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YMENT OPPORTUNITY (EXECUTIVE ORDER 11246) Mississippi Department of Transportation P.O. Box 1850 Jackson, MS 39215-1850 Project No. County (Sub) Subcontract Request No. I (We) Prime Contractor on the above captioned project proposing to (sub) subcontract certain items of work to (Sub) Subcontractor, hereby submit the following information regarding the heretofore mentioned (sub) subcontractor to comply with the contract provisions regarding Executive Order 11246 as duplicated on the reverse.

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