Laserfiche WebLink
E PA "g Environmental Protection a Agency <br />0MB Control No: <br />Approved: <br />Approval Expires: <br />Disadvantaged Business Enterprise (DBE) Program <br />DBE Subcontractor Performance Form <br />I certi fy un d er penalty of perju ry that th e fo rgoing statements are true and correct. Signing this form does not <br />signify a commitm ent to utilize the subcontractors above. I am aware of that in the event of a replacement of a <br />sub contractor, I w ill adh ere to the replacem ent requ irem en ts set forth in 40 CFR Part 33 Section 33.302 (c). <br />MG <br />Print Name <br />1. <br />Print Name <br />/LL2 <br />The public reporting and recordkeeping burden for this collection of information is estimated to average three (3) hours <br />per response. Send comments on the Agency's need for this information, the accuracy of the provided burden <br />estimates, and any suggested methods for minimizing respondent burden, including through the use of automated. <br />collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T}, 1200 <br />Pennsylvania Ave., NW, Washington, D.C. 20460. Include the 0MB control number in any correspondence. Do not send <br />the completed form to this address. <br />EPA FORM 6100-3 (DBE Subcontractor Performance Form)