3-BID-FRM-216 Change of MWBE Subcontractor Form.pdf

PDF 199 KB Posted

Attached to
IRON BRIDGE PUMP STATION REHABILITATION
Solicitation number
CIZ-DWU 25 523
Issued by
Uvalde County, Texas

About this file

This is a Change of M/WBE Subcontractor Form (BID-FRM-216) issued by the City of Dallas Small Business Center - Business Inclusion and Development. The form is used by prime contractors to request approval for changes to their Minority/Women Business Enterprise (M/WBE) subcontractors on city contracts. The form requires documentation of the prime contractor's information, project details, current subcontractor certification number, and the specific scope of work affected. Contractors must indicate the reason for the subcontractor change by selecting from predefined categories, including increases or decreases in scope of work, poor performance, inability or unwillingness to perform, lack of equipment or workforce, or other circumstances. The form captures the original subcontract amount and percentage of total contract value, along with the revised amount and net financial effect of the change.

The form mandates that prime contractors email the completed change request to the City of Dallas Small Business Center staff and project manager prior to executing any changes. The instructions emphasize that failure to obtain prior written approval for subcontractor changes could result in contract termination, sanctions against the prime contractor, and ineligibility for future City of Dallas contracts. The form requires documentation of when the affected subcontractor was notified of the change and the identity of the representative who provided notification, ensuring transparency and adherence to contractual obligations regarding M/WBE participation requirements.

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Text version

BID-FRM-216 Rev.1 – 11/1/2021

CITY OF DALLAS

Small Business Center – Business Inclusion and Development Change of M/WBE Subcontractor Form (BID-FRM-216)

(Note: Please use the Tab button, mouse or arrows to move from one section to the next. Please DO NOT use the “Enter” key.)

Prime Contractor: Officer’s Signature:

Address: Telephone: - - Ext.

Project Name: Bid # : Date:

Project Manager Approval:

Current Subcontractor: Certification #:

Scope of Work:

Please indicate reason for change by checking one or more of the following boxes:

Increase or Decrease in the Scope of Work Poor performance by the subcontractor, sub-consultant, vendor, or supplier Subcontractor is unable or unwilling to perform the work Subcontractor does not have the equipment or workforce to perform the work Other (please explain):

Date Subcontractor Notified of Change:

Representative that notified Subcontractor:

Original Amount ($) % of Total

Revised Amount ($) % of Change Net Effect on Total ($)

Next steps:

1. E-mail this completed form prior to execution of any changes to City of Dallas Small Business Center – Business Inclusion and Development Staff and Project manager for their signature and final approval.

Failure to comply with this provision could result in termination of the contract, sanctions against the prime contractor, and/or ineligibility for future City contracts.

Original Amount ($)

File details come from the government source that posted it. Updated .