10-BEH-FRM-609.SAW Prime Self Performance Declaration.docx
DOCX document 114 KB Posted
- Solicitation number
- CIZ-DWU-25 504E
- Issued by
- Dallas County, Texas
About this file
This is a Prime Self-Performance Declaration form (BEH-FRM-609.SAW) from the Dallas Regional Inclusive Vendor Enterprise related to a Texas state and local contract opportunity for Lift Stations and Diversion Structures Improvements. The form is designed to confirm that a Small Business Enterprise (SBE) prime contractor will self-perform specific portions of work on the project, which involves engineering services for investigation, preliminary design, final design, construction plans and specifications development, bid phase services, construction administration, and start-up services for modifications, repairs, and replacements at lift stations and diversion structures throughout the project area. The project is managed by Maria Wang, PE Senior Engineer.
The declaration requires the SBE prime to identify specific work elements with associated NAICS codes, describe the self-performed work scope, and attest that all work will be performed under Commercially Useful Function (CUF) requirements using the prime's own workforce, management, equipment, and resources. The SBE prime must certify compliance with DRIVE Policy requirements, confirm that all subcontractors are certified in their respective NAICS codes, and attest that subcontracting opportunities were evaluated on a commercially reasonable basis without artificially consolidating scopes. The form specifies that any changes to approved subcontractor participation or work reallocation require prior Business Enterprise HUB (BEH) approval, and that self-performed work will be subject to monitoring and compliance review throughout the contract term.
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Dallas Regional Inclusive Vendor Enterprise Prime Self-Performance Declaration
BEH-FRM-609.SAW
Prime Vendor Information
| Prime Vendor Name |
| Solicitation Number |
| Solicitation Title |
Under the DRIVE Policy, Small Business Enterprise (SBE) primes may count self-performed work toward the contract-specific SBE goal only when that work meets Commercially Useful Function (CUF) requirements and when the SBE firm is properly certified in the NAICS code(s) associated with the work it will perform.
This declaration confirms the SBE prime’s self-performance scope and enables the Business Enterprise HUB (BEH) staff to verify CUF compliance and appropriate NAICS certification before contract execution.
Description of Self – Performed Work Identify the specific portion(s) of work your firm will self-perform as the SBE prime. Include NAICS code(s), work element/packages(s), and a brief description of work.
| NAICS Code(s): |
| Work Element/Package Identify the discrete subcontracting opportunity or supplier package (e.g., trade discipline or bid package): |
| Description of Work |
Briefly describe portion of work included in this package for this contract. Focus on what is include or excluded, not the full contract scope.)
EXAMPLE
238220 – Plumbing, Heating, and Air-Conditioning Contractors
| Mechanical Equipment Installation – Building A HVAC Package |
| Self-perform installation of five (5) owner-furnished rooftop HVAC units and associated ductwork for Building A only. Includes labor, supervision, duct fabrication, and installation. Excludes purchase of HVAC units, electrical connections, BAS programming, and work in other buildings. |
(Add additional pages as needed)
| Prime’s Estimated Contract Value ($): |
| Percentage (%) of Total Contract: |
CUF & NAICS Certification Attestation To count toward the SBE goal, self-performed work must be performed under a Commercially Useful Function (CUF), meaning the Prime:
• Uses its own workforce
• Manages and supervises the work
• Uses its own equipment (or standard commercial lease)
• Is responsible for execution of the work ☐ We certify that all self-performed work listed above will be performed under a CUF and within the Prime’s certified NAICS code(s).
☐ We further certify that all SBE subcontractors identified in the approved SBE Utilization Plan are certified in the NAICS code(s) associated with their scopes of work.
Subcontracting Opportunity Attestation ☐ We certify that commercially reasonable subcontracting opportunities were evaluated consistent with DRIVE policy, and that our firm has not restricted, reduced, or artificially consolidated scopes of work in order to increase SBE prime self-performance.
Subcontracting & No Substitution Statement ☐ We understand that any change to approved subcontractor participation or reallocation of work requires prior BEH approval through submission of the applicable revision and change request forms.
Certification I certify that the information provided in this Self-Performance Declaration is accurate and that all self-performed SBE work will comply with DRIVE Policy requirements, CUF requirements, and NAICS certification requirements.
☐ We understand that self-performed work will be subject to monitoring and compliance review throughout the life of the contract in accordance with DRIVE Monitoring & Compliance procedures.
Officer Signature:
| Printed Name: |
| Title: |
| Date: |
BEH-FRM-609.SAW Revision Date: 2026.03.01 Page 1 of 1 image1.png
File details come from the government source that posted it. Updated .