Local Agency Representative Title. Enter the position/title of the Local Agency Representative certifying the consultant’s DBE commitment form.
Local Agency Representative Title. Enter the position/title of the person signing this section of the form.
Local Agency Representative Title. Enter the position/title of the Local Agency Representative certifying the consultant’s DBE commitment form.
1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
a. contract x. xxxxx c. cooperative agreement d. loan a. bid/offer/application b. initial award c. post-award a. initial
b. material change
Local Agency Representative Title. Enter the position/title of the Local Agency Representative certifying the consultant’s DBE commitment form.
1. Have you or your company, or any agent on behalf of you or your company, made any political contributions of more than $250 to any HCAOG Director(s) in the 12 months preceding the date of the issuance of this request for proposal or request for qualifications?
2. Do you or your company, or any agency on behalf of you or your company, anticipate or plan to make any political contributions of more than $250 to any HCAOG Director(s) in the three months following the award of the contract? Answering yes to either of the two questions above does not preclude RAPS from awarding a contract to your firm. It does, however, preclude the identified Director(s) from participating in the contract award process for this contract. DATE (SIGNATURE OF AUTHORIZED OFFICIAL) (TYPE OR WRITE APPROPRIATE NAME, TITLE) (TYPE OR WRITE NAME OF COMPANY)
(a) The definitions set forth in this subdivision shall govern the interpretation of this section.
Local Agency Representative Title. Enter the position/title of the Local Agency ATTACHMENT 2 BACKGROUND AND SCOPE OF SERVICES CONTRACT BACKGROUND
Local Agency Representative Title. Enter the position/title of the Local Agency Representative certifying the consultant’s DBE commitment form. Exhibit 17-F Final Report-Utilization of Disadvantaged Business Enterprises (DBE) and First-Tier Subcontractors
1. Local Agency Contract Number 2. Federal-Aid Project Number 3. Local Agency 4. Contract Completion Date
Local Agency Representative Title. Enter the position/title of the Local Agency Representative certifying the consultant’s DBE commitment form. SUBCONSULTANT LIST Appendix 13 Subconsultant Firm Name and Address Scope of Work Dollar Amount of Work
1. Have you or your company, or any agent on behalf of you or your company, made any political contributions of more than $250 to any MCOG Director(s) in the 12 months preceding the date of the issuance of this request for proposal or request for qualifications? YES NO
2. Do you or your company, or any agency on behalf of you or your company, anticipate or plan to make any political contributions of more than $250 to any MCOG Director(s) in the three months following the award of the contract? YES NO Answering yes to either of the two questions above does not preclude RAPS from awarding a contract to your firm. It does, however, preclude the identified Director(s) from participating in the contract award process for this contract. DATE (SIGNATURE OF AUTHORIZED OFFICIAL) (TYPE OR WRITE APPROPRIATE NAME, TITLE) (TYPE OR WRITE NAME OF COMPANY)
(a) The definitions set forth in this subdivision shall govern the interpretation of this section.
Local Agency Representative Title. Enter the position/title of the person signing this section of the form. Form Name: Master City of San Xxxx Consultant Agreement Exhibit E – Disadvantaged Business Enterprise Participation Form/FileNo.: T-29972.018/ 1246116 City Attorney Approval Date: September, 2014
Local Agency Representative Title. Enter the position/title of the Local Agency Representative certifying the consultant’s DBE commitment form.
1. Local Agency Contract Number 180018 2. Federal-Aid Project Number BRLO-5910(113) 3. Local Agency Mendocino County Department of Transportation 4. Contract Completion Date
Local Agency Representative Title. Enter the position/title of the Local Agency Representative certifying the consultant’s DBE commitment form.
1. Local Agency: City of Sunnyvale
2. Contract DBE Goal: 20%
3. Project Description: Bikeway and Streetscape Project
4. Project Location: City of Sunnyvale
5. Consultant's Name: CSG Consultants, Inc.
6. Prime Certified DBE: 🞏 7. Total Contract Award Amount: $254,486 8. Total Dollar Amount for ALL Subconsultants: $104,066
