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.
Compliance with Accessibility Standards All parties to this Agreement shall ensure that the plans for and the construction of all projects subject to this Agreement are in compliance with standards issued or approved by the Texas Department of Licensing and Regulation (TDLR) as meeting or consistent with minimum accessibility requirements of the Americans with Disabilities Act (P.L. 101-336) (ADA).
Compliance with Non-Discrimination Requirements During the performance of this Agreement, Company, for itself, its assignees, successors in interest, subcontractors and consultants agrees as follows:
Certification Regarding Prohibition of Certain Terrorist Organizations (Tex Gov. Code 2270) Vendor certifies that Vendor is not a company identified on the Texas Comptroller’s list of companies known to have contracts with, or provide supplies or services to, a foreign organization designated as a Foreign Terrorist Organization by the U.S. Secretary of State. Does Vendor certify? Yes, Vendor certifies Certification Regarding Prohibition of Boycotting Israel (Tex. Gov. Code 2271) If (a) Vendor is not a sole proprietorship; (b) Vendor has ten (10) or more full-time employees; and (c) this Agreement or any agreement with a TIPS Member under this procurement has value of $100,000 or more, the following certification shall apply; otherwise, this certification is not required. Vendor certifies, where applicable, that neither the Vendor, nor any affiliate, subsidiary, or parent company of Vendor, if any, boycotts Israel, and Vendor agrees that Vendor and Vendor Companies will not boycott Israel during the term of this Agreement. For purposes of this Agreement, the term “boycott” shall mean and include refusing to deal with, terminating business activities with, or otherwise taking any action that is intended to penalize, inflict economic harm on, or limit commercial relations with Israel, or with a person or entity doing business in Israel or in an Israeli-controlled territory but does not include an action made for ordinary business purposes. When applicable, does Vendor certify? Yes, Vendor certifies 5 Certification Regarding Prohibition of Contracts with Certain Foreign-Owned Companies (Tex. Gov. 5 Code 2274) Certain public entities are prohibited from entering into a contract or other agreement relating to critical infrastructure that would grant Vendor direct or remote access to or control of critical infrastructure in this state, excluding access specifically allowed by a customer for product warranty and support purposes. Vendor certifies that neither it nor its parent company nor any affiliate of Vendor or its parent company, is (1) owned by or the majority of stock or other ownership interest of the company is held or controlled by individuals who are citizens of China, Iran, North Korea, Russia, or a designated country; (2) a company or other entity, including governmental entity, that is owned or controlled by citizens of or is directly controlled by the government of China, Iran, North Korea, Russia, or a designated country; or (3) headquartered in China, Iran, North Korea, Russia, or a designated country. For purposes of this certification, “critical infrastructure” means “a communication infrastructure system, cybersecurity system, electric grid, hazardous waste treatment system, or water treatment facility.” Vendor certifies that Vendor will not grant direct or remote access to or control of critical infrastructure, except for product warranty and support purposes, to prohibited individuals, companies, or entities, including governmental entities, owned, controlled, or headquartered in China, Iran, North Korea, Russia, or a designated country, as determined by the Governor. When applicable, does Vendor certify? Yes, Vendor certifies 5 Certification Regarding Prohibition of Discrimination Against Firearm and Ammunition Industries (Tex.
Child Support Compliance Act If the Contract Amount is $100,000 or more, this section is applicable. Contractor recognizes the importance of child and family support obligations and fully complies with (and will continue to comply with during the Term) all applicable state and federal laws relating to child and family support enforcement, including disclosure of information and compliance with earnings assignment orders, as provided in Family Code section 5200 et seq. Contractor provides the names of all new employees to the New Hire Registry maintained by the California Employment Development Department.
Compliance with Nondiscrimination Requirements During the performance of this contract, the Contractor, for itself, its assignees, and successors in interest (hereinafter referred to as the “Contractor”), agrees as follows:
