Subcontractor services letter for DEP, February 2012

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

Richard W. Kimball Put SUBCONTRACTOR BUSINESS ADDRESS

302 South 36`h Street, Suite 400 Omaha, NE. 68131

Number Street Borough/City State Zip

SUBCONTRACTOR BILLING ADDRESS (IF DIFFERENT FROM ABOVE)

Number Street Borough/City State Zip

SUBCONTRACTOR TELEPHONE 402-231-4225

SUBCONTRACTOR AMOUNT $7,500

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 sic )QL LL) M COMPLETED Name (PRINT) of Subcon Representative Title

Si Date

MOCS Subcontractor Approval Form (Sept. 2010)

NYC-WTC 000159323