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Robert S. Wertz, Jr. Web loudoun.gov/COR Phone [PHONE REDACTED] Mailing Address PO Box 8000, Leesburg, VA 20177-9804 In-person Service Leesburg - 1 Harrison Street SE, 1st Floor Sterling - 46000 Center Oak Plaza Construction Project Subcontractor Roster Contractor & Project Information 1 I BTA9-0685 Use reverse for more subcontractors Contractor Project Manager Phone Email Project Location City State Zip Subcontractor List Provide all available information; do not include business services, materials, or equipment only subcontracts. Subcontractor Name Phone Street Address & # Subcontractor Specialty Job Duration Start & End Dates Subcontract $ Value VA DPOR License # Email City, State, & Zip ---PAGE BREAK--- Construction Project Subcontractor Roster Subcontractor List, continued Subcontractor Name Phone Street Address & # Subcontractor Specialty Job Duration Start & End Dates Subcontract $ Value VA DPOR License # Email City, State, & Zip Use additional pages, if needed. 2 I Loudoun County I Office of the Commissioner of the Revenue I BTA9-0825 ---PAGE BREAK--- Construction Project Subcontractor Roster General Information Subcontractors working for a contractor within Loudoun County are required to register for local business taxes even if based in another county or are out-of-state. Virginia law 58.1-3109 requires that taxpayers make their books and records available to the Commissioner of the Revenue to verify tax liabilities. Review relevant info at loudoun.gov/BusinessTax. You can find online forms at loudoun.gov/COR-Forms. Use this form when you are a contractor that has hired subcontractors to provide labor to complete a specific project. Use a separate form for each project. Need help? Staff assistance is available Monday through Friday, during County business hours. To reduce your wait time, we encourage scheduling an appointment. We are open 8:30 AM to 5:00 PM in: Leesburg 1 Harrison St. SE, 1st Floor Sterling 46000 Center Oak Plaza For assistance with a specific topic, email or call: 3I Loudoun County I Office of the Commissioner of the Revenue I BTA9-0825 Business Tax Assessment [EMAIL REDACTED] [PHONE REDACTED], option 2 Business Tax Compliance [EMAIL REDACTED] [PHONE REDACTED] Accommodations: If you require a reasonable accommodation for any type of disability or need language assistance in order to access this form, please contact [EMAIL REDACTED]. Three business days advance notice is requested. Privacy: This Office protects records according to applicable Virginia statutes and U.S. federal laws. Any personal information we collect and maintain is retained in compliance with statute. Instructions 1. Contractor & Project Information - Complete fields with all available information, including the name of your contracting business, the project manager's name, phone number, and email address, and the physical location address where the project is occurring. If no street address is available for the project, please provide the Parcel Identification Number (PIN) or location description. 2. Subcontractor List - Supply a list of subcontractors working on the project, excluding those only supplying materials, equipment, or business services (such as janitorial, pest control, lawn maintenance, or building inspection). Include the name of the subcontracting business, their Virginia Department of Professional and Occupational Regulation license number, their phone number, email address, and mailing address, their work specialty, the expected start and end dates of the job, and the contract value. 3. Submit this form in-person at one of the locations listed above or: Upload it to: loudoun.gov/COR-Upload Mail it to: Business Tax Assessment PO Box 8000, Leesburg, VA 20177-9804 Find webforms at: loudoun.gov/COR-Forms