LIDGARD & ASSOCIATES 6 -2015 - Laserfiche WebLink

Home Browse Search

Local Assistance Procedures Manual EXHIBIT 10-01 Consultant Proposal DBE Commitment INSTRUCTIONS - CONSULTANT PROPOSAL DDE COMNUTMENT Consultant &ction The Consulmm shall: - A. Local Agency Name- Enter the Haute of the local or regional agency that is funding the contract. 2. Project Loca6oa - Enter the project location as it appears on the project advertisement. 3. Project Description-Ennter tate project description as it appears on the project advertisement (Bridge Rehab, Seismic Rehab, Overjoy, Widening, ete.). 4, Committed Name- Enter the consultant's firm name, S. Contract DBE Goal %- Enter the contract DBE goal percentage, as it was reported on the Exhibit 104 Notice to Proposers DBE Information farm. See LAPM Chapter 10, G. Description of Services to be Provided - Enter item of work description of services to be provided. Indicate all work to be performed by DBEs including work performed by the prime consultant's own forces, if the prime is a DBE. If 100% of the item is not to be performed or furnished by the DBE, describe the exact portion to be performed or furnished by the DBE. See LAPM Chapter 9 to determine how to count the participation of DBE £amts. 7, DBE Firm Contact Information - Enter the nano and telephone number of all DBE subcontracted consultants. Also, enter the prime consultant's time and telephone number, if the prime is a DBE. S. DBE Cert. Number - Enter the DBEs Certification Identification Number. All DBEs must be certified on the date bids are opened. (I)BE subcontracted consultants should notify the prime consultant in writing with the date of the decertification if their status should change during the course of the contract.) 9. DRE %- Percent participation ofwork to be performed or service provided by a DBE. Include the prime consultant if the prime is a DBE. Sea LAPM Chapter 9 for how to count full/partial participation. 10. Total °I Claimed- Enter the total DBE participation claimed. if the Total °% Claimed is lase than item "b. Contract DBB Goal", an adequately documented Good Faith Effort (GFE) is required (see Exhibit I5 -I4 DHE Information - Goad Faith Efforts of the LAPM). 11, Preparer's Signature -The person completing this section of the form for the consultant's firm must sign their name. 12. 11 repo rer's Name (Print) - Clearly enter the name of the person signing this section of flu, form for the consultant 13. Preparer's Title - Enter the position/thlo of the person signing this section of the form for the consultant. 14, Onto - Enter the date this section of the form is signed by the preparer, 15. (Aron Code) Tel. No. - Enter the oma code and telephone number ofthe person signing this section of the form for the consultant Local Anency Section: The Local Agencv representative shall: I& Local Agency Contract Number- Enter the Local Agency Contract Number. 17. Federal -Aid Project Number - Enter the Federal -Aid Project Number. I& Contract Eaeeauon Date - Enter date the contract was executed midNatice to Proceed issued. See LAPM Chapter 10, page 23. 19. Local Agency Representative Name (Print) - Clearly enter the name of the person completing this section. 20. Local Agency Representative Signature - The person completing this section of the form fenthe Local Agency must sign their name to cerfify that dtc information in this and die Consultant Section of this form is complete and accurate. 21. Date - Enter the date the Local Agency Representative signs the fort. 22. Local Agency Representative Title - Enter the position/title of the person signing this section of the form. 23. (Area Code) Tel. No. - Enter the area code and telephone number of the Local Agency representative signing this section of the form. Page 2 of 2 L11P 13-01 May 8, 2013