2-Appendix Three - HUB Subcontracting Plan (HSP).pdf

While this HSP Quick Checklist is being provided to merely assist you in readily identifying the sections of the HSP form that you will need to complete, it is very important that you adhere to the instructions in the HSP form and instructions provided by the contracting agency.

NOTE:

SECTION 1:

(mm/dd/yyyy)

SECTION 2:

Yes Yes

No No

Item # Subcontracting Opportunity Description

HUBs Non-HUBs

Percentage of the contract expected to be subcontracted to non-HUBs.

Aggregate percentages of the contract expected to be subcontracted:

Yes Yes

No No

SECTION 2: (CONTINUATION SHEET)

This page can be used as a continuation sheet to the HSP Form’s page 2, Section 2, Item b.

Item # Subcontracting Opportunity Description

HUBs Non-HUBs

Aggregate percentages of the contract expected to be subcontracted:

SECTION 3:

SECTION 4:

(mm/dd/yyyy)

Yes SECTION 2, Items c d each

No SECTION 2, Items c and d, each

HSP Good Faith Effort - Method A (Attachment A)

IMPORTANT: Yes each

SECTION A-1:

Item Number Description:

SECTION A 2: N

HSP Good Faith Effort - Method B (Attachment B)

SECTION B-1: Y

Item Number Description:

SECTION B 2:

- Yes Yes

- No / Not Applicable No Not Applicable

SECTION B 3:

a b c d i

HSP Good Faith Effort - Method B (Attachment B) Cont.

Item Number Description:

HUB Subcontracting Opportunity Notification Form

Section B

Section C, Item 2 Section C, Item 1 Section A

Company Name:

Point-of-Contact:

E-mail Address:

State of Texas VID #:

Phone #:

Fax #:

Agency Name:

Point-of-Contact: Phone #:

Requisition #: Bid Open Date:

SECTION A

SECTION B

(mm/dd/yyyy)

SECTION C

1. Potential Subcontractor’s Bid Response Due Date:

If you would like for our company to consider your company’s bid for the subcontracting opportunity identified below in Item 2, we must receive your bid response no later than on .

Central Time Date (mm/dd/yyyy)

2. Subcontracting Opportunity Scope of Work:

3. Required Qualifications: Not Applicable

4. Bonding/Insurance Requirements: Not Applicable

5. Location to review plans/specifications: Not Applicable

HUB Subcontracting Plan (HSP) Prime Contractor Progress Assessment Report (PAR)

Instructions:

1 Project Name, Contract Number assigned by UT Health SA and the UT Health SA solicitation RFP/RFQ number.

2 Date contract was signed by both UT Health SA and prime contractor.

3 Leave blank (completed by UT Health SA).

4 .

5 Awarded company (prime) name.

6 State of Texas VID (14 digits) of prime contractor.

7 Awarded company (prime) contact person.

8 Awarded company (prime) contact phone number.

9 Calendar month and year of reporting period, which should be a prior calendar month (e.g., January 2021). Also include to the LEFT include the Pay Application Number.

Note: Progress Assessment Reports (PARs) must be submitted to UT Health SA for each month that the contract is active, regardless of whether prime contractor makes payments to subcontractors or invoices UT Health SA.

10 Actual payment(s) received from the state agency (UT Health San Antonio) by the awarded company (prime) during the reporting period indicated in 9 above. Explanation: Actual payment being requested on the Pay Application which the PAR is accompanying.

11 Official company name of all subcontractors (HUB and non-HUB) paid from the beginning of the contract through the reporting period. Note: All subcontractors are assumed to be paid directly b st nd https://mycpa.cpa.state.tx.us/tpasscmblsearch/index.jsp) 13 State of Texas VIN (14 digits) or Fed ID (9 digits) of company (subcontractor). Do not enter SSN.

14 Dollar amount awarded to this company (subcontractor) for this contract as listed on the Original or Modified HUB Subcontracting Plan (HSP).

15 Actual amount paid to company (subcontractor) during reporting period indicated in 9 above.

Note: Actual payments to subcontractors must be reported, which may be different than the amount invoiced to UT Health SA for the same period. If both 1st and 2nd Tier subcontractors are listed, enter the amount paid by the prime contractor to the 1st Tier and the amount paid by the 1st Tier to the 2nd Tier. We realize that payments to the 1st Tier subcontractor may include amounts paid to the 2nd Tier, therefore, the sum the 1st and 2nd Tier amounts may exceed contract amount.

16 Actual amount paid to date (through the reporting period indicated in 9 above) to this company (subcontractor) under this contract.

17 Leave blank (completed by UT Health SA).

18 Total amount awarded to all subcontractors (should equal total amount awarded on the Original or Modified HUB Subcontracting Plan-HSP).

19 Total amount paid to all subcontractors for the reporting period listed in 9 above.

20 Total amount paid to date to all subcontractors (through the reporting period listed in 9 above) under this contract.

21 Signature of authorized person (prime contractor) who has verified this report is correct.

22 Title of signing authority.

23 Date signed.

Rev. 10/16

Date of Award: Object Code:

State of Texas VID #:

Phone #:

Texas certified HUB

(Yes or No)

Texas VID or federal EIN Do not enter Social Security

Numbers. If you do not know their VID / EIN, leave their VID / EIN field blank.

Total Contract $ Amount from HSP with Subcontractor

Total $ Amount Paid this Reporting Period to Subcontractor

Total Contract $ Amount Paid to Date to Subcontractor

Object Code (Agency Use Only)

$ $ $ TOTALS:

Reporting (Month) Period: $ Total Amount Paid this Reporting Period to Contractor:

Directory Search located at:

Contracting Agency/University Name:

Report HUB and Non-HUB subcontractor information

This form must be completed and submitted to the contracting agency each month to document compliance with your HSP.

Contractor (Company) Name:

Point of Contact:

Contract/Requisition Number:

HUB Subcontracting Plan (HSP)

Signature: _____________________________________________ Title: _____________________________ Date: _____________________

Prime Contractor Progress Assessment Report http://mycpa.cpa.state.tx.us/tpasscmblsearch/index.jsp.