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KANSAS DEPARTMENT OF TRANSPORTATION
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LPA APPROVED SUB-CONTRACTORS
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CMS Contract Number:
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County:KDOT Project No.
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LPA City:
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Prime Contractor:
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The LPA hereby Certifies that (Check one):
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Federally-Aided contracts. These contracts contain the applicable Required Contract Provisions, Specific Equal Employment Opportunity Responsibilities, and FHWA-1273. The requirements of this Contract Provision will be physically incorporated into such subcontract. State Funded Contracts. These contracts contain the applicable Required Contract Provisions, Specific Equal Employment Opportunity Contractual Requirements. The applicable requirements of this Contract provision will be physically incoprorated into such subcontract.
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Sub-ContractorDBE (Y or N)Line Items Responsible forTotal Amount
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TOTAL $ -
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LPA APPROVAL
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Approved on
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(Month)(Day)(Year)
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By
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 Local Public Authority
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