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STATE ARBITRATION BOARD AUTHORIZATION FOR SUBCONTRACTOR TO PURSUE ARBITRATION DATE: _______________ STATE JOB NO.: _______________________________________
PRIME CONTRACTOR: _______________________________________
TO: State Arbitration Board This will confirm that a portion of the work on the above referred job was subcontracted to: __________________________________________Name of Company __________________________________________ Address __________________________________________ City State Zip The subletting of this work was authorized by the Department of Transportation. The above mentioned subcontractor is hereby authorized to act as an agent of the prime contractor in pursuing claims arising out of the work subcontracted to him. This authorization is limited to the claim covered by our Request For Arbitration Of Claim dated ________________. _________________________________________Prime Contractor __________________________________________ Address __________________________________________ City State Zip
4/25/00
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