Contractors Qualification Form - Michigan



[pic] [pic] MICHIGAN DEPARTMENT OF ENVIRONMENTAL QUALITY

OFFICE OF THE GREAT LAKES

CONTRACTOR’S QUALIFICATIONS FORM

Please list the full name of any subcontractor used to complete the project. The Grantee certifies that it has checked the federal debarment/suspension list, at the Web site , for the agents and/or subcontractors listed below.

Submit this form to your State Contact listed on the cover page of the Agreement.

Grantee:___________________________________________________________________

Project Name:____________________________________________________________________

Contractor Name:

Address:

Not on Debarment Suspension List

Contractor Name:

Address:

Not on Debarment Suspension List

Contractor Name:

Address:

Not on Debarment Suspension List

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