11-10 Exh V.pdf
PDF 166 KB Posted
- Attached to
- Misc NABI Cooling Parts
- Solicitation number
- 2086343
- Issued by
- Dallas County, Texas
About this file
This is an Employee Information Report (DART Form 33.254) submitted to the Dallas Area Rapid Transit Authority (DART) in Dallas, Texas. The form serves as an employment data collection document requiring contractors or establishments to report comprehensive workforce demographic information. The report captures employment data across nine job categories—Officials/Managers, Professionals, Technicians, Sales Workers, Office & Clerical, Craft Workers, Operatives, Laborers, and Service Workers—with employee counts disaggregated by gender and ethnicity (White non-Hispanic, Black non-Hispanic, Hispanic, Asian or Pacific Islander, and American Indian or Alaskan Native). The form accommodates both single-establishment employers and multi-establishment employers with options for consolidated, headquarters unit, or individual establishment reporting. Establishments with 50 or more employees are required to submit individual reports, and the form requires identification of the establishment's major activity and specification of the payroll period used for reporting.
The certification section of the form requires a designated official to verify accuracy and compliance with reporting instructions, with signature, title, date, and contact information required for verification purposes. The form does not specify contract pricing, set-asides, incumbency status, funding sources, or renewal options; rather, it functions as a demographic compliance and monitoring tool within the procurement process. Respondents must indicate whether the establishment employs apprentices and provide complete employment data across all demographic categories, with blank spaces treated as zero entries.
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Text version
B-2086343
DART Form 33.254(04/04) Page 1 of 2
DALLAS AREA RAPID TRANSIT AUTHORITY
DALLAS, TX
EXHIBIT V
EMPLOYEE
INFORMATION REPORT
SECTION A - TYPE OF REPORT
Indicate by marking in the appropriate box the type of reporting unit for which this copy of the form is submitted (MARK ONLY ONE BOX).
Single Establishment Employer Report Multi-Establishment Employer, Consolidated Report (Required) Multi-Establishment Employer, Headquarters Unit Report (Required) Multi-Establishment Employer, Individual Establishment Report (submit one for each establishment with 50 or more employees) Multi-Establishment Employer, Special Report
Total number of reports being filed by this company (answer only if consolidated report).
SECTION B-COMPANY IDENTIFICATION
(To be answered by all)
Parent Company Name & Address:
Establishment Completing Report
Name & Address (Omit if same as above)
Employer ID Number:
SECTION C - ESTABLISHMENT INFORMATION
(Omit on the Consolidated Report)
1. What is the major activity of this establishment? (Be specific, i.e., manufacturing steel castings, retail grocer, wholesale plumbing supplies, title insurance, etc. Include the specific type of product or type of service provided, as well as the principal business or industrial activity.)
B-2086343
DART Form 33.254(04/04) Page 2 of 2
SECTION D-EMPLOYMENT DATA
Employment at this establishment -- Report all permanent full-time and part-time employees including apprentices and on-the-job trainees unless specifically excluded as set forth in the instructions. Enter the appropriate figures on all lines and in all columns.
Blank spaces will be considered zeros.
JOB
CATEGORIES
NUMBER OF EMPLOYEES
Overall Totals
(Sum of Col. B
Thru K)
MALE
FEMALE
White (Not of
Hispanic Origin)
Black (Not of
Hispanic Origin)
Hispanic Asian or Pacific
Islander America n Indian or Alaskan Native
White (Not of
Hispanic Origin)
Black (Not of
Hispanic Origin)
Hispanic Asian or Pacific
Islander America n Indian or Alaskan Native
Officials/Managers Professionals Technicians Sales Workers Office & Clerical Craft Workers (Skilled)
Operatives (Semi-Skilled)
Laborers (Unskilled)
Service Workers
TOTAL
Answer if not consolidated report: Dates of Payroll Period
Used
Does the establishment employ apprentices?
SECTION E - CERTIFICATION
(See Instructions concerning certification in Exhibit G)
Check One: All reports are accurate and were prepared in accordance with the instructions (check on consolidated only)
This report is accurate and was prepared in accordance with the instructions.
Name/Title of Certifying Official
Signature Date:
Contact Name
Address (Number & Street)
Title City & State
Zip Code Telephone Extension
File details come from the government source that posted it. Updated .