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: 8EFE0772-4B8D-4ECA-AFC4-F4778051DC61 PS Contract No. 6388 Texas Department of Transportation Subprovider Monitoring System Commitment Worksheet Contract #:24-7IDP5006 Assigned Goal: 23.7% Federally Funded State Funded X Prime Provider: Halff Associates, Inc. Total Contract Amount: $ 2,000,000 Prime Provider Info: DBE HUB Both _ Vendor ID #: 17513086995 DBE/HUB Expiration Date: N/A (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 H=HUB Expiration Date $ Amount or % of Work * AIA Engineers, LTD Utility CM 17606188799 H 2/11/20 8% Xxxxxxxxxx Engineering Corp. Utility Coord. & Utility Engr. 17415546443 N/A -- 8% The Xxxx Group SUE services 18008303275 H D 10/4/17 7/8/17 8% Xxxxxx, LLC Survey Services 17430098982 H D 1/6/17 12/31/16 8% Subprovider(s) Contract or % of Work* Totals 32% *For Work Authorization Contracts, indicate the % of work to be performed by each subprovider. Total DBE or HUB Commitment Dollars $ Total DBE or HUB Commitment Percentages of Contract 24% (Commitment Dollars and Percentages are for Subproviders only) EXHIBIT H-2 Texas Department of Transportation Legacy Contract No. 24-7IDP5006 DocuSign Envelope ID: 8EFE0772-4B8D-4ECA-AFC4-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). DocuSign Envelope ID: 8EFE0772-4B8D-4ECA-AFC4-F4778051DC61 DocuSign Envelope ID: 84BEDABB-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: 8EFE0772-4B8D-4ECA-AFC4-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
REQUIRED FOR PART 2 JOC - PRICING OF Regular Hours Coefficient What is your regular hours coefficient for the RS Means Price Book? (FAILURE TO RESPOND PROHIBITS PART 2 JOC EVALUATION) Remember that this is a ceiling price proposed. You can discount lower than your proposed contract coefficient, but not higher. This is one of three pricing questions that are required for consideration for award on this solicitation. Please consider your answer carefully. An explanation of the TIPS scoring of pricing is included in the attachments for your information. The below is an Example of how pricing model works (not intended to influence your proposed coefficient, you should propose a coefficient that you determine is right for your business): To propose the exact pricing as the RS Means Unit Price Book, you would insert a 1.0 and to propose a 5% discount for the RS Means Price Book would be a .95 regular hours coefficient and so on.
Documentation Requirements (a) An employee must apply for personal leave in the form required by the CEO as soon as it is reasonably practicable for the employee to make the application.
Application Requirements This application shall contain, as a minimum, a sketch showing the location of proposed facilities; a description, sketch, manufacturer’s brochure, etc. of the proposed facilities; and a description of the operation proposed. (11-28-90) 101. -- 199. (RESERVED) 200. OPERATIONAL AGREEMENT.
Construction Requirements a) All Life and Safety and applicable Building Codes will be strictly enforced (i.e., tempered glass, fire dampers, exit signs, smoke detectors, alarms, etc.). Prior coordination with the Building Manager is required.
Certification Requirements The applicant will provide Vista Laboratories, Inc. with all product information for the evaluation of the product to be certified and warrant that the information provided is accurate and complete so that Vista Labs may perform the services requested. If the product was tested at an external laboratory, the applicant must provide the complete test report to Vista Labs. If the external testing facility is not ISO 17025 accredited, or does not have the proper scope, Vista Labs must determine if the test report can be used for certification activities. The applicant’s information is used to perform a product review and evaluation to determine the product’s compliance to the specific certification requested. Throughout the process, the client agrees to make claims regarding certification consistent with the scope of certification. The applicant agrees to supply the required number of product samples, to be determined by Vista Labs, to the laboratory for testing, measurement, and evaluation purposes. The client understands that certain tests may damage or destroy the sample and acknowledge that Vista Labs is not responsible for such damages. Samples will be returned only upon request by the applicant and at the applicant’s expense, after the completion of certification. Samples will be disposed of after six months if not requested for return by applicant. The product is ineligible for certification if it has been modified by the client after testing or certification. Changes to the product must be approved by Vista Laboratories. Vista Labs reserves the right to re- evaluate the product as a result of information that raises questions concerning the conformance of the product. Certified products maintain fulfilment of product requirements if the certification applies to ongoing production. If the client provides copies of the certification documents to other parties, the documents are reproduced in their entirety, or as specified in the certification scheme. In making reference to its product certification in media, such as brochures or advertisement, the client complies with the requirements of the Vista Labs or as specified by the certification scheme. The client complies with any requirements that may be prescribed in the certification scheme relating to the use of marks of conformity, and on all product correspondences and product related information. Vista Labs reserves the right to revise or withdraw the requirements as required in order to maintain conformance with FCC rules and regulations governing the product. The product may continue with certification and receive certification upon demonstration of compliance with the revised requirements, to the satisfaction of Vista Laboratories.
