APPENDIX B.17

EXAMPLE OF STATEMENT OF QUALIFICATION OF SUBCONTRACTOR

FROM NEW YORK CITY TRANSIT AUTHORITY -

ENGINEERING AND CONSTRUCTION DEPARTMENT

The statements herein are confidential and made solely for the information of the New York City Transit Authority in connection with the proposed subcontract with

Name of General Contractor

Address	City	State	Zip Code

Under its general Contract No. __________________with the New York City Transit Authority.

GENERAL INFORMATION

1.	Name of proposed subcontractor: ____________________________________________

2.	Address: ________________________________________________________________

(Principal office) Address	City	State	Zip Code

3.	If a corporation:	If a partnership:

When Incorporated	_______________	Date of Organization	__________________

Vice-President's name_______________	Names and addresses of partners ________

Secretary's name	_______________	____________________________________

Treasurer's name	_______________	____________________________________

4.	Description of work to be done under proposed subcontract. Indicate clearly whether work involves labor only or labor and material. List principal items of materials, if any to be furnished.

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

5.	Total amount of proposed subcontract: $ _________________________________________

EXPERIENCE

6.	How many years of experience? _____________________________________________

7.	Give, briefly, previous experience of directing officers including chief engineer and general superintendent on similar work.

NAME	PRESENT

POSITION	YRS. OF

CONSTRUCTION

EXPERIENCE	MAGNITUDE AND TYPE OF WORK	WHAT CAPACITY

8.	List principal contracts completed by present organization.

LOCATION	CONTRACT PRICE	CLASS OF WORK	PERCENT COMPLETED	NAME AND ADDRESS OF AWARDING PARTY

9.	List contracts, if any, that present organization has on hand.

LOCATION	CONTRACT PRICE	CLASS OF WORK	PERCENT COMPLETED	NAME AND ADDRESS OF AWARDING PARTY

10.	Give references of at least two engineers or architects for whom present organization has done similar work.

NAME	TELEPHONE NUMBER	ADDRESS	POSITION

11.	Labor employed through ___________________________________________________

12.	Give any supplemental information that the undersigned desires to submit.

________________________________________________________________________

________________________________________________________________________

The undersigned agrees to furnish the New York City Transit Authority additional or supplemental information concerning its financial and/or technical qualifications, when and as required.

___________________________________________	__________________

Name	Date