21-CDOTRM CDOT FORM - 1415 - Commitment Confirmation.pdf
PDF 88 KB Posted
- Solicitation number
- IFB-25-10-PW/PROJECT NO. BRO M750-007 SUB ACCOUNT 25517
- Issued by
- Boulder County, Lakewood City, Colorado
About this file
The document is a Colorado Department of Transportation (CDOT) Form 1415 Commitment Confirmation, which is a standard form used to document Disadvantaged Business Enterprise (DBE) participation in a transportation project. The form is designed to confirm the commitment of a DBE firm to perform specific work on a contract, with sections for both the primary contractor and the DBE subcontractor to provide detailed information about their planned involvement. The form requires information about the work categories, commitment amounts, and specific details about the DBE's role in the project.
The form serves as a mechanism for tracking and verifying DBE participation, requiring both the contractor and the DBE to provide comprehensive information about their intended work, including categories such as construction, trucking, supplies, and services. It includes declarations under penalty of perjury to ensure the accuracy of the information provided, and requires signatures from authorized representatives of both the contractor and the DBE. The form is part of CDOT's process for ensuring diverse business participation in transportation projects, with a final section reserved for review and approval by a CDOT Civil Rights Specialist or Civil Rights and Business Resource Center staff member.
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Text version
1 of 2 CDOT Form # 1415 01/14
COLORADO DEPARTMENT OF TRANSPORTATION
COMMITMENT CONFIRMATION
SECTION 1. This section must be completed by the Contractor.
Project Name: Subaccount #:
Bidder: Bidder Phone:
Bidder Contact: Bidder Email:
DBE Firm Name: DBE Phone:
DBE Address: DBE Email:
Commitment Details
Category Work to be Performed DBE Work Code(s) Commitment Amount
Eligible Participation
Construction
Trucking
Supplies
Services
Total $0.00 $0.00 This section must be signed by an individual with the power to contractually bind the Bidder/Contractor. You declare under penalty of perjury in the second degree and any other applicable state or federal laws that the statements made in this document are complete, true and accurate to the best of your knowledge.
Bidder/Contractor Representative Title Signature Date
SECTION 2. This section must be completed by the DBE. (Attach additional pages if necessary).
This document is not a contract with the Bidder/Contractor; it is an acknowledgement of the obligation that the Bidder/Contractor is making to CDOT. The amounts listed above may be less than the subcontractor or purchase order amount, but can never be more, and shall not reflect any mark up by the Bidder/Contractor. All questions must be answered.
Are you contracting directly with the Bidder/Contractor or with one of its subcontractors? If with a subcontractor, provide the firm name.
Will you be purchasing supplies or materials or leasing or renting equipment from the Bidder/Contractor or its subcontractors? If so, explain.
Do you intend to subcontract any portion of the work listed above? If yes, state to which firms, what work and the approximate amount. Include trucking subcontractors and owner-operators.
Will you be providing trucking services on this project? If so, state how many of your own trucks and employees you will have on this project.
Who within your firm will be supervising and responsible for your firm’s work on this project?
Will you be acting as a broker on this project? If so, state what you will be brokering and your approximate brokerage fee.
2 of 2 CDOT Form # 1415 01/14
Will you be acting as a supplier on this project? If so, please state what you will be supplying and whether you will manufacture the items.
This section must be signed by an individual with the power to contractually bind the DBE. You declare under penalty of perjury in the second degree and any other applicable state or federal laws that the statements made in this document are complete, true and to the best of your knowledge. You attest that you are eligible to participate as a DBE on this contract for the work listed above and have the capacity to perform the work as stated.
DBE Representative Title Signature Date
Review your project's DBE requirements for additional instructions on completing and submitting this form. Questions may also be directed to the CDOT Civil Rights & Business Resource Center at (303) 757-9234 or by email at dot_civilrights@state.co.us.
SECTION 3. This section must be completed by Region Civil Rights Specialist or Civil Rights and Business Resource Center staff member
Name Title Approved or Denied Date of Decision
Pre-award CDOT projects: This form should be uploaded with the Utilization Plan and submitted electronically to the Civil Rights & Business Resource Center via B2GNow.
Pre-award local agency projects: Submit this form to the local agency that will be awarding the project.
CDOT #1415 10/20
| Worksheets |
| Sheet1 |
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