Common use of Required Forms Clause in Contracts

Required Forms. If subcontractors are used under the contract that has no stated HUB goal, Exhibits X-0, X-0, X-0 and H-6 are required. Exhibits H-1 and H-6 are required if no subcontractors are being used to perform work under this contract. State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) is required monthly even when no subcontracting activity has occurred. In addition, State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) should be submitted with the Provider’s invoice. 12/06 HU DocuSign Envelope ID: 34ABC29C-D1A8-49E0-BF33-E68A391DD60F PS Contract No. 7397 EXHIBIT H-1 Texas Department of Transportation Subprovider Monitoring System Commitment Worksheet Contract #: 24-7IDP1003 Assigned Goal: 23.7% Federally Funded State Funded _ X Prime Provider: XxXxxx & XxXxxx Land Surveyors, Inc. Total Contract Amount: $2,000,000.00 Prime Provider Info: DBE HUB Both _X_ Vendor ID #: _17422732929 (First 11 Digits Only) DBE/HUB Expiration Date: __5/5/2019 If no subproviders are used on this contract, please indicate by placing “N/A” on the 1st line under Subproviders. Subprovider(s) (List All) Type of Work Vendor ID # (First 11 Digits Only) D=DBE H=HUB Expiration Date $ Amount or % of Work * Xxxxxx LLC Land Surveying 17430098982 D, H 5/12/2019 8% Dallas Aerial Surveys, Inc. Aerial Mapping 17516161738 H 6/11/2019 16% Xxxxx & Xxxxxx, Inc. State Land Surveying 17418482448 3% Surveying And Mapping, LLC Aerial Mapping Land Surveying 17427049741 2% E.S.P. Associates, P.A., Inc. Land Surveying 15615314679 2% Subprovider(s) Contract or % of Work* Totals 31% *For Work Authorization Contracts, indicate the % of work to be performed by each subprovider. Total DBE or HUB Commitment Dollars $ 480,000 Total DBE or HUB Commitment Percentages of Contract 24 % (Commitment Dollars and Percentages are for Subproviders only) DocuSign Envelope ID: 34ABC29C-D1A8-49E0-BF33-E68A391DD60F Subprovider Monitoring System Commitment Agreement This commitment agreement is subject to the award and receipt of a signed contract from the Texas Department of Transportation (TxDOT). NOTE: Exhibit H-2 is required to be attached to each contract that does not include work authorizations. Exhibit H-2 is required to be attached with each work authorization. Exhibit H-2 is also required to be attached to each supplemental work authorization. If DBE/HUB Subproviders are used, the form must be completed and signed. If no DBE/HUB Subproviders are used, indicate with “N/A” on this line: and attach with the work authorization or supplemental work authorization. Contract #: Assigned Goal: % Prime Provider: Work Authorization (WA)#: WA Amount: _ Date: Supplemental Work Authorization (SWA) #: to WA #: Revised WA Amount: SWA Amount: Description of Work (List by category of work or task description. Attach additional pages, if necessary.) Dollar Amount (For each category of work or task description shown.) Total Commitment Amount (Including all additional pages.) $ IMPORTANT: The signatures of the prime and the DBE/HUB and Second Tier Subprovider, if any (both DBE and Non-DBE) and the total commitment amount must always be on the same page. Provider Name: Name: (Please Print) Title: Signature Date Address: Phone # & Fax #: Email: DBE/HUB Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone # & Fax #: Email: Second Tier Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone #& Fax #: Email: VID Number is the Vendor Identification Number issued by the Comptroller. If a firm does not have a VID Number, please enter the owner’s Social Security or their Federal Employee Identification Number (if incorporated). 4/06 DBE-H2.ATT DocuSign Envelope ID: 34ABC29C-D1A8-49E0-BF33-E68A391DD60F Texas Department of Transportation Subprovider Monitoring System Final Report The Final Report Form should be filled out by the Prime Provider and submitted to the Contract Manager and the Business Opportunity Programs Office for review upon completion of the contract. The report should reflect all subcontract activity on the project. The report will aid in expediting the final estimate for payment. If the HUB or DBE goal requirements were not met, documentation supporting good faith efforts must be submitted. DBE Goal: % OR HUB Goal: % Total Contract Amount: $ Total Contract Amount: $ Contract Number: Vendor ID # Subprovider Total $ Amt Paid to Date TOTAL This is to certify that % of the work was completed by the HUB or DBE subproviders as stated above. By: Prime Provider Per: Signature Subscribed and sworn to before me, this day of ,20 Notary Public County My Commission expires: DocuSign Envelope ID: 34ABC29C-D1A8-49E0-BF33-E68A391DD60F HUB Subcontracting Plan (HSP) Prime Contractor Progress Assessment Report This form must be completed and submitted to the contracting agency each month to document compliance with your HSP. Contract/Requisition Number: Contracting Agency/University Name: Contractor (Company) Name: Point of Contact: Date of Award: Object Code: (mm/dd/yyyy) State of Texas VID #: Phone #: (Agency Use Only) Reporting (Month) Period: Total Amount Paid this Reporting Period to Contractor: $ - Report HUB and Non-HUB subcontractor information *Texas Certified Total Contract $ Total $ Amount Paid Total Contract $ Subcontractor’s VID or HUB HUB? Amount from HSP This Reporting Period to Amount Paid to Date Object Code Subcontractor’s Name Certificate Number (Yes or No) with Subcontractor Subcontractor to Subcontractor (Agency Use Only) $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ TOTALS: $ - $ - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - Signature: Title: Date: *Note: Prime contractors can verify subcontractor HUB certification status on-line at xxxx://xxx0.xxxx.xxxxx.xx.xx/cmbl/cmblhub.html

Appears in 1 contract

Samples: Contract for Surveying Services

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Required Forms. If subcontractors are used under the contract that has no stated HUB goal, Exhibits X-0, X-0, X-0 and H-6 are required. Exhibits H-1 and H-6 are required if no subcontractors are being used to perform work under this contract. State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) is required monthly even when no subcontracting activity has occurred. In addition, State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) should be submitted with the Provider’s invoice. 12/06 HU DocuSign Envelope ID: 34ABC29CFA09ABAD-94E6-D1A84678-49E0A208-BF33-E68A391DD60F PS Contract No. 7397 EXHIBIT H-1 Texas Department of Transportation A80E623CD52C Subprovider Monitoring System Commitment Worksheet Contract #: 2436-7IDP1003 7IDP5017 Assigned Goal: 23.723.7 % Federally Funded State Funded _ X Prime Provider: XxXxxx & XxXxxx Land SurveyorsXxx Xxxxxx, Inc. Total Contract Amount: $2,000,000.00 5,000,000 Prime Provider Info: DBE HUB Both _X_ Vendor ID #: _17422732929 17423309859 (First 11 Digits Only) DBE/HUB Expiration Date: __5/5/2019 If no subproviders are used on this contract, please indicate by placing “N/A” on the 1st line under Subproviders. Subprovider(s) (List All) Type of Work Vendor ID # (First 11 Digits Only) D=DBE Expiration H=HUB Expiration Date $ Amount or % of Work * Xxxxxx LLC Land Surveying 17430098982 DXXXX XXXXXXX, H 5/12/2019 8INC. 14.1.1. 14.2.1, 14.3.1 17416115347 N/A 7.00% Dallas Aerial SurveysKCI TECHNOLOGIES, Inc. Aerial Mapping 17516161738 H 6/11/2019 16INC. 3.5.1, 5.2.1, 18.2.1 15216043867 N/A 11.00% Xxxxx & XxxxxxALLIANCE‐TEXAS ENGINEERING CO. DBA ALLIANCE TRANSPORTATION GROUP INC. 7.4.1, Inc. State Land Surveying 17418482448 38.4.1, Public Involvement 17428514321 HUB 7/23/2018 DBE 5/27/2018 7.00% Surveying And MappingOMEGA ENGINEERS, INC. 5.1.1 17602147351 HUB 12/16/2020 DBE 8/31/2018 5.00% XXXXX CONSULTING, LLC Aerial Mapping Land Surveying 17427049741 2Utility Engineering, Utility Coordination 14544453849 HUB 12/01/2020 DBE 9/30/2018 6.00% E.S.P. AssociatesXXXXX & XXXXXX INC. 10.1.1, P.A.10.2.1 17418482448 N/A 9.00% XXXXXXX ‐ XXXXXXX & ASSOCIATES LLC 8.2.1, Inc. Land Surveying 15615314679 28.5.1 14620551250 HUB 2/28/2019 DBE 2/28/2019 9.00% Subprovider(s) Contract or % of Work* Totals 3154.00% *For Work Authorization Contracts, indicate the % of work to be performed by each subprovider. Total DBE or HUB Commitment Dollars $ 480,000 1,350,000 Total DBE or HUB Commitment Percentages of Contract 24 27 % (Commitment Dollars and Percentages are for Subproviders only) DocuSign Envelope ID: 34ABC29CFA09ABAD-94E6-D1A84678-49E0A208-BF33-E68A391DD60F A80E623CD52C Subprovider Monitoring System Commitment Agreement This commitment agreement is subject to the award and receipt of a signed contract from the Texas Department of Transportation (TxDOT). NOTE: Exhibit H-2 is required to be attached to each contract that does not include work authorizations. Exhibit H-2 is required to be attached with each work authorization. Exhibit H-2 is also required to be attached to each supplemental work authorization. If DBE/HUB Subproviders are used, the form must be completed and signed. If no DBE/HUB Subproviders are used, indicate with “N/A” on this line: and attach with the work authorization or supplemental work authorization. Contract #: Assigned Goal: % Prime Provider: Work Authorization (WA)#: WA Amount: _ Date: Supplemental Work Authorization (SWA) #: to WA #: Revised WA Amount: SWA Amount: Description of Work (List by category of work or task description. Attach additional pages, if necessary.) Dollar Amount (For each category of work or task description shown.) Total Commitment Amount (Including all additional pages.) $ IMPORTANT: The signatures of the prime and the DBE/HUB and Second Tier Subprovider, if any (both DBE and Non-DBE) and the total commitment amount must always be on the same page. Provider Name: Name: (Please Print) Title: Signature Date Address: Phone # & Fax #: Email: DBE/HUB Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone # & Fax #: Email: Second Tier Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone #& Fax #: Email: VID Number is the Vendor Identification Number issued by the Comptroller. If a firm does not have a VID Number, please enter the owner’s Social Security or their Federal Employee Identification Number (if incorporated). 4/06 DBE-H2.ATT DocuSign Envelope ID: 34ABC29CFA09ABAD-94E6-D1A84678-49E0A208-BF33-E68A391DD60F Texas Department of Transportation A80E623CD52C Subprovider Monitoring System Final Report The Final Report Form should be filled out by the Prime Provider and submitted to the Contract Manager and the Business Opportunity Programs Office for review upon completion of the contract. The report should reflect all subcontract activity on the project. The report will aid in expediting the final estimate for payment. If the HUB or DBE goal requirements were not met, documentation supporting good faith efforts must be submitted. DBE Goal: % OR HUB Goal: % Total Contract Amount: $ Total Contract Amount: $ Contract Number: Vendor ID # Subprovider Total $ Amt Paid to Date TOTAL This is to certify that % of the work was completed by the HUB or DBE subproviders as stated above. By: Prime Provider Per: Signature Subscribed and sworn to before me, this day of ,, 20 Notary Public County My Commission expires: 12/06 DBE-H4.A DocuSign Envelope ID: 34ABC29CFA09ABAD-94E6-D1A84678-49E0A208-BF33-E68A391DD60F A80E623CD52C HUB Subcontracting Plan (HSP) Prime Contractor Progress Assessment Report This form must be completed and submitted to the contracting agency each month to document compliance with your HSP. Contract/Requisition Number: Contracting Agency/University Name: Contractor (Company) Name: Point of Contact: Date of Award: Object Code: (mm/dd/yyyy) State of Texas VID #: Phone #: (Agency Use Only) Reporting (Month) Period: Total Amount Paid this Reporting Period to Contractor: $ - Report HUB and Non-HUB subcontractor information *Texas Certified Total Contract $ Total $ Amount Paid Total Contract $ Subcontractor’s VID or HUB HUB? Amount from HSP This Reporting Period to Amount Paid to Date Object Code Subcontractor’s Name Certificate Number (Yes or No) with Subcontractor Subcontractor to Subcontractor (Agency Use Only) $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ TOTALS: $ - $ - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - Signature: Title: Date: *Note: Prime contractors can verify subcontractor HUB certification status on-line at xxxx://xxx0.xxxx.xxxxx.xx.xx/cmbl/cmblhub.html

Appears in 1 contract

Samples: sb20pca.txdot.gov

Required Forms. If subcontractors are used under the contract that has no stated HUB goal, Exhibits X-0H-1, X-0H-2, X-0 H-4 and H-6 are required. Exhibits H-1 and H-6 are required if no subcontractors are being used to perform work under this contract. State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) is required monthly even when no subcontracting activity has occurred. In addition, State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) should be submitted with the Provider’s invoice. 12/06 HU DocuSign Envelope ID: 34ABC29CB7F6594C-D1A8-49E0-BF33-E68A391DD60F PS Contract No. 7397 A33B-4B5F-9C0D-57494FCE16B1 CONTRACT - EXHIBIT H-1 Texas Department of Transportation Subprovider Monitoring System Commitment Worksheet Contract #: 24-7IDP1003 :601CT0000016577 Assigned Goal: 23.70 % Federally Funded State Funded _ X Prime Provider: XxXxxx & XxXxxx Land Surveyors, Inc. The Boston Consulting Group (Vendor # 477119) Total Contract Amount: $2,000,000.00 13,988,289 Prime Provider Info: DBE HUB Both _X_ Vendor Consultant ID #: _17422732929 VID: 1042432614700 (First 11 Digits Only) DBE/HUB Expiration Date: __5/5/2019 N/A If no subproviders are used on this contract, please indicate by placing “N/A” on the 1st line under Subproviders. Subprovider(s) (List All) Type of Work Vendor Consultant ID # (First 11 Digits Only) D=DBE H=HUB Expiration Date $ Amount or % of Work * Xxxxxx LLC Land Surveying 17430098982 D, H 5/12/2019 8% Dallas Aerial Surveys, Inc. Aerial Mapping 17516161738 H 6/11/2019 16% Xxxxx & Xxxxxx, Inc. State Land Surveying 17418482448 3% Surveying And Mapping, LLC Aerial Mapping Land Surveying 17427049741 2% E.S.P. Associates, P.A., Inc. Land Surveying 15615314679 2% NA Subprovider(s) Contract or % of Work* Totals 310% *For Work Authorization Contracts, indicate the % of work to be performed by each subprovider. Total DBE or HUB Commitment Dollars $ 480,000 Total DBE or HUB Commitment Percentages of Contract 24 % (Commitment Dollars and Percentages are for Subproviders only) DocuSign Envelope ID: 34ABC29CB7F6594C-D1A8-49E0-BF33-E68A391DD60F A33B-4B5F-9C0D-57494FCE16B1 CONTRACT - EXHIBIT H-2 Texas Department of Transportation Subprovider Monitoring System Commitment Agreement This commitment agreement is subject to the award and receipt of a signed contract from the Texas Department of Transportation (TxDOT). NOTE: Exhibit H-2 is required to be attached to each contract that does not include work authorizations. Exhibit H-2 is required to be attached with each work authorization. Exhibit H-2 is also required to be attached to each supplemental work authorization. If DBE/HUB Subproviders are used, the form must be completed and signed. If no DBE/HUB Subproviders are used, indicate with “N/A” on this line: N/A and attach with the work authorization or supplemental work authorization. Contract #: Assigned Goal: % Prime Provider: Work Authorization (WA)#: WA Amount: _ Date: Supplemental Work Authorization (SWA) #: to WA #: Revised WA Amount: SWA Amount: Description of Work (List by category of work or task description. Attach additional pages, if necessary.) Dollar Amount (For each category of work or task description shown.) Total Commitment Amount (Including all additional pages.) $ IMPORTANT: The signatures of the prime and the DBE/HUB and Second Tier Subprovider, if any (both DBE and Non-DBE) and the total commitment amount must always be on the same page. Provider Name: Name: (Please Print) Title: Signature Date Address: Phone # & Fax #: Email: DBE/HUB Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone # & Fax #: Email: Second Tier Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone #& Fax #: Email: VID Number is the Vendor Consultant Identification Number issued by the Comptroller. If a firm does not have a VID Number, please enter the owner’s Social Security or their Federal Employee Identification Number (if incorporated). 4/06 DBE-H2.ATT 04/06 DocuSign Envelope ID: 34ABC29CB7F6594C-D1A8-49E0-BF33-E68A391DD60F A33B-4B5F-9C0D-57494FCE16B1 CONTRACT - EXHIBIT H-4 Texas Department of Transportation Subprovider Monitoring System Final Report The Final Report Form should be filled out by the Prime Provider and submitted to the Contract Manager and the Business Opportunity Programs Office for review upon completion of the contract. The report should reflect all subcontract activity on the project. The report will aid in expediting the final estimate for payment. If the HUB or DBE goal requirements were not met, documentation supporting good faith efforts must be submitted. DBE Goal: % OR HUB Goal: % Total Contract Amount: $ Total Contract Amount: $ Contract Number: Vendor Consultant ID # Subprovider Total $ Amt Paid to Date TOTAL This is to certify that % of the work was completed by the HUB or DBE subproviders as stated above. By: Prime Provider Per: Signature Subscribed and sworn to before me, this day of ,, 20 Notary Public County My Commission expires: DocuSign Envelope ID: 34ABC29CB7F6594C-D1A8-49E0-BF33-E68A391DD60F A33B-4B5F-9C0D-57494FCE16B1 HUB Subcontracting Plan (HSP) Prime Contractor Progress Assessment Report This form must be completed and submitted to the contracting agency each month to document compliance with your HSP. Contract/Requisition Number: Contracting Agency/University Name: Contractor (Company) Name: Point of Contact: Date of Award: Object Code: (mm/dd/yyyy) State of Texas VID #: Phone #: (Agency Use Only) Reporting (Month) Period: Total Amount Paid this Reporting Period to Contractor: $ - Report HUB and Non-HUB subcontractor information *Texas Certified Total Contract $ Total $ Amount Paid Total Contract $ Subcontractor’s Name Subcontractor’s VID or HUB Certificate Number Certified HUB? (Yes or Total Contract $ Amount from HSP with Subcontractor This Reporting Period to Subcontractor Amount Paid to Date to Subcontractor Object Code Subcontractor’s Name Certificate Number (Yes or No) with Subcontractor Subcontractor to Subcontractor (Agency Use Only) $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ TOTALS: $ - $ - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - Signature: Title: Date: *Note: Prime contractors can verify subcontractor HUB certification status on-line at xxxx://xxx0.xxxx.xxxxx.xx.xx/cmbl/cmblhub.html

Appears in 1 contract

Samples: sb20pca.txdot.gov

Required Forms. If subcontractors are used under the contract that has no stated HUB goal, Exhibits X-0, X-0, X-0 and H-6 are required. Exhibits H-1 and H-6 are required if no subcontractors are being used to perform work under this contract. State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) is required monthly even when no subcontracting activity has occurred. In addition, State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) should be submitted with the Provider’s invoice. 12/06 HU Page 1 of 1 Attachment H-SN DocuSign Envelope ID: 34ABC29CE78C0186-D1A82850-49E042B8-BF3399A8-E68A391DD60F 6B81CB8EC361 DocuSign Envelope ID: 17A210D3-991C-4541-9438-B8D372726031 WAs Used Contract No. 12-6IDP0004 PS Contract No. 7397 5899 Contract No. 50-6IDP500# ERP Contract No. #### EXHIBIT H-1 Texas Department of Transportation Subprovider Monitoring System Commitment Worksheet Contract #: 2412-7IDP1003 6IDP0004 (PS 5899) Assigned Goal: 23.723.7 % Federally Funded State Funded _ X Prime Provider: XxXxxx & XxXxxx Land SurveyorsProfessional Service Industries, Inc. Total Contract Amount: $2,000,000.00 500,000.00 Prime Provider Info: DBE HUB _ _ Both _X_ Vendor ID #: _17422732929 1U 3709620903U DBE/HUB Expiration Date: U (First 11 Digits Only) DBE/HUB Expiration Date: __5/5/2019 P P If no subproviders are used on this contract, please indicate by placing “N/A” on the 1st line under Subproviders. Subprovider(s) (List All) Type of Work Vendor ID # (First 11 Digits Only) D=DBE Expiration H=HUB Expiration Date $ Amount or % of Work * Xxxxxx LLC Land Surveying 17430098982 D, H 5/12/2019 8Engineering Corporation Construction Materials Testing 17421528195 DBE 8/31/2017 HUB 8/31/2018 12% Dallas Aerial SurveysGeotest Engineering, Inc. Aerial Mapping 17516161738 H 6/11/2019 16% Xxxxx & Xxxxxx, Inc. State Land Surveying 17418482448 3% Surveying And Mapping, LLC Aerial Mapping Land Surveying 17427049741 2% E.S.P. Associates, P.A., Inc. Land Surveying 15615314679 2Construction Materials Testing 17420489209 DBE 6/30/2017 HUB 6/30/2018 12% Subprovider(s) Contract or % of Work* Totals 3124% *For Work Authorization Contracts, indicate the % of work to be performed by each subprovider. Total DBE or HUB Commitment Dollars $ 480,000 $60,000.00 Total DBE or HUB Commitment Percentages of Contract 24 % U24U% Total (Commitment Dollars and Percentages are for Subproviders only) DocuSign Envelope ID: 34ABC29CE78C0186-D1A82850-49E042B8-BF3399A8-E68A391DD60F 6B81CB8EC361 Subprovider Monitoring System Commitment Agreement This commitment agreement is subject to the award and receipt of a signed contract from the Texas Department of Transportation (TxDOT). NOTE: Exhibit H-2 is required to be attached to each contract that does not include work authorizations. Exhibit H-2 is required to be attached with each work authorization. Exhibit H-2 is also required to be attached to each supplemental work authorization. If DBE/HUB Subproviders are used, the form must be completed and signed. If no DBE/HUB Subproviders are used, indicate with “N/A” on this line: and attach with the work authorization or supplemental work authorization. Contract #: Assigned Goal: % Prime Provider: Work Authorization (WA)#: WA Amount: _ Date: Supplemental Work Authorization (SWA) #: to WA #: Revised WA Amount: SWA Amount: Description of Work (List by category of work or task description. Attach additional pages, if necessary.) Dollar Amount (For each category of work or task description shown.) Total Commitment Amount (Including all additional pages.) $ IMPORTANT: The signatures of the prime and the DBE/HUB and Second Tier Subprovider, if any (both DBE and Non-DBE) and the total commitment amount must always be on the same page. Provider Name: Name: (Please Print) Title: Signature Date Address: Phone # & Fax #: Email: DBE/HUB Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone # & Fax #: Email: Second Tier Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone #& Fax #: Email: VID Number is the Vendor Identification Number issued by the Comptroller. If a firm does not have a VID Number, please enter the owner’s Social Security or their Federal Employee Identification Number (if incorporated). 4/06 DBE-H2.ATT DocuSign Envelope ID: 34ABC29CE78C0186-D1A82850-49E042B8-BF3399A8-E68A391DD60F Texas Department of Transportation 6B81CB8EC361 Subprovider Monitoring System Final Report The Final Report Form should be filled out by the Prime Provider and submitted to the Contract Manager and the Business Opportunity Programs Office for review upon completion of the contract. The report should reflect all subcontract activity on the project. The report will aid in expediting the final estimate for payment. If the HUB or DBE goal requirements were not met, documentation supporting good faith efforts must be submitted. DBE Goal: % OR HUB Goal: % Total Contract Amount: $ Total Contract Amount: $ Contract Number: Vendor ID # Subprovider Total $ Amt Paid to Date TOTAL This is to certify that % of the work was completed by the HUB or DBE subproviders as stated above. By: Prime Provider Per: Signature Subscribed and sworn to before me, this day of ,, 20 Notary Public County My Commission expires: DocuSign Envelope ID: 34ABC29C-D1A8-49E0-BF33-E68A391DD60F HUB Subcontracting Plan (HSP) Prime Contractor Progress Assessment Report This form must be completed and submitted to the contracting agency each month to document compliance with your HSP. Contract/Requisition Number: Contracting Agency/University Name: Contractor (Company) Name: Point of Contact: Date of Award: Object Code: (mm/dd/yyyy) State of Texas VID #: Phone #: (Agency Use Only) Reporting (Month) Period: Total Amount Paid this Reporting Period to Contractor: $ - Report HUB and Non-HUB subcontractor information *Texas Certified Total Contract $ Total $ Amount Paid Total Contract $ Subcontractor’s VID or HUB HUB? Amount from HSP This Reporting Period to Amount Paid to Date Object Code Subcontractor’s Name Certificate Number (Yes or No) with Subcontractor Subcontractor to Subcontractor (Agency Use Only) $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ TOTALS: $ - $ - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - Signature: Title: Date: *Note: Prime contractors can verify subcontractor HUB certification status on-line at xxxx://xxx0.xxxx.xxxxx.xx.xx/cmbl/cmblhub.html:

Appears in 1 contract

Samples: sb20pca.txdot.gov

Required Forms. If subcontractors are used under the contract that has no stated HUB goal, Exhibits X-0, X-0, X-0 and H-6 are required. Exhibits H-1 and H-6 are required if no subcontractors are being used to perform work under this contract. State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) is required monthly even when no subcontracting activity has occurred. In addition, State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) should be submitted with the Provider’s invoice. 12/06 HU DocuSign Envelope ID: 34ABC29C64E4AFB3-D1A8F5A2-49E04281-BF339919-E68A391DD60F PS BBE17D9C3283 Commercial Lab wWA PeopleSoft Contract No. 7397 601CT0000000000000000000008586 Legacy Contract No. 46-8IDP0001 EXHIBIT H-1 Texas Department of Transportation Subprovider Monitoring System Commitment Worksheet Contract #: 2446-7IDP1003 8IDP0001 Assigned Goal: 23.70% Federally Funded State Funded _ X Prime Provider: XxXxxx & XxXxxx Land SurveyorsXxxxxxxx-Xxxxxxxx, Inc. Total Contract Amount: $2,000,000.00 2,500,000.00 Prime Provider Info: DBE _ HUB _ _ Both _X_ Vendor ID #: _17422732929 11125370749_ DBE/HUB Expiration Date: N/A (First 11 Digits Only) DBE/HUB Expiration Date: __5/5/2019 If no subproviders are used on this contract, please indicate by placing “N/A” on the 1st line under Subproviders. Subprovider(s) (List All) Type of Work Vendor ID # (First 11 Digits Only) D=DBE H=HUB Expiration Date $ Amount or % of Work * Xxxxxx LLC Land Surveying 17430098982 DWiss, H 5/12/2019 8% Dallas Aerial SurveysJanney, Elstner Associates, Inc. Aerial Mapping 17516161738 H 6/11/2019 16Cathodic Protection 13627579561 N/A N/A 5% Xxxxx & XxxxxxGPI Laboratories, Inc. State Land Surveying 17418482448 3% Surveying And Mapping, LLC Aerial Mapping Land Surveying 17427049741 2% E.S.P. Associates, P.A., Inc. Land Surveying 15615314679 2Materials Testing 32059069479 N/A N/A 10% Subprovider(s) Contract or % of Work* Totals 3115% *For Work Authorization Contracts, indicate the % of work to be performed by each subprovider. Total DBE or HUB Commitment Dollars $ 480,000 0 Total DBE or HUB Commitment Percentages of Contract 24 0 % (Commitment Dollars and Percentages are for Subproviders only) 12/06 XXXX0.XX DocuSign Envelope ID: 34ABC29C64E4AFB3-D1A8F5A2-49E04281-BF339919-E68A391DD60F BBE17D9C3283 Commercial Lab wWA PeopleSoft Contract No. 601CT0000000000000000000008586 Legacy Contract No. 46-8IDP0001 EXHIBIT H-2 Texas Department of Transportation Subprovider Monitoring System Commitment Agreement This commitment agreement is subject to the award and receipt of a signed contract from the Texas Department of Transportation (TxDOT). NOTE: Exhibit H-2 is required to be attached to each contract that does not include work authorizations. Exhibit H-2 is required to be attached with each work authorization. Exhibit H-2 is also required to be attached to each supplemental work authorization. If DBE/HUB Subproviders are used, the form must be completed and signed. If no DBE/HUB Subproviders are used, indicate with “N/A” on this line: and attach with the work authorization or supplemental work authorization. Contract #: Assigned Goal: % Prime Provider: Work Authorization (WA)#: WA Amount: _ Date: Supplemental Work Authorization (SWA) #: to WA #: Revised WA Amount: SWA Amount: Description of Work (List by category of work or task description. Attach additional pages, if necessary.) Dollar Amount (For each category of work or task description shown.) Total Commitment Amount (Including all additional pages.) $ IMPORTANT: The signatures of the prime and the DBE/HUB and Second Tier Subprovider, if any (both DBE and Non-DBE) and the total commitment amount must always be on the same page. Provider Name: Name: (Please Print) Title: Signature Date Address: Phone # & Fax #: Email: DBE/HUB Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone # & Fax #: Email: Second Tier Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone #& Fax #: Email: VID Number is the Vendor Identification Number issued by the Comptroller. If a firm does not have a VID Number, please enter the owner’s Social Security or their Federal Employee Identification Number (if incorporated). 4/06 DBE-H2.ATT DocuSign Envelope ID: 34ABC29C64E4AFB3-D1A8F5A2-49E04281-BF339919-E68A391DD60F BBE17D9C3283 Commercial Lab wWA PeopleSoft Contract No. 601CT0000000000000000000008586 Legacy Contract No. 46-8IDP0001 EXHIBIT H-4 Texas Department of Transportation Subprovider Monitoring System Final Report The Final Report Form should be filled out by the Prime Provider and submitted to the Contract Manager and the Business Opportunity Programs Office for review upon completion of the contract. The report should reflect all subcontract activity on the project. The report will aid in expediting the final estimate for payment. If the HUB or DBE goal requirements were not met, documentation supporting good faith efforts must be submitted. DBE Goal: % OR HUB Goal: % Total Contract Amount: $ Total Contract Amount: $ Contract Number: Vendor ID # Subprovider Total $ Amt Paid to Date TOTAL This is to certify that % of the work was completed by the HUB or DBE subproviders as stated above. By: Prime Provider Per: Signature Subscribed and sworn to before me, this day of ,, 20 Notary Public County My Commission expires: 12/06 DBE-H4.A DocuSign Envelope ID: 34ABC29C64E4AFB3-D1A8F5A2-49E04281-BF339919-E68A391DD60F BBE17D9C3283 DocuSignCEonmvemlopeercIDia: lDL9a32b60wFW0-AAD37-4395-BF8E-A7E372877132 PeopleSoft Contract No. 601CT0000000000000000000008586 Legacy Contract No. 46-8IDP0001 HUB Subcontracting Plan (HSP) Prime Contractor Progress Assessment Report This form must be completed and submitted to the contracting agency each month to document compliance with your HSP. Contract/Requisition Number: Contracting Agency/University Name: Contractor (Company) Name: Point of Contact: Date of Award: Object Code: (mm/dd/yyyy) State of Texas VID #: Phone #: (Agency Use Only) Reporting (Month) Period: Total Amount Paid this Reporting Period to Contractor: $ - Report HUB and Non-HUB subcontractor information *Texas Certified Total Contract $ Total $ Amount Paid Total Contract $ Subcontractor’s VID or HUB HUB? Amount from HSP This Reporting Period to Amount Paid to Date Object Code Subcontractor’s Name Certificate Number (Yes or No) with Subcontractor Subcontractor to Subcontractor (Agency Use Only) $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ TOTALS: $ - $ - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - Signature: Title: Date: *Note: Prime contractors can verify subcontractor HUB certification status on-line at xxxx://xxx0.xxxx.xxxxx.xx.xx/cmbl/cmblhub.html

Appears in 1 contract

Samples: sb20pca.txdot.gov

Required Forms. If subcontractors are used under the contract that has no stated HUB goal, Exhibits X-0, X-0, X-0 and H-6 are required. Exhibits H-1 and H-6 are required if no subcontractors are being used to perform work under this contract. State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) is required monthly even when no subcontracting activity has occurred. In addition, State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) should be submitted with the Provider’s invoice. 12/06 HU DocuSign Envelope ID: 34ABC29CBBE20E13-D1A87BB4-49E04CB6-BF33AF11-E68A391DD60F PS Contract No. 7397 EXHIBIT H-1 202E150D2F61 Texas Department of Transportation Subprovider Monitoring System Commitment Worksheet Contract #: 2457-7IDP1003 6IDP5009 Assigned Goal: 23.70% Federally Funded State Funded _X_ X Prime Provider: XxXxxx & XxXxxx Land SurveyorsTRC Companies, Inc. Total Contract Amount: $2,000,000.00 250,000.00 Prime Provider Info: DBE HUB Both _X_ Vendor ID #: _17422732929 1060861618000 (First 11 Digits Only) DBE/HUB Expiration Date: __5/5/2019 If no subproviders are used on this contract, please indicate by placing “N/A” on the 1st line under Subproviders. Subprovider(s) (List All) Type of Work Vendor ID # (First 11 Digits Only) D=DBE H=HUB Expiration Date $ Amount or % of Work * Xxxxxx LLC Land Surveying 17430098982 D, H 5/12/2019 8% Dallas Aerial Surveys, Inc. Aerial Mapping 17516161738 H 6/11/2019 16% Xxxxx & Xxxxxx, Inc. State Land Surveying 17418482448 3% Surveying And Mapping, LLC Aerial Mapping Land Surveying 17427049741 2% E.S.P. Associates, P.A., Inc. Land Surveying 15615314679 2% N/A Subprovider(s) Contract or % of Work* Totals 310.0% *For Work Authorization Contracts, indicate the % of work to be performed by each subprovider. Total DBE or HUB Commitment Dollars $ 480,000 Total DBE or HUB Commitment Percentages of Contract 24 0.0% (Commitment Dollars and Percentages are for Subproviders only) 12/06 XXXX0.XX DocuSign Envelope ID: 34ABC29CBBE20E13-D1A87BB4-49E04CB6-BF33AF11-E68A391DD60F 202E150D2F61 Subprovider Monitoring System Commitment Agreement This commitment agreement is subject to the award and receipt of a signed contract from the Texas Department of Transportation (TxDOT). NOTE: Exhibit H-2 is required to be attached to each contract that does not include work authorizations. Exhibit H-2 is required to be attached with each work authorization. Exhibit H-2 is also required to be attached to each supplemental work authorization. If DBE/HUB Subproviders are used, the form must be completed and signed. If no DBE/HUB Subproviders are used, indicate with “N/A” on this line: and attach with the work authorization or supplemental work authorization. Contract #: Assigned Goal: % Prime Provider: Work Authorization (WA)#: WA Amount: _ Date: Supplemental Work Authorization (SWA) #: to WA #: Revised WA Amount: SWA Amount: Description of Work (List by category of work or task description. Attach additional pages, if necessary.) Dollar Amount (For each category of work or task description shown.) Total Commitment Amount (Including all additional pages.) $ IMPORTANT: The signatures of the prime and the DBE/HUB and Second Tier Subprovider, if any (both DBE and Non-DBE) and the total commitment amount must always be on the same page. Provider Name: Name: (Please Print) Title: Signature Date Address: Phone # & Fax #: Email: DBE/HUB Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone # & Fax #: Email: Second Tier Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone #& Fax #: Email: VID Number is the Vendor Identification Number issued by the Comptroller. If a firm does not have a VID Number, please enter the owner’s Social Security or their Federal Employee Identification Number (if incorporated). 4/06 DBE-H2.ATT DocuSign Envelope ID: 34ABC29CBBE20E13-D1A87BB4-49E04CB6-BF33AF11-E68A391DD60F Texas Department of Transportation Subprovider Monitoring System Final Report 202E150D2F61 The Final Report Form should be filled out by the Prime Provider and submitted to the Contract Manager and the Business Opportunity Programs Office for review upon completion of the contract. The report should reflect all subcontract activity on the project. The report will aid in expediting the final estimate for payment. If the HUB or DBE goal requirements were not met, documentation supporting good faith efforts must be submitted. DBE Goal: % OR HUB Goal: % Total Contract Amount: $ Total Contract Amount: $ Contract Number: Vendor ID # Subprovider Total $ Amt Paid to Date TOTAL This is to certify that % of the work was completed by the HUB or DBE subproviders as stated above. By: Prime Provider Per: Signature Subscribed and sworn to before me, this day of ,, 20 Notary Public County My Commission expires: 12/06 DBE-H4.A DocuSign Envelope ID: 34ABC29CBBE20E13-D1A87BB4-49E04CB6-BF33AF11-E68A391DD60F 202E150D2F61 HUB Subcontracting Plan (HSP) Prime Contractor Progress Assessment Report This form must be completed and submitted to the contracting agency each month to document compliance with your HSP. Contract/Requisition Number: Contracting Agency/University Name: Contractor (Company) Name: Point of Contact: Date of Award: Object Code: (mm/dd/yyyy) State of Texas VID #: Phone #: (Agency Use Only) Reporting (Month) Period: Total Amount Paid this Reporting Period to Contractor: $ - Report HUB and Non-HUB subcontractor information *Texas Certified Total Contract $ Total $ Amount Paid Total Contract $ Subcontractor’s Name Subcontractor’s VID or HUB Certificate Number *Texas Certified HUB? Amount from HSP This Reporting Period to Amount Paid to Date Object Code Subcontractor’s Name Certificate Number (Yes or No) Total Contract $ Amount from HSP with Subcontractor Subcontractor Total $ Amount Paid This Reporting Period to Subcontractor Total Contract $ Amount Paid to Date to Subcontractor Object Code (Agency Use Only) $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ TOTALS: $ - $ - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - Signature: Title: Date: *Note: Prime contractors can verify subcontractor HUB certification status on-line at xxxx://xxx0.xxxx.xxxxx.xx.xx/cmbl/cmblhub.html

Appears in 1 contract

Samples: sb20pca.txdot.gov

Required Forms. If subcontractors are used under the contract that has no stated HUB goal, Exhibits X-0, X-0, X-0 and H-6 are required. Exhibits H-1 and H-6 are required if no subcontractors are being used to perform work under this contract. State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) is required monthly even when no subcontracting activity has occurred. In addition, State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) should be submitted with the Provider’s invoice. 12/06 HU DocuSign Envelope ID: 34ABC29CFC73BE0B-3903-D1A84659-49E082E3-BF33-E68A391DD60F PS Contract No. 7397 10CDDCE94116 EXHIBIT H-1 Texas Department of Transportation Subprovider Monitoring System Commitment Worksheet Contract #: :24-7IDP1003 8IDP5002 Assigned Goal: 23.7% Federally Funded State Funded _ X Prime Provider: XxXxxx Amec Xxxxxx Xxxxxxx Environment & XxXxxx Land SurveyorsInfrastructure, Inc. Total Contract Amount: $2,000,000.00 500,000.00 Prime Provider Info: DBE HUB Both _X_ Vendor ID #: _17422732929 19116417726 DBE/HUB Expiration Date: N/A (First 11 Digits Only) DBE/HUB Expiration Date: __5/5/2019 If no subproviders are used on this contract, please indicate by placing “N/A” on the 1st line under Subproviders. Subprovider(s) (List All) Type of Work Vendor ID # (First 11 Digits Only) D=DBE H=HUB Expiration Date $ Amount or % of Work * Xxxxxx LLC Land Surveying 17430098982 D, H 5/12/2019 8% Dallas Aerial Surveys, Inc. Aerial Mapping 17516161738 H 6/11/2019 16% Xxxxx & Xxxxxx, Inc. State Land Surveying 17418482448 3% Surveying And MappingB2Z Engineering, LLC Aerial Mapping Land Surveying 17427049741 2Soil Exploration, Transportation Foundation Studies 13715808781 H 02/28/2020 13% E.S.P. AssociatesCQC Testing and Engineering, P.A.LLC Soil Exploration, Inc. Land Surveying 15615314679 2Geotechnical Testing, Transportation Foundation Studies 12612421979 H 06/26/2019 22% Subprovider(s) Contract or % of Work* Totals 3135% *For Work Authorization Contracts, indicate the % of work to be performed by each subprovider. Total DBE or HUB Commitment Dollars $ 480,000 $175,000.00 Total DBE or HUB Commitment Percentages of Contract 24 35% (Commitment Dollars and Percentages are for Subproviders only) 12/06 DBEH1 DocuSign Envelope ID: 34ABC29CFC73BE0B-3903-D1A84659-49E082E3-BF33-E68A391DD60F 10CDDCE94116 Subprovider Monitoring System Commitment Agreement This commitment agreement is subject to the award and receipt of a signed contract from the Texas Department of Transportation (TxDOT). NOTE: Exhibit H-2 is required to be attached to each contract that does not include work authorizations. Exhibit H-2 is required to be attached with each work authorization. Exhibit H-2 is also required to be attached to each supplemental work authorization. If DBE/HUB Subproviders are used, the form must be completed and signed. If no DBE/HUB Subproviders are used, indicate with “N/A” on this line: and attach with the work authorization or supplemental work authorization. Contract #: Assigned Goal: % Prime Provider: Work Authorization (WA)#: WA Amount: _ Date: Supplemental Work Authorization (SWA) #: to WA #: Revised WA Amount: SWA Amount: Description of Work (List by category of work or task description. Attach additional pages, if necessary.) Dollar Amount (For each category of work or task description shown.) Total Commitment Amount (Including all additional pages.) $ IMPORTANT: The signatures of the prime and the DBE/HUB and Second Tier Subprovider, if any (both DBE and Non-DBE) and the total commitment amount must always be on the same page. Provider Name: Name: (Please Print) Title: Signature Date Address: Phone # & Fax #: Email: DBE/HUB Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone # & Fax #: Email: Second Tier Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone #& Fax #: Email: VID Number is the Vendor Identification Number issued by the Comptroller. If a firm does not have a VID Number, please enter the owner’s Social Security or their Federal Employee Identification Number (if incorporated). 4/06 DBE-H2.ATT DocuSign Envelope ID: 34ABC29CFC73BE0B-3903-D1A84659-49E082E3-BF33-E68A391DD60F Texas Department of Transportation 10CDDCE94116 Subprovider Monitoring System Final Report The Final Report Form should be filled out by the Prime Provider and submitted to the Contract Manager and the Business Opportunity Programs Office for review upon completion of the contract. The report should reflect all subcontract activity on the project. The report will aid in expediting the final estimate for payment. If the HUB or DBE goal requirements were not met, documentation supporting good faith efforts must be submitted. DBE Goal: % OR HUB Goal: % Total Contract Amount: $ Total Contract Amount: $ Contract Number: Vendor ID # Subprovider Total $ Amt Paid to Date TOTAL This is to certify that % of the work was completed by the HUB or DBE subproviders as stated above. By: Prime Provider Per: Signature Subscribed and sworn to before me, this day of ,, 20 Notary Public County My Commission expires: 12/06 DBE-H4.A DocuSign Envelope ID: 34ABC29CFC73BE0B-3903-D1A84659-49E082E3-BF33-E68A391DD60F 10CDDCE94116 HUB Subcontracting Plan (HSP) Prime Contractor Progress Assessment Report This form must be completed and submitted to the contracting agency each month to document compliance with your HSP. Contract/Requisition Number: Contracting Agency/University Name: Contractor (Company) Name: Point of Contact: Date of Award: Object Code: (mm/dd/yyyy) State of Texas VID #: Phone #: (Agency Use Only) Reporting (Month) Period: Total Amount Paid this Reporting Period to Contractor: $ - Report HUB and Non-HUB subcontractor information *Texas Certified Total Contract $ Total $ Amount Paid Total Contract $ Subcontractor’s VID or HUB HUB? Amount from HSP This Reporting Period to Amount Paid to Date Object Code Subcontractor’s Name Certificate Number (Yes or No) with Subcontractor Subcontractor to Subcontractor (Agency Use Only) $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ TOTALS: $ - $ - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - Signature: Title: Date: *Note: Prime contractors can verify subcontractor HUB certification status on-line at xxxx://xxx0.xxxx.xxxxx.xx.xx/cmbl/cmblhub.html

Appears in 1 contract

Samples: sb20pca.txdot.gov

Required Forms. If subcontractors are used under the contract that has no stated HUB goal, Exhibits X-0, X-0, X-0 and H-6 are required. Exhibits H-1 and H-6 are required if no subcontractors are being used to perform work under this contract. State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) is required monthly even when no subcontracting activity has occurred. In addition, State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) should be submitted with the Provider’s invoice. 12/06 HU EXHIBIT H-1 Legacy Contract No. 24-9IDP1001 DocuSign Envelope ID: 34ABC29CC10691C7-D1A8E673-49E04544-BF33A340-E68A391DD60F 5ADD28C1973F PS Contract No. 7397 EXHIBIT H-1 9656 Texas Department of Transportation Subprovider Monitoring System Commitment Worksheet Contract #: 24-7IDP1003 9IDP1001 Assigned Goal: 23.7% Federally Funded State Funded X_ X Prime Provider: XxXxxx & XxXxxx Land SurveyorsLandtech, Inc. Total Contract Amount: $2,000,000.00 3,000,000.00 Prime Provider Info: DBE HUB Both _X_ X Vendor ID #: _17422732929 17604210165 (First 11 Digits Only) DBE/HUB Expiration Date: __5/5/2019 HUB 09/05/2022 DBE 11/30/2017 _ If no subproviders are used on this contract, please indicate by placing “N/A” on the 1st line under Subproviders. Subprovider(s) (List All) Type of Work Vendor ID # (First 11 Digits Only) D=DBE H=HUB Expiration Date $ Amount or % of Work * Xxxxxx LLC Land Xxxxx & Xxxxxxxxx, Inc. Design Surveying 17430098982 D, H 5/12/2019 817417095308 HUB 5 Feb 2022 3.7 % Dallas Aerial SurveysGorrondona & Assoc., Inc. Aerial Mapping 17516161738 H 6/11/2019 16Photogrammetry Terrestrial LiDAR 17523329708 HUB 31 Jan 2023 12 % Xxxxx & XxxxxxLamb-Star Engineering, Inc. State Land Surveying 17418482448 3L.P. Terrestrial Photogrammetry Mobile and Airborne LiDAR 12037996670 HUB 05 Dec 2021 10 % Surveying And MappingQuantum Spatial, LLC Inc Aerial Mapping Land Surveying 17427049741 2% E.S.P. Associates, P.A., Inc. Land Surveying 15615314679 2Photogrammetry 13911331810 HUB N/A 10% Subprovider(s) Contract or % of Work* Totals 3135.7% *For Work Authorization Contracts, indicate the % of work to be performed by each subprovider. Total DBE or HUB Commitment Dollars $ 480,000 Total DBE or HUB Commitment Percentages of Contract 24 25.7% (Commitment Dollars and Percentages are for Subproviders only) 12/06 XXXX0.XX DocuSign Envelope ID: 34ABC29CC10691C7-D1A8E673-49E04544-BF33A340-E68A391DD60F 5ADD28C1973F Subprovider Monitoring System Commitment Agreement This commitment agreement is subject to the award and receipt of a signed contract from the Texas Department of Transportation (TxDOT). NOTE: Exhibit H-2 is required to be attached to each contract that does not include work authorizations. Exhibit H-2 is required to be attached with each work authorization. Exhibit H-2 is also required to be attached to each supplemental work authorization. If DBE/HUB Subproviders are used, the form must be completed and signed. If no DBE/HUB Subproviders are used, indicate with “N/A” on this line: and attach with the work authorization or supplemental work authorization. Contract #: Assigned Goal: % Prime Provider: Work Authorization (WA)#: WA Amount: _ Date: Supplemental Work Authorization (SWA) #: to WA #: Revised WA Amount: SWA Amount: Description of Work (List by category of work or task description. Attach additional pages, if necessary.) Dollar Amount (For each category of work or task description shown.) Total Commitment Amount (Including all additional pages.) $ IMPORTANT: The signatures of the prime and the DBE/HUB and Second Tier Subprovider, if any (both DBE and Non-DBE) and the total commitment amount must always be on the same page. Provider Name: Name: (Please Print) Title: Signature Date Address: Phone # & Fax #: Email: DBE/HUB Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone # & Fax #: Email: Second Tier Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone #& Fax #: Email: VID Number is the Vendor Identification Number issued by the Comptroller. If a firm does not have a VID Number, please enter the owner’s Social Security or their Federal Employee Identification Number (if incorporated). 4/06 DBE-H2.ATT DocuSign Envelope ID: 34ABC29CC10691C7-D1A8E673-49E04544-BF33A340-E68A391DD60F 5ADD28C1973F EXHIBIT H-4 Texas Department of Transportation Subprovider Monitoring System Final Report The Final Report Form should be filled out by the Prime Provider and submitted to the Contract Manager and the Business Opportunity Programs Office for review upon completion of the contract. The report should reflect all subcontract activity on the project. The report will aid in expediting the final estimate for payment. If the HUB or DBE goal requirements were not met, documentation supporting good faith efforts must be submitted. DBE Goal: % OR HUB Goal: % Total Contract Amount: $ Total Contract Amount: $ Contract Number: Vendor ID # Subprovider Total $ Amt Paid to Date TOTAL This is to certify that % of the work was completed by the HUB or DBE subproviders as stated above. By: Prime Provider Per: Signature Subscribed and sworn to before me, this day of ,20 Notary Public County My Commission expires: DocuSign Envelope ID: 34ABC29CC10691C7-D1A8E673-49E04544-BF33A340-E68A391DD60F 5ADD28C1973F HUB Subcontracting Plan (HSP) Prime Contractor Progress Assessment Report This form must be completed and submitted to the contracting agency each month to document compliance with your HSP. Contract/Requisition Number: Contracting Agency/University Name: Contractor (Company) Name: Point of Contact: Date of Award: Object Code: (mm/dd/yyyy) State of Texas VID #: Phone #: (Agency Use Only) Reporting (Month) Period: Total Amount Paid this Reporting Period to Contractor: $ - Report HUB and Non-HUB subcontractor information *Texas Certified Total Contract $ Total $ Amount Paid Total Contract $ Subcontractor’s VID or HUB HUB? Amount from HSP This Reporting Period to Amount Paid to Date Object Code Subcontractor’s Name Certificate Number (Yes or No) with Subcontractor Subcontractor to Subcontractor (Agency Use Only) $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ TOTALS: $ - $ - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - Signature: Title: Date: *Note: Prime contractors can verify subcontractor HUB certification status on-line at xxxx://xxx0.xxxx.xxxxx.xx.xx/cmbl/cmblhub.html

Appears in 1 contract

Samples: sb20pca.txdot.gov

Required Forms. If subcontractors are used under the contract that has no stated HUB goal, Exhibits X-0, X-0, X-0 and H-6 are required. Exhibits H-1 and H-6 are required if no subcontractors are being used to perform work under this contract. State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) is required monthly even when no subcontracting activity has occurred. In addition, State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) should be submitted with the Provider’s invoice. 12/06 HU DocuSign Envelope ID: 34ABC29C9AE6F0BE-9346-D1A84342-49E09F86-BF33-E68A391DD60F PS Contract No. 7397 D6E3CDDE4CB5 EXHIBIT H-1 Texas Department of Transportation Subprovider Monitoring System Commitment Worksheet Contract #: 247392 50-7IDP1003 7IDP5002 Assigned Goal: 23.70% Federally Funded State Funded _ X Prime Provider: XxXxxx & XxXxxx Land Surveyors, Xxxxxx Engineering Group Inc. Total Contract Amount: $2,000,000.00 500,000.00 Prime Provider Info: DBE HUB Both _X_ Vendor ID #: _17422732929 19540816360 DBE/HUB Expiration Date: N/A (First 11 Digits Only) DBE/HUB Expiration Date: __5/5/2019 If no subproviders are used on this contract, please indicate by placing “N/A” on the 1st line under Subproviders. Subprovider(s) (List All) Type of Work Vendor ID # (First 11 Digits Only) D=DBE Expiration H=HUB Expiration Date $ Amount or % of Work * Xxxxxx LLC Land Surveying 17430098982 D, H 5/12/2019 8% Dallas Aerial Surveys, Inc. Aerial Mapping 17516161738 H 6/11/2019 16% Xxxxx & Xxxxxx, Inc. State Land Surveying 17418482448 3% Surveying And Mapping, LLC Aerial Mapping Land Surveying 17427049741 2% E.S.P. Associates, P.A., Inc. Land Surveying 15615314679 2% N/A Subprovider(s) Contract or % of Work* Totals 310% *For Work Authorization Contracts, indicate the % of work to be performed by each subprovider. Total DBE or HUB Commitment Dollars $ 480,000 0 Total DBE or HUB Commitment Percentages of Contract 24 0% (Commitment Dollars and Percentages are for Subproviders only) 12/06 XXXX0.XX DocuSign Envelope ID: 34ABC29C9AE6F0BE-9346-D1A84342-49E09F86-BF33-E68A391DD60F Subprovider Monitoring System Commitment Agreement This commitment agreement is subject to the award and receipt of a signed contract from the Texas Department of Transportation (TxDOT). NOTE: Exhibit H-2 is required to be attached to each contract that does not include work authorizations. Exhibit H-2 is required to be attached with each work authorization. Exhibit H-2 is also required to be attached to each supplemental work authorization. If DBE/HUB Subproviders are used, the form must be completed and signed. If no DBE/HUB Subproviders are used, indicate with “N/A” on this line: and attach with the work authorization or supplemental work authorization. Contract #: Assigned Goal: % Prime Provider: Work Authorization (WA)#: WA Amount: _ Date: Supplemental Work Authorization (SWA) #: to WA #: Revised WA Amount: SWA Amount: Description of Work (List by category of work or task description. Attach additional pages, if necessary.) Dollar Amount (For each category of work or task description shown.) Total Commitment Amount (Including all additional pages.) $ IMPORTANT: The signatures of the prime and the DBE/HUB and Second Tier Subprovider, if any (both DBE and Non-DBE) and the total commitment amount must always be on the same page. Provider Name: Name: (Please Print) Title: Signature Date Address: Phone # & Fax #: Email: DBE/HUB Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone # & Fax #: Email: Second Tier Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone #& Fax #: Email: VID Number is the Vendor Identification Number issued by the Comptroller. If a firm does not have a VID Number, please enter the owner’s Social Security or their Federal Employee Identification Number (if incorporated). 4/06 DBE-H2.ATT DocuSign Envelope ID: 34ABC29C-D1A8-49E0-BF33-E68A391DD60F Texas Department of Transportation Subprovider Monitoring System Final Report The Final Report Form should be filled out by the Prime Provider and submitted to the Contract Manager and the Business Opportunity Programs Office for review upon completion of the contract. The report should reflect all subcontract activity on the project. The report will aid in expediting the final estimate for payment. If the HUB or DBE goal requirements were not met, documentation supporting good faith efforts must be submitted. DBE Goal: % OR HUB Goal: % Total Contract Amount: $ Total Contract Amount: $ Contract Number: Vendor ID # Subprovider Total $ Amt Paid to Date TOTAL This is to certify that % of the work was completed by the HUB or DBE subproviders as stated above. By: Prime Provider Per: Signature Subscribed and sworn to before me, this day of ,20 Notary Public County My Commission expires: DocuSign Envelope ID: 34ABC29C-D1A8-49E0-BF33-E68A391DD60F D6E3CDDE4CB5 EXHIBIT H-6 HUB Subcontracting Plan (HSP) Prime Contractor Progress Assessment Report This form must be completed and submitted to the contracting agency each month to document compliance with your HSP. Contract/Requisition Number: Contracting Agency/University Name: Contractor (Company) Name: Point of Contact: Date of Award: Object Code: (mm/dd/yyyy) State of Texas VID #: Phone #: (Agency Use Only) Reporting (Month) Period: Total Amount Paid this Reporting Period to Contractor: $ - Report HUB and Non-HUB subcontractor information *Texas Certified Total Contract $ Total $ Amount Paid Total Contract $ Subcontractor’s VID or HUB HUB? Amount from HSP This Reporting Period to Amount Paid to Date Object Code Subcontractor’s Name Certificate Number (Yes or No) with Subcontractor Subcontractor to Subcontractor (Agency Use Only) $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ TOTALS: $ - $ - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - Signature: Title: Date: *Note: Prime contractors can verify subcontractor HUB certification status on-line at xxxx://xxx0.xxxx.xxxxx.xx.xx/cmbl/cmblhub.htmlxxxx://xxx0.xxxx.xxxxx.xx.xx/cmbl/cmblhub.html HSP-PAR Rev. 9/05

Appears in 1 contract

Samples: sb20pca.txdot.gov

Required Forms. If subcontractors are used under the contract that has no stated HUB goal, Exhibits X-0, X-0, X-0 and H-6 are required. Exhibits H-1 and H-6 are required if no subcontractors are being used to perform work under this contract. State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) is required monthly even when no subcontracting activity has occurred. In addition, State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) should be submitted with the Provider’s invoice. 12/06 HU EXHIBIT H-1 Legacy Contract No. 24-7IDP1002 DocuSign Envelope ID: 34ABC29C4F9A8FEF-D1A8B719-49E0472C-BF33BF25-E68A391DD60F DD3B0F7B4A55 PS Contract No. 7397 EXHIBIT H-1 7401 Texas Department of Transportation Subprovider Monitoring System Commitment Worksheet Contract #: 24-7IDP1003 7IDP1002 Assigned Goal: 23.723.7 % Federally Funded State Funded _ X Prime Provider: XxXxxx & XxXxxx Land SurveyorsLandtech, Inc. Total Contract Amount: $2,000,000.00 2,000,000 Prime Provider Info: DBE HUB Both _X_ X Vendor ID #: _17422732929 17604210165 (First 11 Digits Only) DBE/HUB Expiration Date: __5/5/2019 HUB 05/27/2020 DBE 11/30/2017 _ If no subproviders are used on this contract, please indicate by placing “N/A” on the 1st line under Subproviders. Subprovider(s) (List All) Type of Work Vendor ID # (First 11 Digits Only) D=DBE H=HUB Expiration Date $ Amount or % of Work * Xxxxxx LLC Land Surveying 17430098982 D, H 5/12/2019 8% Dallas Aerial Surveys, Inc. Aerial Mapping 17516161738 H 6/11/2019 16% Xxxxx Shine & XxxxxxAssociates, Inc. State Land Surveying 17418482448 312013020982 HUB 11 Dec 2017 3 % Surveying And MappingXxxxx & Xxxxxxxxx, LLC Inc. Design and Construction Survey 17417095308 HUB 30 Jan 2018 5 % Gorrondona & Assoc., Inc. Aerial Mapping Land Surveying 17427049741 2% E.S.P. Associates, P.A., Inc. Land Surveying 15615314679 217523329708 HUB 23 Feb 2019 17 % Subprovider(s) Contract or % of Work* Totals 31% *For Work Authorization Contracts, indicate the % of work to be performed by each subprovider. Total DBE or HUB Commitment Dollars $ 480,000 500,000 Total DBE or HUB Commitment Percentages of Contract 24 25 % (Commitment Dollars and Percentages are for Subproviders only) 12/06 XXXX0.XX DocuSign Envelope ID: 34ABC29C4F9A8FEF-D1A8B719-49E0472C-BF33BF25-E68A391DD60F DD3B0F7B4A55 Subprovider Monitoring System Commitment Agreement This commitment agreement is subject to the award and receipt of a signed contract from the Texas Department of Transportation (TxDOT). NOTE: Exhibit H-2 is required to be attached to each contract that does not include work authorizations. Exhibit H-2 is required to be attached with each work authorization. Exhibit H-2 is also required to be attached to each supplemental work authorization. If DBE/HUB Subproviders are used, the form must be completed and signed. If no DBE/HUB Subproviders are used, indicate with “N/A” on this line: and attach with the work authorization or supplemental work authorization. Contract #: Assigned Goal: % Prime Provider: Work Authorization (WA)#: WA Amount: _ Date: Supplemental Work Authorization (SWA) #: to WA #: Revised WA Amount: SWA Amount: Description of Work (List by category of work or task description. Attach additional pages, if necessary.) Dollar Amount (For each category of work or task description shown.) Total Commitment Amount (Including all additional pages.) $ IMPORTANT: The signatures of the prime and the DBE/HUB and Second Tier Subprovider, if any (both DBE and Non-DBE) and the total commitment amount must always be on the same page. Provider Name: Name: (Please Print) Title: Signature Date Address: Phone # & Fax #: Email: DBE/HUB Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone # & Fax #: Email: Second Tier Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone #& Fax #: Email: VID Number is the Vendor Identification Number issued by the Comptroller. If a firm does not have a VID Number, please enter the owner’s Social Security or their Federal Employee Identification Number (if incorporated). 4/06 DBE-H2.ATT DocuSign Envelope ID: 34ABC29C4F9A8FEF-D1A8B719-49E0472C-BF33BF25-E68A391DD60F DD3B0F7B4A55 EXHIBIT H-4 Texas Department of Transportation Subprovider Monitoring System Final Report The Final Report Form should be filled out by the Prime Provider and submitted to the Contract Manager and the Business Opportunity Programs Office for review upon completion of the contract. The report should reflect all subcontract activity on the project. The report will aid in expediting the final estimate for payment. If the HUB or DBE goal requirements were not met, documentation supporting good faith efforts must be submitted. DBE Goal: % OR HUB Goal: % Total Contract Amount: $ Total Contract Amount: $ Contract Number: Vendor ID # Subprovider Total $ Amt Paid to Date TOTAL This is to certify that % of the work was completed by the HUB or DBE subproviders as stated above. By: Prime Provider Per: Signature Subscribed and sworn to before me, this day of ,20 Notary Public County My Commission expires: DocuSign Envelope ID: 34ABC29C4F9A8FEF-D1A8B719-49E0472C-BF33BF25-E68A391DD60F DD3B0F7B4A55 HUB Subcontracting Plan (HSP) Prime Contractor Progress Assessment Report This form must be completed and submitted to the contracting agency each month to document compliance with your HSP. Contract/Requisition Number: Contracting Agency/University Name: Contractor (Company) Name: Point of Contact: Date of Award: Object Code: (mm/dd/yyyy) State of Texas VID #: Phone #: (Agency Use Only) Reporting (Month) Period: Total Amount Paid this Reporting Period to Contractor: $ - Report HUB and Non-HUB subcontractor information *Texas Certified Total Contract $ Total $ Amount Paid Total Contract $ Subcontractor’s VID or HUB HUB? Amount from HSP This Reporting Period to Amount Paid to Date Object Code Subcontractor’s Name Certificate Number (Yes or No) with Subcontractor Subcontractor to Subcontractor (Agency Use Only) $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ TOTALS: $ - $ - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - Signature: Title: Date: *Note: Prime contractors can verify subcontractor HUB certification status on-line at xxxx://xxx0.xxxx.xxxxx.xx.xx/cmbl/cmblhub.html

Appears in 1 contract

Samples: Contract for Surveying Services

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Required Forms. If subcontractors are used under the contract that has no stated HUB goal, Exhibits X-0, X-0, X-0 and H-6 are required. Exhibits H-1 and H-6 are required if no subcontractors are being used to perform work under this contract. State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) is required monthly even when no subcontracting activity has occurred. In addition, State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) should be submitted with the Provider’s invoice. 12/06 HU DocuSign Envelope ID: 34ABC29C6EFD4AA6-D1A81290-49E04298-BF339122-E68A391DD60F 547DBF71FEF7 DocuSign Envelope ID: 2B178E16-45FC-4113-A19B-288BDDBAC82C WAs Used Contract No. 36-7IDP5010 PS Contract No. 7397 6823 EXHIBIT H-1 Texas Department of Transportation Subprovider Monitoring System Commitment Worksheet Contract #: 2436-7IDP1003 7IDP5010 Assigned Goal: 23.723.7 % Federally Funded State Funded _ X Prime Provider: XxXxxx Xxxxxxx & XxXxxx Land SurveyorsFields, Inc. L.P. Total Contract Amount: $2,000,000.00 5,000,000 Prime Provider Info: DBE HUB Both _X_ X Vendor ID #: _17422732929 17606945404 (First 11 Digits Only) DBE/HUB Expiration Date: __5/5/2019 02/28/2018 / 10/29/2017 If no subproviders are used on this contract, please indicate by placing “N/A” on the 1st line under Subproviders. Subprovider(s) (List All) Type of Work Vendor ID # (First 11 Digits Only) D=DBE H=HUB Expiration Date $ Amount or % of Work * Xxxxxx Xxxx, Xxxxxxx & Associates, Inc. 7.4.118.2.1NLC-1NLC-2 17421928791 10% CivilCorp, LLC Land Surveying 17430098982 D8.1.1 12612129812 HUB 09/30/2018 10% 8.5.1 DBE 07/31/2019 10.1.1 10.2.1 Xxxxxxx & Associates, H 5/12/2019 Inc. 15.1.1 17417936329 HUB 08/31/2019 4% 15.2.1 DBE 08/31/2017 Gorrondona & Associates, Inc. 14.1.1 17523329708 HUB 02/23/2019 8% Dallas Aerial Surveys14.2.1 15.1.1 15.2.1 Xxxx-Xxxxxx Consulting Engineers, 4.1.1 17416762528 10% Inc. 7.3.1 10.3.1 10.5.1 Xxxxxxx Xxxx Consulting Engineers,Inc. 9.1.1 17523171100 HUB 10/27/2018 3% Terra Associates, Inc. Aerial Mapping 17516161738 H 6/11/2019 16% Xxxxx & Xxxxxx, Inc. State Land Surveying 17418482448 8.4.1 17600003481 HUB 12/02/2019 3% Surveying And Mapping, Concept Development & Planning,LLC Aerial Mapping Land Surveying 17427049741 2NLC-3 12605240576 HUBDBE 06/19/2019 12/16/2017 1% E.S.P. Associates, P.A., Inc. Land Surveying 15615314679 2% Subprovider(sSubpro vider(s) Contract or % of Work* Totals 3149% *For Work Authorization Contracts, indicate the % of work to be performed by each subprovider. Total DBE or HUB Commitment Dollars $ 480,000 Total DBE or HUB Commitment Percentages of Contract 24 29 % (Commitment Dollars and Percentages are for Subproviders only) DocuSign Envelope ID: 34ABC29C6EFD4AA6-D1A81290-49E04298-BF339122-E68A391DD60F 547DBF71FEF7 Subprovider Monitoring System Commitment Agreement This commitment agreement is subject to the award and receipt of a signed contract from the Texas Department of Transportation (TxDOT). NOTE: Exhibit H-2 is required to be attached to each contract that does not include work authorizations. Exhibit H-2 is required to be attached with each work authorization. Exhibit H-2 is also required to be attached to each supplemental work authorization. If DBE/HUB Subproviders are used, the form must be completed and signed. If no DBE/HUB Subproviders are used, indicate with “N/A” on this line: and attach with the work authorization or supplemental work authorization. Contract #: Assigned Goal: % Prime Provider: Work Authorization (WA)#: WA Amount: _ Date: Supplemental Work Authorization (SWA) #: to WA #: Revised WA Amount: SWA Amount: Description of Work (List by category of work or task description. Attach additional pages, if necessary.) Dollar Amount (For each category of work or task description shown.) Total Commitment Amount (Including all additional pages.) $ IMPORTANT: The signatures of the prime and the DBE/HUB and Second Tier Subprovider, if any (both DBE and Non-DBE) and the total commitment amount must always be on the same page. Provider Name: Name: (Please Print) Title: Signature Date Address: Phone # & Fax #: Email: DBE/HUB Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone # & Fax #: Email: Second Tier Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone #& Fax #: Email: VID Number is the Vendor Identification Number issued by the Comptroller. If a firm does not have a VID Number, please enter the owner’s Social Security or their Federal Employee Identification Number (if incorporated). 4/06 DBE-H2.ATT DocuSign Envelope ID: 34ABC29C6EFD4AA6-D1A81290-49E04298-BF339122-E68A391DD60F Texas Department of Transportation 547DBF71FEF7 Subprovider Monitoring System Final Report The Final Report Form should be filled out by the Prime Provider and submitted to the Contract Manager and the Business Opportunity Programs Office for review upon completion of the contract. The report should reflect all subcontract activity on the project. The report will aid in expediting the final estimate for payment. If the HUB or DBE goal requirements were not met, documentation supporting good faith efforts must be submitted. DBE Goal: % OR HUB Goal: % Total Contract Amount: $ Total Contract Amount: $ Contract Number: Vendor ID # Subprovider Total $ Amt Paid to Date TOTAL This is to certify that % of the work was completed by the HUB or DBE subproviders as stated above. By: Prime Provider Per: Signature Subscribed and sworn to before me, this day of ,, 20 Notary Public County My Commission expires: 12/06 DBE-H4.A DocuSign Envelope ID: 34ABC29C6EFD4AA6-D1A81290-49E04298-BF339122-E68A391DD60F 547DBF71FEF7 HUB Subcontracting Plan (HSP) Prime Contractor Progress Assessment Report This form must be completed and submitted to the contracting agency each month to document compliance with your HSP. Contract/Requisition Number: Contracting Agency/University Name: Contractor (Company) Name: Point of Contact: Date of Award: Object Code: (mm/dd/yyyy) State of Texas VID #: Phone #: (Agency Use Only) Reporting (Month) Period: Total Amount Paid this Reporting Period to Contractor: $ - Report HUB and Non-HUB subcontractor information *Texas Certified Total Contract $ Total $ Amount Paid Total Contract $ Subcontractor’s VID or HUB HUB? Amount from HSP This Reporting Period to Amount Paid to Date Object Code Subcontractor’s Name Certificate Number (Yes or No) with Subcontractor Subcontractor to Subcontractor (Agency Use Only) $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ TOTALS: $ - $ - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - Signature: Title: Date: *Note: Prime contractors can verify subcontractor HUB certification status on-line at xxxx://xxx0.xxxx.xxxxx.xx.xx/cmbl/cmblhub.html

Appears in 1 contract

Samples: sb20pca.txdot.gov

Required Forms. If subcontractors are used under the contract that has no stated HUB goal, Exhibits X-0, X-0, X-0 and H-6 are required. Exhibits H-1 and H-6 are required if no subcontractors are being used to perform work under this contract. State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) is required monthly even when no subcontracting activity has occurred. In addition, State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) should be submitted with the Provider’s invoice. 12/06 HU EXHIBIT H-1 Legacy Contract No. 24-7IDP5006 DocuSign Envelope ID: 34ABC29C8EFE0772-D1A84B8D-4ECA-49E0AFC4-BF33-E68A391DD60F F4778051DC61 PS Contract No. 7397 EXHIBIT H-1 6388 Texas Department of Transportation Subprovider Monitoring System Commitment Worksheet Contract #: :24-7IDP1003 7IDP5006 Assigned Goal: 23.7% Federally Funded State Funded _ X Prime Provider: XxXxxx & XxXxxx Land SurveyorsHalff Associates, Inc. Total Contract Amount: $2,000,000.00 $ 2,000,000 Prime Provider Info: DBE HUB Both _X_ Vendor ID #: _17422732929 17513086995 DBE/HUB Expiration Date: N/A (First 11 Digits Only) DBE/HUB Expiration Date: __5/5/2019 If no subproviders are used on this contract, please indicate by placing “N/A” on the 1st line under Subproviders. Subprovider(s) (List All) Type of Work Vendor ID # (First 11 Digits Only) D=DBE H=HUB Expiration Date $ Amount or % of Work * Xxxxxx LLC Land Surveying 17430098982 DAIA Engineers, LTD Utility CM 17606188799 H 5/12/2019 2/11/20 8% Dallas Aerial Surveys, Inc. Aerial Mapping 17516161738 Xxxxxxxxxx Engineering Corp. Utility Coord. & Utility Engr. 17415546443 N/A -- 8% The Xxxx Group SUE services 18008303275 H 6/11/2019 16D 10/4/17 7/8/17 8% Xxxxx & Xxxxxx, Inc. State Land Surveying 17418482448 3% Surveying And Mapping, LLC Aerial Mapping Land Surveying 17427049741 2% E.S.P. Associates, P.A., Inc. Land Surveying 15615314679 2Survey Services 17430098982 H D 1/6/17 12/31/16 8% Subprovider(s) Contract or % of Work* Totals 3132% *For Work Authorization Contracts, indicate the % of work to be performed by each subprovider. Total DBE or HUB Commitment Dollars $ 480,000 Total DBE or HUB Commitment Percentages of Contract 24 24% (Commitment Dollars and Percentages are for Subproviders only) EXHIBIT H-2 Texas Department of Transportation Legacy Contract No. 24-7IDP5006 DocuSign Envelope ID: 34ABC29C8EFE0772-D1A84B8D-4ECA-49E0AFC4-BF33-E68A391DD60F F4778051DC61 PS Contract No. 6388 Subprovider Monitoring System Commitment Agreement This commitment agreement is subject to the award and receipt of a signed contract from the Texas Department of Transportation (TxDOT). NOTE: Exhibit H-2 is required to be attached to each contract that does not include work authorizations. Exhibit H-2 is required to be attached with each work authorization. Exhibit H-2 is also required to be attached to each supplemental work authorization. If DBE/HUB Subproviders are used, the form must be completed and signed. If no DBE/HUB Subproviders are used, indicate with “N/A” on this line: and attach with the work authorization or supplemental work authorization. Contract #: Assigned Goal: % Prime Provider: Work Authorization (WA)#: WA Amount: _ Date: Supplemental Work Authorization (SWA) #: to WA #: Revised WA Amount: SWA Amount: Description of Work (List by category of work or task description. Attach additional pages, if necessary.) Dollar Amount (For each category of work or task description shown.) Total Commitment Amount (Including all additional pages.) $ IMPORTANT: The signatures of the prime and the DBE/HUB and Second Tier Subprovider, if any (both DBE and Non-DBE) and the total commitment amount must always be on the same page. Provider Name: Name: (Please Print) Title: Signature Date Address: Phone # & Fax #: Email: DBE/HUB Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone # & Fax #: Email: Second Tier Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone #& Fax #: Email: VID Number is the Vendor Identification Number issued by the Comptroller. If a firm does not have a VID Number, please enter the owner’s Social Security or their Federal Employee Identification Number (if incorporated). 4/06 DBE-H2.ATT DocuSign Envelope ID: 34ABC29C8EFE0772-D1A84B8D-4ECA-49E0AFC4-BF33F4778051DC61 DocuSign Envelope ID: 84BEDABB-E68A391DD60F BE5D-4AEF-8367-73737B001986 Legacy Contract No. 24-7IDP5006 PS Contract No. 6388 EXHIBIT H-3 Texas Department of Transportation Subprovider Monitoring System for Federally Funded Contracts Progress Assessment Report for month of (Mo./Yr.) /_ Contract #: Original Contract Amount: Date of Execution: Approved Supplemental Agreements: Prime Provider: Total Contract Amount: Work Authorization No. Work Authorization Amount: If no subproviders are used on this contract, please indicate by placing “N/A” on the 1st line under Subproviders. DBE All Subproviders Category of Work Total Subprovider Amount % Total Contract Amount Amount Paid This Period Amount Paid To Date Subcontract Balance Remaining Fill out Progress Assessment Report with each estimate/invoice submitted, for all subcontracts, and forward as follows: 1 Copy with Invoice - Contract Manager/Managing Office 1 Copy – TxDOT, BOP Office, 000 X. 00xx, Xxxxxx, XX 00000, 000-000-0000, toll free 000-000-0000, or Fax to 000-000-0000 I hereby certify that the above is a true and correct statement of the amounts paid to the firms listed above. Print Name - Company Official /DBE Liaison Officer Signature Phone Date Email Fax EXHIBIT H-4 Texas Department of Transportation Subprovider Monitoring System Final Report Legacy Contract No. 24-7IDP5006 DocuSign Envelope ID: 8EFE0772-4B8D-4ECA-AFC4-F4778051DC61 PS Contract No. 6388 The Final Report Form should be filled out by the Prime Provider and submitted to the Contract Manager and the Business Opportunity Programs Office for review upon completion of the contract. The report should reflect all subcontract activity on the project. The report will aid in expediting the final estimate for payment. If the HUB or DBE goal requirements were not met, documentation supporting good faith efforts must be submitted. DBE Goal: % OR HUB Goal: % Total Contract Amount: $ Total Contract Amount: $ Contract Number: Vendor ID # Subprovider Total $ Amt Paid to Date TOTAL This is to certify that % of the work was completed by the HUB or DBE subproviders as stated above. By: Prime Provider Per: Signature Subscribed and sworn to before me, this day of ,, 20 Notary Public County My Commission expires: 12/06 DBE-H4.A DocuSign Envelope ID: 34ABC29C8EFE0772-D1A84B8D-4ECA-49E0AFC4-BF33-E68A391DD60F F4778051DC61 WAs Used Contract No. HUB Subcontracting Plan (HSP) Prime Contractor Progress Assessment Report This form must be completed and submitted to the contracting agency each month to document compliance with your HSP. Contract/Requisition Number: Contracting Agency/University Name: Contractor (Company) Name: Point of Contact: Date of Award: Object Code: (mm/dd/yyyy) State of Texas VID #: Phone #: (Agency Use Only) Reporting (Month) Period: Total Amount Paid this Reporting Period to Contractor: $ - Report HUB and Non-HUB subcontractor information *Texas Certified Total Contract $ Total $ Amount Paid Total Contract $ Subcontractor’s VID or HUB HUB? Amount from HSP This Reporting Period to Amount Paid to Date Object Code Subcontractor’s Name Certificate Number (Yes or No) with Subcontractor Subcontractor to Subcontractor (Agency Use Only) $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ TOTALS: $ - $ - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - Signature: Title: Date: *Note: Prime contractors can verify subcontractor HUB certification status on-line at xxxx://xxx0.xxxx.xxxxx.xx.xx/cmbl/cmblhub.html

Appears in 1 contract

Samples: sb20pca.txdot.gov

Required Forms. If subcontractors are used under the contract that has no stated HUB goal, Exhibits X-0, X-0, X-0 and H-6 are required. Exhibits H-1 and H-6 are required if no subcontractors are being used to perform work under this contract. State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) is required monthly even when no subcontracting activity has occurred. In addition, State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) should be submitted with the Provider’s invoice. 12/06 HU Page 1 of 1 Attachment H-SN DocuSign Envelope ID: 34ABC29C3339A818-D1A81F06-49E04F1E-92F6-BF33B7C43270F995 WAs Used Contract No. 12-E68A391DD60F 6IDP0003 PS Contract No. 7397 5901 EXHIBIT H-1 Texas Department of Transportation Subprovider Monitoring System Commitment Worksheet Contract #: 2412-7IDP1003 6IDP0003 (PS5901) Assigned Goal: 23.723.7 % Federally Funded State Funded _ X Prime Provider: XxXxxx & XxXxxx Land SurveyorsPaveTex Engineering and Testing, Inc. Total Contract Amount: $2,000,000.00 500,000.00 Prime Provider Info: DBE HUB _ _ Both _X_ X Vendor ID #: _17422732929 (First 11 Digits Only) 17429482064 DBE/HUB Expiration Date: __5/5/2019 4/17/18 (First 11 Digits Only) If no subproviders are used on this contract, please indicate by placing “N/A” on the 1st line under Subproviders. Subprovider(s) (List All) Type of Work Vendor ID # (First 11 Digits Only) D=DBE Expiration H=HUB Expiration Date $ Amount or % of Work * Xxxxxx LLC Land Surveying 17430098982 D, H 5/12/2019 8% Dallas Aerial Surveys, Inc. Aerial Mapping 17516161738 H 6/11/2019 16% Xxxxx & Xxxxxx, Inc. State Land Surveying 17418482448 3% Surveying And Mapping, LLC Aerial Mapping Land Surveying 17427049741 2% E.S.P. Associates, P.A., Inc. Land Surveying 15615314679 2% N/A Subprovider(s) Contract or % of Work* Totals 31% *For Work Authorization Contracts, indicate the % of work to be performed by each subprovider. Total DBE or HUB Commitment Dollars $ 480,000 Total DBE or HUB Commitment Percentages of Contract 24 % (Commitment Dollars and Percentages are for Subproviders only) Page 1 of 1 Exhibit H-1 DocuSign Envelope ID: 34ABC29C3339A818-D1A81F06-49E04F1E-92F6-BF33-E68A391DD60F B7C43270F995 Subprovider Monitoring System Commitment Agreement This commitment agreement is subject to the award and receipt of a signed contract from the Texas Department of Transportation (TxDOT). NOTE: Exhibit H-2 is required to be attached to each contract that does not include work authorizations. Exhibit H-2 is required to be attached with each work authorization. Exhibit H-2 is also required to be attached to each supplemental work authorization. If DBE/HUB Subproviders are used, the form must be completed and signed. If no DBE/HUB Subproviders are used, indicate with “N/A” on this line: and attach with the work authorization or supplemental work authorization. Contract #: Assigned Goal: % Prime Provider: Work Authorization (WA)#: WA Amount: _ Date: Supplemental Work Authorization (SWA) #: to WA #: Revised WA Amount: SWA Amount: Description of Work (List by category of work or task description. Attach additional pages, if necessary.) Dollar Amount (For each category of work or task description shown.) Total Commitment Amount (Including all additional pages.) $ IMPORTANT: The signatures of the prime and the DBE/HUB and Second Tier Subprovider, if any (both DBE and Non-DBE) and the total commitment amount must always be on the same page. Provider Name: Name: (Please Print) Title: Signature Date Address: Phone # & Fax #: Email: DBE/HUB Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone # & Fax #: Email: Second Tier Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone #& Fax #: Email: VID Number is the Vendor Identification Number issued by the Comptroller. If a firm does not have a VID Number, please enter the owner’s Social Security or their Federal Employee Identification Number (if incorporated). 4/06 DBE-H2.ATT DocuSign Envelope ID: 34ABC29C3339A818-D1A81F06-49E04F1E-92F6-BF33-E68A391DD60F Texas Department of Transportation B7C43270F995 Subprovider Monitoring System Final Report The Final Report Form should be filled out by the Prime Provider and submitted to the Contract Manager and the Business Opportunity Programs Office for review upon completion of the contract. The report should reflect all subcontract activity on the project. The report will aid in expediting the final estimate for payment. If the HUB or DBE goal requirements were not met, documentation supporting good faith efforts must be submitted. DBE Goal: % OR HUB Goal: % Total Contract Amount: $ Total Contract Amount: $ Contract Number: Vendor ID # Subprovider Total $ Amt Paid to Date TOTAL This is to certify that % of the work was completed by the HUB or DBE subproviders as stated above. By: Prime Provider Per: Signature Subscribed and sworn to before me, this day of ,, 20 Notary Public County My Commission expires: DocuSign Envelope ID: 34ABC29C-D1A8-49E0-BF33-E68A391DD60F HUB Subcontracting Plan (HSP) Prime Contractor Progress Assessment Report This form must be completed and submitted to the contracting agency each month to document compliance with your HSP. Contract/Requisition Number: Contracting Agency/University Name: Contractor (Company) Name: Point of Contact: Date of Award: Object Code: (mm/dd/yyyy) State of Texas VID #: Phone #: (Agency Use Only) Reporting (Month) Period: Total Amount Paid this Reporting Period to Contractor: $ - Report HUB and Non-HUB subcontractor information *Texas Certified Total Contract $ Total $ Amount Paid Total Contract $ Subcontractor’s VID or HUB HUB? Amount from HSP This Reporting Period to Amount Paid to Date Object Code Subcontractor’s Name Certificate Number (Yes or No) with Subcontractor Subcontractor to Subcontractor (Agency Use Only) $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ TOTALS: $ - $ - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - Signature: Title: Date: *Note: Prime contractors can verify subcontractor HUB certification status on-line at xxxx://xxx0.xxxx.xxxxx.xx.xx/cmbl/cmblhub.html:

Appears in 1 contract

Samples: sb20pca.txdot.gov

Required Forms. If subcontractors subconsultants are used under the contract Contract that has no stated HUB goal, Exhibits X-0H-1, X-0H-2, X-0 H-4 and H-6 are required. Exhibits H-1 and H-6 are required if no subcontractors subconsultants are being used to perform work under this contract. State of Texas HUB Subcontracting Plan Prime Contractor Consultant Progress Assessment Report (Exhibit H-6) is required monthly even when no subcontracting activity has occurred. In addition, State of Texas HUB Subcontracting Plan Prime Contractor Consultant Progress Assessment Report (Exhibit H-6) should be submitted with the Provider’s invoice. 12/06 HU DocuSign Envelope ID: 34ABC29CE4235588-D1A82A23-49E04900-BF33-E68A391DD60F PS Contract No. 7397 BC1E-263412EE0C9F EXHIBIT H-1 Texas Department of Transportation Subprovider Monitoring System Commitment Worksheet Contract #: 24-7IDP1003 :601CT0000013863 Assigned Goal: 23.7% Federally Funded State Funded _ X Prime Provider: XxXxxx & XxXxxx Land Surveyors, Inc. The North Highland Company LLC Total Contract Amount: $2,000,000.00 3,598,000 Prime Provider Info: DBE HUB Both _X_ Vendor ID #: _17422732929 1581823492200 (First 11 Digits Only) DBE/HUB Expiration Date: __5/5/2019 N/A If no subproviders are used on this contract, please indicate by placing “N/A” on the 1st line under Subproviders. Subprovider(s) (List All) Type of Work Vendor ID # (First 11 Digits Only) D=DBE H=HUB Expiration Date $ Amount or % of Work * Xxxxxx LLC Land Surveying 17430098982 D, H 5/12/2019 8% Dallas Aerial SurveysGB Tech, Inc. Aerial Mapping 17516161738 918-71 Technology Consulting 1760163628900 H 6/11/2019 16% Xxxxx & Xxxxxx, Inc. State Land Surveying 17418482448 3% Surveying And Mapping, LLC Aerial Mapping Land Surveying 17427049741 2% E.S.P. Associates, P.A., Inc. Land Surveying 15615314679 231-DEC- 2017 15% Subprovider(s) Contract or % of Work* Totals 3115% *For Work Authorization Contracts, indicate the % of work to be performed by each subprovider. Total DBE or HUB Commitment Dollars $ 480,000 $500,000 Total DBE or HUB Commitment Percentages of Contract 24 15% (Commitment Dollars and Percentages are for Subproviders only) DocuSign Envelope ID: 34ABC29CE4235588-D1A82A23-49E04900-BF33-E68A391DD60F BC1E-263412EE0C9F EXHIBIT H-2 Texas Department of Transportation Subprovider Monitoring System Commitment Agreement This commitment agreement is subject to the award and receipt of a signed contract from the Texas Department of Transportation (TxDOT). NOTE: Exhibit H-2 is required to be attached to each contract that does not include work authorizations. Exhibit H-2 is required to be attached with each work authorization. Exhibit H-2 is also required to be attached to each supplemental work authorization. If DBE/HUB Subproviders are used, the form must be completed and signed. If no DBE/HUB Subproviders are used, indicate with “N/A” on this line: and attach with the work authorization or supplemental work authorization. Contract #: 601CT0000013863 Assigned Goal: % Prime Provider: The North Highland Company, LLC Work Authorization (WA)#: WA Amount: _ Date: Supplemental Work Authorization (SWA) #: to WA #: Revised WA Amount: SWA Amount: Description of Work (List by category of work or task description. Attach additional pages, if necessary.) Dollar Amount (For each category of work or task description shown.) 918-71 Technology Consulting $500,000 Total Commitment Amount (Including all additional pages.) $ $500,000 IMPORTANT: The signatures of the prime and the DBE/HUB and Second Tier Subprovider, if any (both DBE and Non-DBE) and the total commitment amount must always be on the same page. Provider Name: The North Highland Company LLC Address: 0000 Xxxxxxxx Xx XX #0000, Xxxxxxx, XX 00000 Phone # & Fax #: (000) 000-0000 & (000) 000-0000 Email: xxxxx.xxxxxxx@xxxxxxxxxxxxx.xxx Name: Xxxxx Xxxxxxx (Please Print) Title: Associate Vice President 3/17/2017 Signature Date DBE/HUB Sub Provider Subprovider Name: GB Tech, Inc. VID Number: 1760163628900 Address: 0000 Xxxxx Xxxx Xxxxx, Xxxxx 000, Xxxxxxx, XX 00000 Phone # & Fax #: (000) 000-0000 & (000) 000-0000 Email: DBE/HUB Sub Provider xxxxxxx@xxxxxx.xxx Name: Xxxxx Xxxxxx (Please Print) Title: Vice President 3/17/2017 Signature Date Subprovider Name: VID Number: Address: Phone # & Fax #: Email: Second Tier Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone #& Fax #: Email: Name: (Please Print) Title: Signature Date VID Number is the Vendor Identification Number issued by the Comptroller. If a firm does not have a VID Number, please enter the owner’s Social Security or their Federal Employee Identification Number (if incorporated). 4/06 DBE-H2.ATT DocuSign Envelope ID: 34ABC29CE4235588-D1A82A23-49E04900-BF33-E68A391DD60F BC1E-263412EE0C9F EXHIBIT H-4 Texas Department of Transportation Subprovider Monitoring System Final Report The Final Report Form should be filled out by the Prime Provider and submitted to the Contract Manager and the Business Opportunity Programs Office for review upon completion of the contract. The report should reflect all subcontract activity on the project. The report will aid in expediting the final estimate for payment. If the HUB or DBE goal requirements were not met, documentation supporting good faith efforts must be submitted. DBE Goal: % OR HUB Goal: % Total Contract Amount: $ Total Contract Amount: $ Contract Number: Vendor ID # Subprovider Total $ Amt Paid to Date TOTAL This is to certify that % of the work was completed by the HUB or DBE subproviders as stated above. By: Prime Provider Per: Signature Subscribed and sworn to before me, this day of ,20 Notary Public County My Commission expires: DocuSign Envelope ID: 34ABC29C-D1A8-49E0-BF33-E68A391DD60F HUB Subcontracting Plan (HSP) Prime Contractor Progress Assessment Report This form must be completed and submitted to the contracting agency each month to document compliance with your HSP. Contract/Requisition Number: Contracting Agency/University Name: Contractor (Company) Name: Point of Contact: Date of Award: Object Code: (mm/dd/yyyy) State of Texas VID #: Phone #: (Agency Use Only) Reporting (Month) Period: Total Amount Paid this Reporting Period to Contractor: $ - Report HUB and Non-HUB subcontractor information *Texas Certified Total Contract $ Total $ Amount Paid Total Contract $ Subcontractor’s VID or HUB HUB? Amount from HSP This Reporting Period to Amount Paid to Date Object Code Subcontractor’s Name Certificate Number (Yes or No) with Subcontractor Subcontractor to Subcontractor (Agency Use Only) $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ TOTALS: $ - $ - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - Signature: Title: Date: *Note: Prime contractors can verify subcontractor HUB certification status on-line at xxxx://xxx0.xxxx.xxxxx.xx.xx/cmbl/cmblhub.html.

Appears in 1 contract

Samples: Consultant Services

Required Forms. If subcontractors are used under the contract that has no stated HUB goal, Exhibits X-0, X-0, X-0 and H-6 are required. Exhibits H-1 and H-6 are required if no subcontractors are being used to perform work under this contract. State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) is required monthly even when no subcontracting activity has occurred. In addition, State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) should be submitted with the Provider’s invoice. 12/06 HU DocuSign Envelope ID: 34ABC29C626E1CDB-920E-4D66-D1A8-49E0-BF33-E68A391DD60F PS Contract No. 7397 EXHIBIT H-1 B07C-90A24FC0DA29 Texas Department of Transportation Subprovider Monitoring System Commitment Worksheet Contract #: 2485-7IDP1003 6SDP5002 Assigned Goal: 23.70 % Federally Funded State Funded _ _X Prime Provider: XxXxxx & XxXxxx Land SurveyorsXxxxxx-Xxxx and Associates, Inc. Total Contract Amount: $2,000,000.00 Prime Provider Info: DBE HUB Both _X_ Vendor ID #: _17422732929 15608856157 (First 11 Digits Only) DBE/HUB Expiration Date: __5/5/2019 If no subproviders are used on this contract, please indicate by placing “N/A” on the 1st line under Subproviders. Subprovider(s) (List All) Type of Work Vendor ID # (First 11 Digits Only) D=DBE H=HUB Expiration Date $ Amount or % of Work * Xxxxxx LLC Land Surveying 17430098982 D, H 5/12/2019 8% Dallas Aerial Surveys, Inc. Aerial Mapping 17516161738 H 6/11/2019 16% Xxxxx & Xxxxxx, Inc. State Land Surveying 17418482448 3% Surveying And Mapping, LLC Aerial Mapping Land Surveying 17427049741 2% E.S.P. Associates, P.A., Inc. Land Surveying 15615314679 2% Subprovider(s) Contract or % of Work* Totals 31% *For Work Authorization Contracts, indicate the % of work to be performed by each subprovider. Total DBE or HUB Commitment Dollars $ 480,000 Total DBE or HUB Commitment Percentages of Contract 24 % (Commitment Dollars and Percentages are for Subproviders only) 12/06 XXXX0.XX DocuSign Envelope ID: 34ABC29C626E1CDB-920E-4D66-D1A8-49E0-BF33-E68A391DD60F Subprovider Monitoring System Commitment Agreement This commitment agreement is subject to the award and receipt of a signed contract from the Texas Department of Transportation (TxDOT). NOTE: Exhibit H-2 is required to be attached to each contract that does not include work authorizations. Exhibit H-2 is required to be attached with each work authorization. Exhibit H-2 is also required to be attached to each supplemental work authorization. If DBE/HUB Subproviders are used, the form must be completed and signed. If no DBE/HUB Subproviders are used, indicate with “N/A” on this line: and attach with the work authorization or supplemental work authorization. Contract #: Assigned Goal: % Prime Provider: Work Authorization (WA)#: WA Amount: _ Date: Supplemental Work Authorization (SWA) #: to WA #: Revised WA Amount: SWA Amount: Description of Work (List by category of work or task description. Attach additional pages, if necessary.) Dollar Amount (For each category of work or task description shown.) Total Commitment Amount (Including all additional pages.) $ IMPORTANT: The signatures of the prime and the DBE/HUB and Second Tier Subprovider, if any (both DBE and Non-DBE) and the total commitment amount must always be on the same page. Provider Name: Name: (Please Print) Title: Signature Date Address: Phone # & Fax #: Email: DBE/HUB Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone # & Fax #: Email: Second Tier Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone #& Fax #: Email: VID Number is the Vendor Identification Number issued by the Comptroller. If a firm does not have a VID Number, please enter the owner’s Social Security or their Federal Employee Identification Number (if incorporated). 4/06 DBE-H2.ATT DocuSign Envelope ID: 34ABC29C-D1A8-49E0-BF33-E68A391DD60F Texas Department of Transportation Subprovider Monitoring System Final Report The Final Report Form should be filled out by the Prime Provider and submitted to the Contract Manager and the Business Opportunity Programs Office for review upon completion of the contract. The report should reflect all subcontract activity on the project. The report will aid in expediting the final estimate for payment. If the HUB or DBE goal requirements were not met, documentation supporting good faith efforts must be submitted. DBE Goal: % OR HUB Goal: % Total Contract Amount: $ Total Contract Amount: $ Contract Number: Vendor ID # Subprovider Total $ Amt Paid to Date TOTAL This is to certify that % of the work was completed by the HUB or DBE subproviders as stated above. By: Prime Provider Per: Signature Subscribed and sworn to before me, this day of ,20 Notary Public County My Commission expires: DocuSign Envelope ID: 34ABC29C-D1A8-49E0-BF33-E68A391DD60F B07C-90A24FC0DA29 HUB Subcontracting Plan (HSP) Prime Contractor Progress Assessment Report This form must be completed and submitted to the contracting agency each month to document compliance with your HSP. Contract/Requisition Number: Contracting Agency/University Name: Contractor (Company) Name: Point of Contact: Date of Award: Object Code: (mm/dd/yyyy) (Agency Use Only) Contractor (Company) Name: Point of Contact: State of Texas VID #: Phone #: (Agency Use Only) Reporting (Month) Period: Total Amount Paid this Reporting Period to Contractor: $ - Report HUB and Non-HUB subcontractor information *Texas Certified Total Contract $ Total $ Amount Paid Total Contract $ Subcontractor’s VID or HUB HUB? Amount from HSP This Reporting Period to Amount Paid to Date Object Code Subcontractor’s Name Certificate Number (Yes or No) with Subcontractor Subcontractor to Subcontractor (Agency Use Only) $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ TOTALS: $ - $ - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - Signature: Title: Date: *Note: Prime contractors can verify subcontractor HUB certification status can be verified on-line at xxxx://xxx0.xxxx.xxxxx.xx.xx/cmbl/cmblhub.htmlat: xxxx://xxx0.xxx.xxxxx.xx.xx/cmbl/hubonly.html

Appears in 1 contract

Samples: sb20pca.txdot.gov

Required Forms. If subcontractors are used under the contract that has no stated HUB goal, Exhibits X-0, X-0, X-0 and H-6 are required. Exhibits H-1 and H-6 are required if no subcontractors are being used to perform work under this contract. State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) is required monthly even when no subcontracting activity has occurred. In addition, State of Texas HUB Subcontracting Plan Prime Contractor Progress Assessment Report (Exhibit H-6) should be submitted with the Provider’s invoice. 12/06 HU DocuSign Envelope ID: 34ABC29C62B8B863-D1A8A77E-4FF0-49E0BEE2-BF33-E68A391DD60F PS Contract No. 7397 B5D164BF64C8 EXHIBIT H-1 Texas Department of Transportation Subprovider Monitoring System Commitment Worksheet Contract #: 247391 50-7IDP1003 7IDP5003_ Assigned Goal: 23.70 % Federally Funded State Funded _ X Prime Provider: XxXxxx & XxXxxx Land SurveyorsRS&H, Inc. Total Contract Amount: $2,000,000.00 500,000.00 Prime Provider Info: DBE HUB Both _X_ Vendor ID #: _17422732929 15929864666 (First 11 Digits Only) DBE/HUB Expiration Date: __5/5/2019 N/A If no subproviders are used on this contract, please indicate by placing “N/A” on the 1st line under Subproviders. Subprovider(s) (List All) Type of Work Vendor ID # (First 11 Digits Only) D=DBE Expiration H=HUB Expiration Date $ Amount or % of Work * Xxxxxx LLC Land Surveying 17430098982 D, H 5/12/2019 8% Dallas Aerial Surveys, Inc. Aerial Mapping 17516161738 H 6/11/2019 16% Xxxxx & Xxxxxx, Inc. State Land Surveying 17418482448 3% Surveying And Mapping, LLC Aerial Mapping Land Surveying 17427049741 2% E.S.P. Associates, P.A., Inc. Land Surveying 15615314679 2% N/A Subprovider(s) Contract or % of Work* Totals 310% *For Work Authorization Contracts, indicate the % of work to be performed by each subprovider. Total DBE or HUB Commitment Dollars $ 480,000 0 Total DBE or HUB Commitment Percentages of Contract 24 0% (Commitment Dollars and Percentages are for Subproviders only) 12/06 XXXX0.XX DocuSign Envelope ID: 34ABC29C62B8B863-D1A8A77E-4FF0-49E0BEE2-BF33-E68A391DD60F Subprovider Monitoring System Commitment Agreement This commitment agreement is subject to the award and receipt of a signed contract from the Texas Department of Transportation (TxDOT). NOTE: Exhibit H-2 is required to be attached to each contract that does not include work authorizations. Exhibit H-2 is required to be attached with each work authorization. Exhibit H-2 is also required to be attached to each supplemental work authorization. If DBE/HUB Subproviders are used, the form must be completed and signed. If no DBE/HUB Subproviders are used, indicate with “N/A” on this line: and attach with the work authorization or supplemental work authorization. Contract #: Assigned Goal: % Prime Provider: Work Authorization (WA)#: WA Amount: _ Date: Supplemental Work Authorization (SWA) #: to WA #: Revised WA Amount: SWA Amount: Description of Work (List by category of work or task description. Attach additional pages, if necessary.) Dollar Amount (For each category of work or task description shown.) Total Commitment Amount (Including all additional pages.) $ IMPORTANT: The signatures of the prime and the DBE/HUB and Second Tier Subprovider, if any (both DBE and Non-DBE) and the total commitment amount must always be on the same page. Provider Name: Name: (Please Print) Title: Signature Date Address: Phone # & Fax #: Email: DBE/HUB Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone # & Fax #: Email: Second Tier Sub Provider Name: (Please Print) Title: Signature Date Subprovider Name: VID Number: Address: Phone #& Fax #: Email: VID Number is the Vendor Identification Number issued by the Comptroller. If a firm does not have a VID Number, please enter the owner’s Social Security or their Federal Employee Identification Number (if incorporated). 4/06 DBE-H2.ATT DocuSign Envelope ID: 34ABC29C-D1A8-49E0-BF33-E68A391DD60F Texas Department of Transportation Subprovider Monitoring System Final Report The Final Report Form should be filled out by the Prime Provider and submitted to the Contract Manager and the Business Opportunity Programs Office for review upon completion of the contract. The report should reflect all subcontract activity on the project. The report will aid in expediting the final estimate for payment. If the HUB or DBE goal requirements were not met, documentation supporting good faith efforts must be submitted. DBE Goal: % OR HUB Goal: % Total Contract Amount: $ Total Contract Amount: $ Contract Number: Vendor ID # Subprovider Total $ Amt Paid to Date TOTAL This is to certify that % of the work was completed by the HUB or DBE subproviders as stated above. By: Prime Provider Per: Signature Subscribed and sworn to before me, this day of ,20 Notary Public County My Commission expires: DocuSign Envelope ID: 34ABC29C-D1A8-49E0-BF33-E68A391DD60F B5D164BF64C8 EXHIBIT H-6 HUB Subcontracting Plan (HSP) Prime Contractor Progress Assessment Report This form must be completed and submitted to the contracting agency each month to document compliance with your HSP. Contract/Requisition Number: Contracting Agency/University Name: Contractor (Company) Name: Point of Contact: Date of Award: Object Code: (mm/dd/yyyy) State of Texas VID #: Phone #: (Agency Use Only) Reporting (Month) Period: Total Amount Paid this Reporting Period to Contractor: $ - Report HUB and Non-HUB subcontractor information *Texas Certified Total Contract $ Total $ Amount Paid Total Contract $ Subcontractor’s VID or HUB HUB? Amount from HSP This Reporting Period to Amount Paid to Date Object Code Subcontractor’s Name Certificate Number (Yes or No) with Subcontractor Subcontractor to Subcontractor (Agency Use Only) $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ $ - $ TOTALS: $ - $ - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - - $ - Signature: Title: Date: *Note: Prime contractors can verify subcontractor HUB certification status on-line at xxxx://xxx0.xxxx.xxxxx.xx.xx/cmbl/cmblhub.htmlxxxx://xxx0.xxxx.xxxxx.xx.xx/cmbl/cmblhub.html HSP-PAR Rev. 9/05

Appears in 1 contract

Samples: sb20pca.txdot.gov

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