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 X EIN SSN
Jenny/BAC Killam, A Joint Venture P11
DEP CONTRACT #EE-GEO-02 & EE-GEO-03 REGISTRATION #82620060020284
SUBCONTRACTOR NAME EIN X SSN
Ronald E. Heuer PII
SUBCONTRACTOR BUSINESS ADDRESS
3317 West Ringwood Road McHenry, IL 60051
Number Street Borough/City State Zip
SUBCONTRACTOR BILLING ADDRESS (IF DIFFERENT FROM ABOVE)
Number Street Borough/City State Zip
SUBCONTRACTOR TELEPHONE (815) 675-2003
SUBCONTRACTOR AMOUNT $10,800
DESCRIPTION OF SUBCONTRACT AND LOCATION
providing input to
Reviewing information, travel to Technical Review Committee (TRC) meeting(s), participation in the TRC, and
report prepared by others
Ci 9 t,. c c -'
FORM
COMPLETED Name (PRINT) of Subcontractor's Representative Title
BY (i 1=, (L
( l
Signature Date
MOCS Subcontractor Approval Form (Sept. 2010)
NYC-WTC 000159321
OCR can misread numbers and units. Confirm readings against the page image before using them.