentry / Millwork Concrete Drywall / Plaster / Insulation Electrical

Electrical - Access Control Electrical - Fire Alarm Electrical - Telecommunications Elevator (Other) Excavation - Grading

Excavation - Grading (Site Utilities) Fire Protection Flooring Heavy Construction HVAC - Controls

HVAC - Ductwork HVAC - Hydronic Landscaping Painting Paving

Plumbing Roofing / Siding / Sheet Metal Steel / Metals (Other) Windows / Curtainwall Wrecking / Demolition

Material Supplier Only (Other) Other: Specify:       Comments:      

|ISU Use Only: |Tax| |

| |Exe| |

| |mpt| |

| |Ent| |

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| |Cer| |

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| |ica| |

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|Section & Description: | |      |

|Iowa Contractor Registration #: | |      |

|Federal ID #: | |      |

|Street Address: | |      |

|City, State, Zip: | |      |

|Office Phone #: | |      |

|Fax #: | |      |

|Emergency Contact: | |      Phone #:       |

|Primary Contact & Title: | |      E-mail Address:       |

| | |(Required for access to Centric Project) |

Type of work:

Brickwork / Masonry Carpentry / Millwork Concrete Drywall / Plaster / Insulation Electrical

Electrical - Access Control Electrical - Fire Alarm Electrical - Telecommunications Elevator (Other) Excavation - Grading

Excavation - Grading (Site Utilities) Fire Protection Flooring Heavy Construction HVAC - Controls

HVAC - Ductwork HVAC - Hydronic Landscaping Painting Paving

Plumbing Roofing / Siding / Sheet Metal Steel / Metals (Other) Windows / Curtainwall Wrecking / Demolition

Material Supplier Only (Other) Other: Specify:       Comments:      

|ISU Use Only: |Tax| |

| |Exe| |

| |mpt| |

| |Ent| |

| |ry | |

| |& | |

| |Cer| |

| |tif| |

| |ica| |

| |te:| |

|Section & Description: | |      |

|Iowa Contractor Registration #: | |      |

|Federal ID #: | |      |

|Street Address: | |      |

|City, State, Zip: | |      |

|Office Phone #: | |      |

|Fax #: | |      |

|Emergency Contact: | |      Phone #:       |

|Primary Contact & Title: | |      E-mail Address:       |

| | |(Required for access to Centric Project) |

Type of work:

Brickwork / Masonry Carpentry / Millwork Concrete Drywall / Plaster / Insulation Electrical

Electrical - Access Control Electrical - Fire Alarm Electrical - Telecommunications Elevator (Other) Excavation - Grading

Excavation - Grading (Site Utilities) Fire Protection Flooring Heavy Construction HVAC - Controls

HVAC - Ductwork HVAC - Hydronic Landscaping Painting Paving

Plumbing Roofing / Siding / Sheet Metal Steel / Metals (Other) Windows / Curtainwall Wrecking / Demolition

Material Supplier Only (Other) Other: Specify:       Comments:      

|ISU Use Only: |Tax| |

| |Exe| |

| |mpt| |

| |Ent| |

| |ry | |

| |& | |

| |Cer| |

| |tif| |

| |ica| |

| |te:| |

|Section & Description: | |      |

|Iowa Contractor Registration #: | |      |

|Federal ID #: | |      |

|Street Address: | |      |

|City, State, Zip: | |      |

|Office Phone #: | |      |

|Fax #: | |      |

|Emergency Contact: | |      Phone #:       |

|Primary Contact & Title: | |      E-mail Address:       |

| | |(Required for access to Centric Project) |

Type of work:

Brickwork / Masonry Carpentry / Millwork Concrete Drywall / Plaster / Insulation Electrical

Electrical - Access Control Electrical - Fire Alarm Electrical - Telecommunications Elevator (Other) Excavation - Grading

Excavation - Grading (Site Utilities) Fire Protection Flooring Heavy Construction HVAC - Controls

HVAC - Ductwork HVAC - Hydronic Landscaping Painting Paving

Plumbing Roofing / Siding / Sheet Metal Steel / Metals (Other) Windows / Curtainwall Wrecking / Demolition

Material Supplier Only (Other) Other: Specify:       Comments:      

|ISU Use Only: |Tax| |

| |Exe| |

| |mpt| |

| |Ent| |

| |ry | |

| |& | |

| |Cer| |

| |tif| |

| |ica| |

| |te:| |

|Section & Description: | |      |

|Iowa Contractor Registration #: | |      |

|Federal ID #: | |      |

|Street Address: | |      |

|City, State, Zip: | |      |

|Office Phone #: | |      |

|Fax #: | |      |

|Emergency Contact: | |      Phone #:       |

|Primary Contact & Title: | |      E-mail Address:       |

| | |(Required for access to Centric Project) |

Type of work:

Brickwork / Masonry Carpentry / Millwork Concrete Drywall / Plaster / Insulation Electrical

Electrical - Access Control Electrical - Fire Alarm Electrical - Telecommunications Elevator (Other) Excavation - Grading

Excavation - Grading (Site Utilities) Fire Protection Flooring Heavy Construction HVAC - Controls

HVAC - Ductwork HVAC - Hydronic Landscaping Painting Paving

Plumbing Roofing / Siding / Sheet Metal Steel / Metals (Other) Windows / Curtainwall Wrecking / Demolition

Material Supplier Only (Other) Other: Specify:       Comments:      

|ISU Use Only: |Tax| |

| |Exe| |

| |mpt| |

| |Ent| |

| |ry | |

| |& | |

| |Cer| |

| |tif| |

| |ica| |

| |te:| |

|Section & Description: | |      |

|Iowa Contractor Registration #: | |      |

|Federal ID #: | |      |

|Street Address: | |      |

|City, State, Zip: | |      |

|Office Phone #: | |      |

|Fax #: | |      |

|Emergency Contact: | |      Phone #:       |

|Primary Contact & Title: | |      E-mail Address:       |

| | |(Required for access to Centric Project) |

Type of work:

Brickwork / Masonry Carpentry / Millwork Concrete Drywall / Plaster / Insulation Electrical

Electrical - Access Control Electrical - Fire Alarm Electrical - Telecommunications Elevator (Other) Excavation - Grading

Excavation - Grading (Site Utilities) Fire Protection Flooring Heavy Construction HVAC - Controls

HVAC - Ductwork HVAC - Hydronic Landscaping Painting Paving

Plumbing Roofing / Siding / Sheet Metal Steel / Metals (Other) Windows / Curtainwall Wrecking / Demolition

Material Supplier Only (Other) Other: Specify:       Comments:      

|ISU Use Only: |Tax| |

| |Exe| |

| |mpt| |

| |Ent| |

| |ry | |

| |& | |

| |Cer| |

| |tif| |

| |ica| |

| |te:| |

|Section & Description: | |      |

|Iowa Contractor Registration #: | |      |

|Federal ID #: | |      |

|Street Address: | |      |

|City, State, Zip: | |      |

|Office Phone #: | |      |

|Fax #: | |      |

|Emergency Contact: | |      Phone #:       |

|Primary Contact & Title: | |      E-mail Address:       |

| | |(Required for access to Centric Project) |

Type of work:

Brickwork / Masonry Carpentry / Millwork Concrete Drywall / Plaster / Insulation Electrical

Electrical - Access Control Electrical - Fire Alarm Electrical - Telecommunications Elevator (Other) Excavation - Grading

Excavation - Grading (Site Utilities) Fire Protection Flooring Heavy Construction HVAC - Controls

HVAC - Ductwork HVAC - Hydronic Landscaping Painting Paving

Plumbing Roofing / Siding / Sheet Metal Steel / Metals (Other) Windows / Curtainwall Wrecking / Demolition

Material Supplier Only (Other) Other: Specify:       Comments:      

|ISU Use Only: |Tax| |

| |Exe| |

| |mpt| |

| |Ent| |

| |ry | |

| |& | |

| |Cer| |

| |tif| |

| |ica| |

| |te:| |

|Section & Description: | |      |

|Iowa Contractor Registration #: | |      |

|Federal ID #: | |      |

|Street Address: | |      |

|City, State, Zip: | |      |

|Office Phone #: | |      |

|Fax #: | |      |

|Emergency Contact: | |      Phone #:       |

|Primary Contact & Title: | |      E-mail Address:       |

| | |(Required for access to Centric Project) |

Type of work:

Brickwork / Masonry Carpentry / Millwork Concrete Drywall / Plaster / Insulation Electrical

Electrical - Access Control Electrical - Fire Alarm Electrical - Telecommunications Elevator (Other) Excavation - Grading

Excavation - Grading (Site Utilities) Fire Protection Flooring Heavy Construction HVAC - Controls

HVAC - Ductwork HVAC - Hydronic Landscaping Painting Paving

Plumbing Roofing / Siding / Sheet Metal Steel / Metals (Other) Windows / Curtainwall Wrecking / Demolition

Material Supplier Only (Other) Other: Specify:       Comments:      

|ISU Use Only: |Tax| |

| |Exe| |

| |mpt| |

| |Ent| |

| |ry | |

| |& | |

| |Cer| |

| |tif| |

| |ica| |

| |te:| |

|Section & Description: | |      |

|Iowa Contractor Registration #: | |      |

|Federal ID #: | |      |

|Street Address: | |      |

|City, State, Zip: | |      |

|Office Phone #: | |      |

|Fax #: | |      |

|Emergency Contact: | |      Phone #:       |

|Primary Contact & Title: | |      E-mail Address:       |

| | |(Required for access to Centric Project) |

Type of work:

Brickwork / Masonry Carpentry / Millwork Concrete Drywall / Plaster / Insulation Electrical

Electrical - Access Control Electrical - Fire Alarm Electrical - Telecommunications Elevator (Other) Excavation - Grading

Excavation - Grading (Site Utilities) Fire Protection Flooring Heavy Construction HVAC - Controls

HVAC - Ductwork HVAC - Hydronic Landscaping Painting Paving

Plumbing Roofing / Siding / Sheet Metal Steel / Metals (Other) Windows / Curtainwall Wrecking / Demolition

Material Supplier Only (Other) Other: Specify:       Comments:      

|ISU Use Only: |Tax| |

| |Exe| |

| |mpt| |

| |Ent| |

| |ry | |

| |& | |

| |Cer| |

| |tif| |

| |ica| |

| |te:| |

|Section & Description: | |      |

|Iowa Contractor Registration #: | |      |

|Federal ID #: | |      |

|Street Address: | |      |

|City, State, Zip: | |      |

|Office Phone #: | |      |

|Fax #: | |      |

|Emergency Contact: | |      Phone #:       |

|Primary Contact & Title: | |      E-mail Address:       |

| | |(Required for access to Centric Project) |

Type of work:

Brickwork / Masonry Carpentry / Millwork Concrete Drywall / Plaster / Insulation Electrical

Electrical - Access Control Electrical - Fire Alarm Electrical - Telecommunications Elevator (Other) Excavation - Grading

Excavation - Grading (Site Utilities) Fire Protection Flooring Heavy Construction HVAC - Controls

HVAC - Ductwork HVAC - Hydronic Landscaping Painting Paving

Plumbing Roofing / Siding / Sheet Metal Steel / Metals (Other) Windows / Curtainwall Wrecking / Demolition

Material Supplier Only (Other) Other: Specify:       Comments:      

|ISU Use Only: |Tax| |

| |Exe| |

| |mpt| |

| |Ent| |

| |ry | |

| |& | |

| |Cer| |

| |tif| |

| |ica| |

| |te:| |

|Section & Description: | |      |

|Iowa Contractor Registration #: | |      |

|Federal ID #: | |      |

|Street Address: | |      |

|City, State, Zip: | |      |

|Office Phone #: | |      |

|Fax #: | |      |

|Emergency Contact: | |      Phone #:       |

|Primary Contact & Title: | |      E-mail Address:       |

| | |(Required for access to Centric Project) |

Type of work:

Brickwork / Masonry Carpentry / Millwork Concrete Drywall / Plaster / Insulation Electrical

Electrical - Access Control Electrical - Fire Alarm Electrical - Telecommunications Elevator (Other) Excavation - Grading

Excavation - Grading (Site Utilities) Fire Protection Flooring Heavy Construction HVAC - Controls

HVAC - Ductwork HVAC - Hydronic Landscaping Painting Paving

Plumbing Roofing / Siding / Sheet Metal Steel / Metals (Other) Windows / Curtainwall Wrecking / Demolition

Material Supplier Only (Other) Other: Specify:       Comments:      

|ISU Use Only: |Tax| |

| |Exe| |

| |mpt| |

| |Ent| |

| |ry | |

| |& | |

| |Cer| |

| |tif| |

| |ica| |

| |te:| |

|Section & Description: | |      |

|Iowa Contractor Registration #: | |      |

|Federal ID #: | |      |

|Street Address: | |      |

|City, State, Zip: | |      |

|Office Phone #: | |      |

|Fax #: | |      |

|Emergency Contact: | |      Phone #:       |

|Primary Contact & Title: | |      E-mail Address:       |

| | |(Required for access to Centric Project) |

Type of work:

Brickwork / Masonry Carpentry / Millwork Concrete Drywall / Plaster / Insulation Electrical

Electrical - Access Control Electrical - Fire Alarm Electrical - Telecommunications Elevator (Other) Excavation - Grading

Excavation - Grading (Site Utilities) Fire Protection Flooring Heavy Construction HVAC - Controls

HVAC - Ductwork HVAC - Hydronic Landscaping Painting Paving

Plumbing Roofing / Siding / Sheet Metal Steel / Metals (Other) Windows / Curtainwall Wrecking / Demolition

Material Supplier Only (Other) Other: Specify:       Comments:      

ISU Use Only: |Tax Exempt Entry & Certificate: | | |CP Set Up: | | | | | | | | | | | |

G:\Project Management\Capital Projects\Templates\Contractor Web Forms\Project Information And Contact List.Doc

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