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Document / 31 pages

Subcontractor services letter for DEP, February 2012

Machine-extracted title · confidence 95%

Letter regarding subcontractor services for a water tunnel project dated February 27, 2012.

NYC-WTC_000159316–000159346

Folder label: “Requests 2012

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Scanned page image, NYC-WTC_000159325
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NYC 9/11 Public Portal Document

CITY OF NEW YORK SUBCONTRACTOR PROFILE FORM

TO BE COMPLETED BY SUBCONTRACTOR INSTRUCTIONS TO PRIME CONTRACTOR

A Subcontractor Profile Form must be completed by EACH subcontractor that will perform on the contract. Make additional copies of this form as needed.

PRIME CONTRACTOR NAME XEIN SSN Jenny/BAC Killam, A Joint Venture pTi

DEP CONTRACT #EE-GEO-02 & EE-GEO-03 REGISTRATION #82620060020284

SUBCONTRACTOR NAME EIN XSSN

Galyn Rippentrop PH

SUBCONTRACTOR BUSINESS ADDRESS

P.O. Box 89321 Sioux Falls, SD 57109

Number Street Borough/City State Zip

SUBCONTRACTOR BILLING ADDRESS (IF DIFFERENT FROM ABOVE)

Number Street Borough/City State Zip

SUBCONTRACTOR TELEPHONE (812)431-8364

SUBCONTRACTOR AMOUNT $15,000 DESCRIPTION OF SUBCONTRACT AND LOCATION

Reviewing information, travel to Technical Review Committee (TRC) meeting(s), participation in the TRC, and providing input to report prepared by others

FORM /yy COMPLETED Name (PRINT) of Subc/ntractofs Representative Title BY

y Signature I J Date

MOCS Subcontractor Approval Form (Sept. 2010)

NYC-WTC_000159325

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NYC-WTC_000159325Source: NYC Law Department, mirrored locally

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