13-BEH-FRM - 604 - Local Participation Workforce Impact.docx

This is a Local Participation & Workforce Impact certification form for the City of Dallas used in conjunction with the Home Improvement and Preservation Program (HIPP) NonFederal Home Repair Services solicitation. The form is required for all procurement actions including competitive solicitations, change orders, supplemental agreements, Inter Local Agreements, cooperative purchases, and sole source agreements. Prime vendors must provide their legal business name, headquarters address, local office address if applicable, and primary contact information. The solicitation establishes a two-year service contract with two optional two-year renewal periods for qualified applicants to administer and implement the HIPP.

The form requires vendors to report total company-wide employees and the number of employees residing in the City of Dallas, with automatic calculation of the percentage of local workforce residency. A company officer must certify under penalty of law that all information provided is accurate and complete. The City of Dallas reserves the right to verify submitted information, including workforce totals and residency data, and may request supporting documentation during reporting, evaluation, or compliance review processes. Submission of false, misleading, or materially incomplete information may result in disqualification, scoring adjustments, or other remedial actions permitted under City policy. This form represents the City's commitment to tracking and reporting local participation metrics to the City Council for all procurement actions.