3-CIZ26-TPW-4001 - EXHIBIT A - City Forms.pdf

EXHIBIT A

REQUIRED FORMS

PROPOSAL FORMS REQUIRED FOR BID SUBMISSION

(ALL HANDWRITING MUST BE NEAT AND LEGIBLE)

Contractor Must Submit with Completed Bid Tabs (Bid Tabs MUST be Signed):

Incomplete submittal packages may cause the contractor's BID submittal to be rejected as nonresponsive. ALL addendums published through the life of the open procurement must also be signed and submitted as part of the BID package.

Required Forms for BID Submittal:

• BID Tabs (completed and MUST be signed (excel and PDF version available)

• Time of Completion (completed and MUST be signed)

• Bid Bond – Form 1

• Cashier’s Check or attached Bid Bond, payable to the City of Dallas in an amount not less than 5% of the total Bid submitted must accompany the Bid.

City reserves the right to reject any or all Bids.

• NOTE: Using another Form of Bid Bond other than the one included in these Specifications may result in rejection of your Bid.

• SBE Affidavit – BEH-FRM-602.SAW (PDF and Word versions available)

• Schedule of Work and Actual Payment – BEH-FRM-603.SAW (PDF and Excel versions available)

• Local Participation and Workforce Impact – BEH-FRM-604.SAW (PDF and Word versions available)

• SBE Good Faith Effort Documentation Form – BEH-FRM-607.SAW (PDF and Word versions available)

• Prime Self Performance Declaration – BEH-FRM-609.SAW (PDF and Word versions available)

• SBE Subcontractor Intent Form – BEH-FRM-610.SAW (PDF and Word versions available)

• Form 1295 (link: https://www.ethics.state.tx.us/filinginfo/1295/)

• Conflict of Interest Form – Form 2

• Non-Collusion Affidavit – Form 3

• Disclosure of Lobbying Activities – Form 4

• Prohibition on Contracts with Companies Boycotting Israel & Prohibition on Contracts with Foreign

Terrorist Organizations – Acknowledgement – Form 1-0001

• Bidder’s Safety Affidavit – Form 5

• Environmental Record Affidavit – Form 6

• Cement Certification – Form 7

• Statement of Insurability Form – Form 8

• Suspension/Debarment Certification Form - Form 9

The Following Forms are Required Upon Request for Contract Award

• Sample Civil Construction Services Contract – Form 9

• Davis-Bacon Wage Rates – Form 10

• Sample Performance Bond – Form 11

• Sample Payment Bond – Form 12

• Street Excavation Data Form – Form 13

• Concrete/Cement Delivery Certification – Form 14

• Inspection Overtime Request Form – Form 15

• Sample Certificate of Insurance (COI) – Form 16

• Insurance Requirements – Form 17

*Please note, failure to submit a BID Bond, on the City's provided BID Bond form (Form

1) or the appropriate allowed alternative (see note under BID Bond above), WILL result in the rejection of bid as per NCTCOG Standard Specifications 5th Edition - 2021 Addendum.

https://www.ethics.state.tx.us/filinginfo/1295/

ITEM NO. DESCRIPTION UNIT EST. QTY BID PRICE BID TOTAL

MOBILIZATION (MINIMUM LUMP SUM PER WORK ORDER)

(SEE ITEM 1 IN SPECIFICATIONS)

LS 1 $ -

PROCUREMENT AND INSTALLATION OF BASE-MOUNTED CONTROLLER CABINET

AND CONTROLLER

EA 3 $ -

5 PROCUREMENT AND INSTALLATION OF TRAFFIC SIGNAL HEAD EA 28 $ -

PROCUREMENT AND INSTALLATION OF SINGLE SECTION TRAFFIC SIGNAL

HEAD

EA 5 $ -

10 PROCUREMENT AND INSTALLATION OF PEDESTRIAN SIGNAL HEAD EA 16 $ -

14 PROCUREMENT AND INSTALLATION OF ACCESSIBLE PEDESTRIAN SIGNAL UNIT EA 16 $ -

A. PROCUREMENT AND INSTALLATION OF ACCESSIBLE PEDESTRIAN SIGNAL

CABINET CONSOLE

EA 3 $ -

PROCUREMENT AND INSTALLATION OF TXDOT DALLAS STYLE MAST ARM SIGNAL

POLE ASSEMBLY (SMA, 20' TO 32')

D. POWDERCOATED, NO LUMINAIRE EXTENSION EA 2 $ -

PROCUREMENT AND INSTALLATION OF TXDOT DALLAS STYLE MAST ARM

SIGNAL POLE ASSEMBLY (SMA, 36' TO 48')

A. GALVANIZED WITH LUMINAIRE EXTENSION EA 5 $ -

B. GALVANIZED, NO LUMINIARE EXTENSION EA 1 $ -

24 PROCUREMENT AND INSTALLATION OF PEDESTAL SIGNAL POLE .

C. ALUMINUM, TYPE II, 10 FOOT EA 4 $ -

D. POWDERCOATED, TYPE II, 10 FOOT EA 1 $ -

25 PROCUREMENT AND INSTALLATION OF DAMPING PLATE ON MAST ARM EA 8 $ -

34 INSTALLATION OF TXDOT DALLAS DISTRICT STYLE TRAFFIC SIGNAL FOUNDATION .

DEPARTMENT OF TRANSPORTATION & PUBLIC WORKS

TRANSPORTATION OPERATIONS DIVISION

Bid Sheet

CIZ26-TPW-4001 – Bond Group 2024 Group 5 – Knox Street at Katy Trail Mountain Creek Pkwy at Fox Creek Trail

DEPARTMENT OF TRANSPORTATION & PUBLIC WORKS

TRANSPORTATION OPERATIONS DIVISION

Bid Sheet

CIZ26-TPW-4001 – Bond Group 2024 Group 5 – Knox Street at Katy Trail Mountain Creek Pkwy at Fox Creek Trail

A. TYPE 24A LF 36 $ -

B. TYPE 30-A LF 22 $ -

C. TYPE 36-A LF 78 $ -

INSTALLATION OF BASE MOUNTED TRAFFIC SIGNAL CONTROLLER CABINET

FOUNDATION

EA 3 $ -

38 PROCUREMENT AND INSTALLATION OF PVC CONDUIT (BORED OR TRENCHED) .

A. 2 INCH (TRENCHED) LF 330 $ -

B. 2 INCH (BORED) LF 180 $ -

C. 3 INCH (TRENCHED) LF 435 $ -

D. 3 INCH (BORED) LF 945 $ -

E. 4 INCH (TRENCHED) LF 240 $ -

F. 4 INCH (BORED) LF 535 $ -

PROCUREMENT AND INSTALLATION OF ELECTRICAL POWER SERVICE WITH

INSPECTION PERMIT OBTAINED BY VENDOR

A. OVERHEAD SERVICE EA 3 $ -

43 PROCUREMENT AND INSTALLATION OF GROUND BOX .

A. SMALL GROUND BOX (12X12X12) EA 2 $ -

C. LARGE GROUND BOX (16X28X18) EA 12 $ -

44 PROCUREMENT AND INSTALLATION OF MULTICONDUCTOR SIGNAL CABLE .

TRANSPORTATION OPERATIONS DIVISION

Bid Sheet

CIZ26-TPW-4001 – Bond Group 2024 Group 5 – Knox Street at Katy Trail Mountain Creek Pkwy at Fox Creek Trail

A. 2 CONDUCTOR LF 1860 $ -

B. 5 CONDUCTOR LF 1206 $ -

C. 7 CONDUCTOR LF 136 $ -

D. 12 CONDUCTOR LF 1055 $ -

G. 25 CONDUCTOR LF 990 $ -

45 PROCUREMENT AND INSTALLATION OF ELECTRICAL POWER WIRE LF 5345 $ -

46 PROCUREMENT AND INSTALLATION OF MULTICONDUCTOR VEHICLE DETECTOR

OR COMMUNICATION CABLE

A. RADAR DETECTOR CABLE LF 1028 $ -

C. CAT5E ETHERNET CABLE LF 440 $ -

50 PROCUREMENT AND INSTALLATION OF RADAR DETECTION CABINET CONTROL

UNIT (5 OR 6 SENSORS)

EA 1 $ -

53 PROCUREMENT AND INSTALLATION OF RADAR VEHICLE PRESENCE DETECTOR EA 4 $ -

54 PROCUREMENT AND INSTALLATION OF RADAR VEHICLE ADVANCE DETECTOR EA 2 $ -

60 INSTALLATION OF TRAFFIC SIGN .

A. TRAFFIC SIGNAL MOUNTED EA 20 $ -

D. GROUND MOUNTED ON TXDOT BREAKAWAY POST EA 13 $ -

61 INSTALLATION OF CONCRETE SIDEWALK SY 249 $ -

62 INSTALLATION OF BARRIER FREE SIDEWALK RAMP SY 184 $ -

TRANSPORTATION OPERATIONS DIVISION

Bid Sheet

CIZ26-TPW-4001 – Bond Group 2024 Group 5 – Knox Street at Katy Trail Mountain Creek Pkwy at Fox Creek Trail

63 INSTALLATION OF PEDESTRIAN HANDRAIL (GALVANIZED STEEL, 42") LF 63 $ -

64 INSTALLATION OF CONCRETE CURB (6") LF 308 $ -

65 INSTALLATION OF CONCRETE CURB AND GUTTER (6") LF 283 $ -

67 INSTALLATION OF CONTINUOUSLY REINFORCED RIGID PAVEMENT GREATER SF 125 $ -

75 PROCUREMENT AND INSTALLATION OF 4-INCH REFLECTORIZED PAVEMENT

MARKER

EA 348 $ -

76 PROCUREMENT AND INSTALLATION OF 4-INCH THERMOPLASTIC PAVEMENT

MARKING

A. WHITE LF 2529 $ -

77 PROCUREMENT AND INSTALLATION OF 6-INCH THERMOPLASTIC PAVEMENT

MARKING

A. WHITE LF 1499 $ -

80 PROCUREMENT AND INSTALLATION OF 18-INCH THERMOPLASTIC PAVEMENT

MARKING

A. WHITE LF 296 $ -

81 PROCUREMENT AND INSTALLATION OF 24-INCH THERMOPLASTIC PAVEMENT

MARKING

A. WHITE LF 605 $ -

82 PROCUREMENT AND INSTALLATION OF WHITE THERMOPLASTIC FOR PAVEMENT

LEGEND MARKING

SF 202 $ -

97 REMOVAL OF TRAFFIC SIGN EA 11 $ -

102 REMOVAL OF RIGID PAVEMENT SY 50 $ -

103 REMOVAL OF CONCRETE SIDEWALK SY 266 $ -

TRANSPORTATION OPERATIONS DIVISION

Bid Sheet

CIZ26-TPW-4001 – Bond Group 2024 Group 5 – Knox Street at Katy Trail Mountain Creek Pkwy at Fox Creek Trail

105 REMOVAL OF CONCRETE CURB AND GUTTER (6") LF 271 $ -

108 REMOVAL OF SPECIALTY PAVING MATERIALS (CONCRETE PAVERS, BRICK, ST SY 33 $ -

109 REMOVAL OF RAISED REFLECTORIZED MARKER AND CERAMIC BUTTON EA 85 $ -

111 REMOVAL OF PAVEMENT MARKING LINE LF 3886 $ -

114 PROCURE AND INSTALL BLANK-OUT SIGN EA 1 $ -

142 PROCUREMENT AND INSTALLATION OF TRAFFIC MONITORING SYSTEM EA 2 $ -

200 ITS GND BOX (PCAST) TY I (243636) W/APRON EA 3 $ -

203 INSTALLATION OF SOD SY 43 $ -

204 EXCAVATION OF EXISTING GRADE CY 20 $ -

REMOVAL OF ILLUMINATION POLE ASSEMBLY EA 1 $ -

INSTALLATION OF CONCRETE CURB (9") LF 22 $ -

RESET EXISTING WATER VALVE EA 1 $ -

PROCUREMENT AND INSTALLATION OF ROADWAY ILLUMINATION ASSEMBLY

(13.5' POLE W/20' MOUNTING HEIGHT)

EA 2 $ -

PROCUREMENT AND INSTALLATION OF ROADWAY ILLUMINATION ASSEMBLY

(POWDERCOATED COLOR FINISH) (13.5' POLE W/20' MOUNTING HEIGHT)

EA 2 $ -

PROCUREMENT AND INSTALLATION OF ROADWAY ILLUMINATION ASSEMBLY

(23.5' POLE W/30' MOUNTING HEIGHT)

EA 1 $ -

INSTALLATION OF TXDOT STANDARD ROADWAY ILLUMINATION ASSEMBLY

FOUNDATION (TYPE 30-A)

LF 40 $ -

500 EXTRA WORK EA 1 $ 75,000.00 $ 75,000.00

TRANSPORTATION OPERATIONS DIVISION

Bid Sheet

CIZ26-TPW-4001 – Bond Group 2024 Group 5 – Knox Street at Katy Trail Mountain Creek Pkwy at Fox Creek Trail

GRAND TOTAL BID . 75,000.00$

Name of Contractor: ______________________________________

Printed Name of Authorized Signer: _________________________

Signature of Authorized Signer: _____________________________

PROPOSAL FORMS

TIME OF COMPLETION: The undersigned agrees to complete ALL WORK on or before 240 Working Days. The Work Order will be issued in accordance with Item 103.2 COD, “AWARD AND EXECUTION OF CONTRACT,” of the COD 2021 Addendum to the Standard Specifications and Special Provision A.5, “CONTRACT TIME.” The undersigned further declares that he will provide all necessary tools and apparatus, do all the work, furnish all materials, and do everything required to carry out the above mentioned work covered by this proposal, in strict accordance with the contract documents, and the requirements pertaining thereto, for the sum or sums above set forth.

Submitted:

By:

Signature

Printed Name

Address

City State Zip

Code (SEAL- If the bidder is a Corporation)

NOTE: DO NOT DETACH bid from other papers.

Fill in with ink and submit complete with attached papers.

(Form 1)

BID BOND

STATE OF TEXAS }

} KNOW ALL MEN BY THESE PRESENTS

COUNTY OF DALLAS }

That we , as Principal, and . a Corporation duly organized under the laws of the State of and fully authorized to transact business in the State of Texas, as Surety, are held and firmly bound unto the

CITY of DALLAS, TEXAS, a municipal corporation, as Obligee, in the penal sum of FIVE PERCENT (5%) OF THE GREATEST AMOUNT BID, lawful money of the United States of America; for the payment of which sum, well and truly to be made, we hereby bind ourselves, our heirs, executors, administrators, and successors and assigns, jointly and severally, firmly by these presents.

SIGNED, SEALED, and DATED this day of , .

WHEREAS, the Principal is herewith submitting its proposal for:

THE CONDITION OF THE ABOVE OBLIGATIONS ARE SUCH, that if the aforesaid Principal shall be awarded the Contract, the said Principal will, within the time required, enter into a Contract and give Bonds, if required, for the faithful performance of the Contract and the prompt payment for labor and materials in the prosecution thereof, then this obligation shall be null and void, otherwise the Principal and Surety will pay unto the Obligee the full penal sum thereof, as liquidated damages, it being difficult and impractical to determine accurately the actual amount of damages occurring to Obligee by reason of Principal’s failure to execute said Contract and Bonds.

PROVIDED FURTHER, that if any legal action be filed upon this Bond, venue shall lie exclusively in Dallas, County, Texas.

The Resident Agent of the Surety in Dallas County, Texas for delivery of notice and service of process is:

NAME: ADDRESS:

TELEPHONE: E-MAIL ADDRESS:

ATTEST: PRINCIPAL:

By Secretary Name/Title

ATTEST: SURETY:

By Secretary Name/Title

NOTE: CERTIFIED COPY OF POWER-OF-ATTORNEY MUST BE ATTACHED HERETO.

The bidder must complete this form regardless of whether or not the same information is given in the Bidder’s Bond:

1. Complete name and address of the Surety Company for Performance and Payment Bonds:

2. Name of the Attorney-In-Fact for the Surety Company:

3. The name of the resident agent of the Surety Company in Dallas County, Texas, (this name must be the name of a natural person residing in Dallas County, Texas):

4. Address of the resident agent of the Surety Company in Dallas County, Texas, (this must be a street address and not a post office box number):

Name of Bidder

Address of Bidder

(Form 1 contd.)

PROVIDE THE FOLLOWING INFORMATION:

1. If the Contractor is a corporation:

State of Incorporation:

If other than Texas, provide copy of a Certificate of Authority to do business in Texas.

2. Street Address:

Suite, Room or Building

Street Address

City, County, State, Zip Code

3. Mailing Address:

Suite, Room or Building

Street Address

City, County, State, Zip Code

4. If the contractor is a corporation:

A. Name of the Contractor’s President:

B. Name of the Contractor’s Corporate Secretary:

C. If other than A and B are to sign contract provide:

NAME TITLE

Attach a notarized copy of legal authorization granting contract signing authority.

5. All notices under the contract should be sent to:

Name Title

6. Provide information for a person who may be contacted concerning the proposal or other required documents:

Name Telephone Number

PROPOSAL GUARANTY FORM

The undersigned further agrees that the proposal guaranty may be retained by the City of Dallas, Texas, provided the undersigned is one of three lowest and most advantageous bidders, and that said proposal guaranty shall remain with the City of Dallas until the contract has been signed, and the bond required for the faithful performance of the contract has been made by one of the three lowest responsible bidders; otherwise, proposal guaranty may be obtained from the City Secretary after forty-eight hours from the time of opening the bids. The undersigned hereby declares that he has visited the sites, has had sufficient time to make all tests and investigations to arrive at an intelligent estimate of the cost of doing the work, and has carefully examined the details, specifications and contract documents relating to the work covered by his bid or bids, that he agrees to do the work, and that no representations made by the City are in any sense a warranty, but are mere estimates for the guidance of the Contractor. Upon receipt of notice of the acceptance of the bid, the Contractor will execute the formal contract attached in quintuplicate, within ten days, and will deliver a Surety Bond for the faithful performance of this contract, and such other bonds as may have been required in the specifications. The bid security attached, in the sum of:

is to become the property of the City of Dallas if a cashier’s check, and if a bond, the principal amount shall be paid to the City, in the event the contract and bond are not executed within the time above set forth, and to be considered as liquidated damages because the delay and additional work caused thereby are incapable of accurate ascertainment.

Developing Regional Inclusive Vendor Enterprise Small Business Enterprise (SBE) Affidavit

BEH-FRM-602.SAW

BEH-FRM-602.SAW Revision Date: 2026.03.19 Page 1 of 3

Solicitation Name: Solicitation #:

Prime Vendor Information Prime Vendor Legal Business Name:

Headquarters (HQ) Address:

City: State: County:

Local Office Address (if different than HQ):

City: State: County:

Primary Contact Name:

Title:

Email:

Phone:

SBE Program Acknowledgement It is the policy of the City of Dallas to promote contracting and broaden opportunities for small businesses through the Developing Regional Inclusive Vendor Enterprise (DRIVE) Policy, adopted by City Council under Council Resolution #25-1879. All respondents to City solicitations are required to support the City’s goals of increasing small business participation, strengthening the regional vendor marketplace, and advancing economic impact across Dallas and the Dallas–Fort Worth–Arlington Metropolitan Statistical Area (MSA).

The respondent acknowledges that the City establishes two types of SBE goals under the DRIVE Policy: (1) annual aspirational SBE benchmarks by procurement category, and (2) contract-specific SBE subcontracting goals.

Aspirational benchmarks represent the City’s overall, program-wide participation goals for major procurement categories such as Goods, Construction, Architecture & Engineering, Professional Services, and Other Services. These benchmarks are based on regional marketplace conditions and may be adjusted periodically. They are used to measure the City’s overall progress in advancing small business participation.

Category Aspirational Benchmark Goal Category Aspirational

Benchmark Goal

Goods 33% Architecture & Engineering (A/E) 34%

Construction 33% Professional Services 38%

Other Services 30%

BEH-FRM-602.SAW

BEH-FRM-602.SAW Revision Date: 2026.03.19 Page 2 of 3

The City updates these benchmarks periodically based on market availability, utilization data, and regional capacity. The respondent is responsible for complying with the most current benchmarks as published or referenced in the solicitation.

Contract-specific SBE goals are tailored for each solicitation and reflect the availability of ready, willing, and able SBE firms for the scopes, trades, and disciplines included in that contract. The Business Enterprise Hub (BEH) uses marketplace research, availability analysis, and historical participation data to determine these goals. Contract-specific goals may be higher or lower than the aspirational benchmarks depending on the opportunities associated with the specific solicitation.

By signing this Affidavit, the respondent acknowledges receipt of the SBE Program requirements, including the annual aspirational benchmarks and any contract-specific SBE goals established for this procurement.

The respondent further affirms responsibility for submitting accurate and truthful information regarding SBE participation, subcontractor commitments, SBE self-performance (if applicable), and any documentation required to demonstrate good-faith efforts under the DRIVE Policy.

Subcontracting, CUF Obligation, & Change of Sub Requirements The respondent understands that the SBE subcontracting commitments submitted with their solicitation response constitute material representations of intent. Only the work performed by subcontractors who execute a Commercially Useful Function (CUF) including managing, supervising, and performing their contracted scope of work with their own labor and resources may be counted toward SBE participation.

Any proposed change involving SBE subcontractors including reductions in scope, reassignment of work, substitution, or removal requires prior submission of:

(1) a revised BEH-FRM-603.SAW — Schedule of Work and Actual Payment, and

(2) a BEH-FRM-501.PAC — Change of SBE Subcontractor Request Form to the Business Enterprise Hub (BEH) for review and approval before any change may be implemented.

Work shall not proceed under a modified subcontracting arrangement until written approval is issued by

BEH.

Misrepresentation of CUF performance, subcontractor participation, certification status, or vendor location may result in corrective actions or sanctions consistent with City policy.

BEH-FRM-602.SAW

BEH-FRM-602.SAW Revision Date: 2026.03.19 Page 3 of 3

Monthly Compliance & Auditing Reporting The respondent acknowledges that the City conducts monthly compliance audits through its designated City of Dallas Compliance System [https://dallas.gob2g.com/]. Both the Prime and all subcontractors are required to respond to audit inquiries, including payment verification, CUF confirmation, and progress reporting.

A designated point of contact must be identified and updated throughout the contract term.

Failure to provide timely audit responses may result in payment delays, adjustments to SBE participation, corrective actions, or impacts to future contract eligibility.

Audit Reporting Point-of-Contact (POC):

Name:

Phone:

Email:

Affidavit & Certification By signing below, I certify that all information provided in this Affidavit and accompanying documentation is true and complete. I further acknowledge and will comply with the requirements of the DRIVE Policy and Program.

Officer Signature:

Printed Name:

Title:

Date:

https://dallas.gob2g.com/

Schedule of Work and Actual Payment

BEH-FRM-603.SAW

Contract/Project Name:

Solicitation #: Contract #:

Purpose

Instructions for Completing this Schedule 1 The first row in the Schedule of Work table must list the Prime Contractor and identify SBE certification if applicable.

2 Enter only one firm per row 3 If a firm performs more than one distinct type of work, list each scope on a separate row.

4 Provide all required information for each firm. If a SBE does not apply, leave blank 5 Enter dollar values without commas or special characters unless otherwise indicated.

6 If the firm is certified as an SBE, provide the certification number exactly as issued.

Definitions Scope/Work Element SBE #

NAICS Code Code

Lookup

Value of Work

Company Name Percent (%)

Company Address Payments to Date

Contact Name, Phone & Email

Payment this Period

Schedule

Scope/Work Element

NAICS/NIGP

Code Company Name Company Address Contact Name, Phone &

Email SBE # Value of Work Percent

Payments to

Date Payment this

Period

$25,000.00 100.00%

Legal business name of the firm performing the work.

Local Address (City, State, ZIP, County) *Use ALT+Enter for new line within the cell* Primary contact for this firm (name, phone, email) *Use ALT+Enter for new Line*

SBE certification number (if applicable)

Total dollar value of work assigned to this firm

Percentage of total contract value assigned to this firm (Auto Calculates Total amount paid to the firm to date

Amount paid to the firm during current reporting period

Enter the code(s) that correspond to the specific scope of work listed in that row.

If multiple distinct scopes are performed, use separate rows.

Description of the specific type of work being performed by the firm (Prime or 1st-tier subcontractor).

This Schedule of Work confirms the Prime Contractor’s final team composition, subcontractor participation, certification status, and planned SBE utilization at time of award. This form establishes the baseline for SBE participation monitoring throughout the life of the contract.

BEH-FRM-603.SAW Revision Date 2026.04.20 1 of 5 https://www.census.gov/naics/ https://www.census.gov/naics/

BEH-FRM-603.SAW

Contract/Project Name:

Solicitation #: Contract #:

BEH-FRM-603.SAW Revision Date 2026.04.20 2 of 5

BEH-FRM-603.SAW

Contract/Project Name:

BEH-FRM-603.SAW Revision Date 2026.04.20 3 of 5

BEH-FRM-603.SAW

Contract/Project Name:

Solicitation #: Contract #:

Totals $25,000.00 100.00%

Instructions:

Contract Amount to be Paid to Prime $0.00 SBE Total Amount $0.00

0.00% Total Contract Amount $25,000.00 Anticipated Total SBE Participation Percentage 0.00%

Prime Contractor Certification and Signature

Respondent's SBE Participation Plan Total Enter the "Goal (As Stated in Specifications)" and your "Committed amount. All other fields calculate automatically.

Goal (As Stated in Specifications) SBE Utilization Committed % Committed To date

The undersigned intends to enter into a formal agreement with the subcontractors listed, conditioned upon being awarded the City of Dallas contract. The Prime contractor further certifies that each listed SBE firm will perform a Commercially Useful Function (CUF), meaning it will manage, supervise, and independently perform its identified scope of work with its own labor and resources, and that only such work is eligible for SBE participation credit under the DRIVE Policy.

If any changes are made to this list, the Prime contractor must submit to the City for approval a revised schedule with documented explanations for the changes and the BEH-FRM-501.PAC Change of Subcontractor Form. Failure to comply with this provision may result in termination of the contract, sanctions against the Prime contractor, and/or ineligibility for future City contracts.

BEH-FRM-603.SAW Revision Date 2026.04.20 4 of 5

BEH-FRM-603.SAW

Contract/Project Name:

Company Name Printed Name

Title Date

By checking this box, I certify that I am authorized to submit this schedule; that the listed SBE firms will perform a Commercially Useful Function as described above; and that I will comply with all requirements regarding changes and approvals. Additionally, I certify that the information provided in this Schedule of Work and Actual Payment form is accurate and complete and that the City may verify all information provided.

BEH-FRM-603.SAW Revision Date 2026.04.20 5 of 5

Local Participation & Workforce Impact

BEH-FRM-604.SAW

BEH-FRM-604.SAW Revision Date: 2026.03.19 Page 1 of 1

Solicitation Name: Solicitation #:

Prime Vendor Information

Prime Vendor Legal Business Name:

Headquarters (HQ) Address:

City: State: County:

Local Office Address (if different than HQ):

City: State: County:

Primary Contact Name:

Title:

Email:

Phone:

Local Participation & Workforce Impact The City reports vendor location and workforce residency to City Council for all procurement actions, including competitive solicitations, change orders, supplemental agreements, Inter Local Agreements (ILA), Cooperative (COOP) purchases, and sole source agreements.

Required Totals & Local Workforce Residency (Vendors.enter.totals·.Staff.calculates.percentage)

Total Employees (Company-wide):

Employee Residing in the City of Dallas:

Percentage of Employees Residing in the City of Dallas:

= (Dallas Employees ÷ Total Employees) × 100 BEH ONLY

Certification of Local Participation Information & Workforce By signing below, I certify that the information provided in this Local Participation & Workforce Impact form is accurate and complete to the best of my knowledge. I understand that the City of Dallas may verify the information provided, including workforce totals and residency data, and may request supporting documentation as part of reporting, evaluation, or compliance review. Submission of false, misleading, or materially incomplete information may result in disqualification, scoring adjustments, or other actions permitted under City policy.

Officer Signature:

Printed Name:

SBE Good Faith Effort Documentation Form

BEH-FRM-607.SAW

BEH-FRM-607.SAW Revision Date: 2026.03.19 Page 1 of 5

Prime Vendor Information Prime Vendor Name:

Solicitation Title:

Solicitation Number:

Good Faith Effort (GFE) documentation is required only if a respondent does not meet the contract-specific SBE goal or when specifically requested by the City of Dallas for compliance review. This form is not required from respondents who meet or exceed the SBE goal at time of submission unless otherwise directed by the City.

Prime Attestations (check all that apply):

We evaluated commercially reasonable subcontracting opportunities consistent with DRIVE policy and did not artificially consolidate or restrict scopes of work. ☐

We did not artificially limit or withhold subcontracting opportunities in order to increase SBE prime self-performance. (If.applicable) ☐

We verified that every SBE contacted holds active certification in the NAICS code for the scope of work for which they were contacted. ☐

We understand that only SBE firms performing under a Commercially Useful Function (CUF) may be counted toward the SBE goal. ☐

Identification & Segmentation of Subcontracting Opportunities The DRIVE Policy requires respondents to evaluate commercially reasonable subcontracting opportunities and segment work into economically feasible packages consistent with market availability and the contract-specific SBE goal.

A. Describe how your firm identified subcontracting opportunities:

B. Describe how scopes were segmented into economically feasible subcontracting packages:

BEH-FRM-607.SAW

BEH-FRM-607.SAW Revision Date: 2026.03.19 Page 2 of 5

C. Attach or summarize applicable portions of your SBE Team Make-Up and Trade Summary information.

Outreach to SBE’s: Notice and Response Window Respondents must demonstrate intentional, timely, and adequate outreach to available SBEs.

A. Minimum Response Window We provided at least 7 business days for SBEs to respond to our request for quotes.

(If fewer than 7 days, explanation required.) ☐

Explanation:

B. Information Provided We provided SBEs with complete and accurate plans/specifications

We provided written notice detailing scopes, deadlines, and points of contact

We responded to SBE inquiries or requests for clarification

C. Documentation Required Attach proof of outreach, such as:

• Email notices with timestamps

• Call logs (date/time)

• Screenshots or distribution lists

• Copies of bid solicitation requests

• Date range of outreach activity (first notice through final follow-up)

Dallas Regional Inclusive Vendor Enterprise

BEH-FRM-607.SAW

BEH-FRM-607.SAW Revision Date: 2026.03.19 Page 3 of 5

SBE Response & Quote Evaluation List all SBEs contacted for this solicitation and describe the outcome. (Add.additional.pages.as.needed¡)

SBE Firm Work Element

Date Contacted Quote Received (Y/N)

Quote Amount

Reason Selected / Not Selected Reason No Quote Received (if applicable)

Other Response Provided

BEH-FRM-607.SAW

BEH-FRM-607.SAW Revision Date: 2026.03.19 Page 4 of 5

If an SBE quote was rejected due to cost, indicate percentage difference from selected quote:

If SBE(s) not selected, provide justification:

(Examples: did not meet scope, materially higher cost, incomplete quote.)

Assistance Provided to SBE’s Respondents must demonstrate efforts to support SBEs in competing for subcontracting opportunities.

Check all that apply:

Provided bonding or insurance guidance ☐ Provided clarification of plans or specifications ☐ Offered flexible scheduling or phased work ☐ Assisted with supplier or material sourcing ☐ Broke out work into smaller components to increase opportunity ☐ Other: ☐

Provide narrative summary:

Summary of Good Faith Efforts Provide a brief summary explaining the proposed SBE participation percentage and how it compares to the contract-specific SBE goal.

If the goal is not met, describe the specific impediments encountered despite genuine outreach:

BEH-FRM-607.SAW

BEH-FRM-607.SAW Revision Date: 2026.03.19 Page 5 of 5

Certification I certify that:

• The information provided in this Good Faith Effort Form is true and correct;

• Our firm did not artificially reduce subcontracting opportunities;

• All SBEs listed were contacted for scopes matching their certified NAICS codes;

• All work proposed for SBE participation will be performed under a CUF; and

• Documentation attached is accurate and complete.

We understand that Good Faith Efforts and SBE participation commitments are subject to monitoring and compliance review throughout the life of the contract.

Officer Signature:

Printed Name:

Prime Self-Performance Declaration

BEH-FRM-609.SAW

BEH-FRM-609.SAW Revision Date: 2026.03.19 Page 1 of 2

Prime Vendor Information Prime Vendor Name Solicitation Number Solicitation Title

Under the DRIVE Policy, Small Business Enterprise (SBE) primes may count self-performed work toward the contract-specific SBE goal only when that work meets Commercially Useful Function (CUF) requirements and when the SBE firm is properly certified in the NAICS code(s) associated with the work it will perform.

This declaration confirms the SBE prime’s self-performance scope and enables the Business Enterprise HUB (BEH) staff to verify CUF compliance and appropriate NAICS certification before contract execution.

Description of Self – Performed Work Identify the specific portion(s) of work your firm will self-perform as the SBE prime. Include NAICS code(s), work element/packages(s), and a brief description of work.

NAICS Code(s): Work Element/Package Identify.the.discrete.subcontracting.

opportunity.or.supplier.package.

(e¡g¡?.trade.discipline.or.bid.

package)¿

Description of Work Briefly.describe.portion.of.work.included.in.this.package.for.

this.contract¡.Focus.on.what.is.include.or.excluded?.not.the.full.

contract.scope¡)

EXAMPLE

89❹886. .Plumbing?.

Heating?.and.Air‗ Conditioning.

Contractors

Mechanical.Equipment.Installation.

.Building.A.HVAC.Package

Self‗perform.installation.of.five.(❶).owner‗furnished.rooftop.

HVAC.units.and.associated.ductwork.for.Building.A.only¡.

Includes.labor?.supervision?.duct.fabrication?.and.installation¡.

Excludes.purchase.of.HVAC.units?.electrical.connections?.BAS.

programming?.and.work.in.other.buildings¡

(Add additional pages as needed)

Prime’s Estimated Contract Value ($):

Percentage (%) of Total Contract:

Prime Self-Performance Declaration

BEH-FRM-609.SAW

BEH-FRM-609.SAW Revision Date: 2026.03.19 Page 2 of 2

CUF & NAICS Certification Attestation To count toward the SBE goal, self-performed work must be performed under a Commercially Useful Function (CUF), meaning the Prime:

• Uses its own workforce

• Manages and supervises the work

• Uses its own equipment (or standard commercial lease)

• Is responsible for execution of the work

☐ We certify that all self-performed work listed above will be performed under a CUF and within the Prime’s certified NAICS code(s).

☐ We further certify that all SBE subcontractors identified in the approved SBE Utilization Plan are certified in the NAICS code(s) associated with their scopes of work.

Subcontracting Opportunity Attestation

☐ We certify that commercially reasonable subcontracting opportunities were evaluated consistent with DRIVE policy, and that our firm has not restricted, reduced, or artificially consolidated scopes of work in order to increase SBE prime self-performance.

Subcontracting & No Substitution Statement

☐ We understand that any change to approved subcontractor participation or reallocation of work requires prior BEH approval through submission of the applicable revision and change request forms.

Certification I certify that the information provided in this Self-Performance Declaration is accurate and that all self-performed SBE work will comply with DRIVE Policy requirements, CUF requirements, and NAICS certification requirements.

☐ We understand that self-performed work will be subject to monitoring and compliance review throughout the life of the contract in accordance with DRIVE Monitoring & Compliance procedures.

Officer Signature:

Printed Name:

SBE Subcontractor Intent Form

BEH-FRM-610.SAW

BEH-FRM-610.SAW Revision Date: 2026.03.19 Page 1 of 1

TO: City of Dallas – Business Enterprise Hub (BEH) DATE:

Project Name: Solicitation# intends to enter contract with: , Small Business Enterprise (SBE) Subcontracting Vendor (legal name)

Prime Vendor (legal name) to provide the following good(s)/service/work element(s):

Under NAICS code(s): , for which company is certified to perform.

SBE vendor is currently certified by the following agency (select one):

DFW Business Council: ☐ North Central Texas Regional Certification Agency: ☐ Women’s Business Council SW ☐

Other: ☐ If other, provide certification agency name:

SBE Vendor Certification Number: # Certification Expiration Date:

Certification must be kept current / valid for the entire duration of this contract. Failure to comply with this provision could be subject to removal from contract.

For the purpose of SBE subcontracting participation, the City of Dallas does not include amounts paid to the prime by the sub-contractor.

Prime Vendor’s Total Contract Amount: $ Contract-Specific SBE goal per solicitation: %

SBE Vendor’s Participation Amount: $ SBE Vendor’s Percentage of Total Contract: %

Prime & Subcontractor Acknowledgments

• The Prime Vendor affirms its intent to subcontract with the SBE identified herein, conditioned upon award.

• The SBE subcontractor affirms it will perform the identified scope under a Commercially Useful Function (CUF), within its certified NAICS code(s), and using its own workforce and supervision.

• Only work performed within certified NAICS code(s) and under a CUF may be counted toward the SBE goal.

• Any reduction, substitution, or reallocation of the subcontractor’s scope, value, or percentage participation requires prior BEH approval.

Failure to comply with DRIVE policy requirements may result in adjustment of SBE participation credit or other actions permitted under City policy.

By signing below, the Prime Vendor and SBE Subcontractor certify that the information provided in this Intent Form is accurate and reflects their commitment for purposes of SBE participation, subject to BEH approval and compliance monitoring.

Prime Vendor – Officer’s Signature Printed Name Title Date

SBE Vendor – Officer’s Signature Printed Name Title Date

Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 12/22/2017

FORM 1295CERTIFICATE OF INTERESTED PARTIES

OFFICE USE ONLOFFICE USE ONLOFFICE USE ONLOFFICE USE ONLOFFICE USE ONLYYYYY

6 UNSWORN DECLARATION

My name is _______________________________________________________, and my date of birth is _______________________________.

My address is ________________________________________________, ___________________, _______, __________, ______________.

(street) (city) (state) (zip code) (country)

I declare under penalty of perjury that the foregoing is true and correct.

Executed in ___________________ County, State of ______________ , on the _______ day of _______________, 20______.

(month) (year)

Signature of authorized agent of contracting business entity (Declarant)

ADD ADDITIONAL PAGES AS NECESSARY

Name of Interested Party Nature of Interest (check applicable)City, State, Country

(place of business) Controlling Intermediary

Name of governmental entity or state agency that is a party to the contract for which the form is being filed.

3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract.

Complete Nos. 1 - 4 and 6 if there are interested parties.

Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties.

1 Name of business entity filing form, and the city, state and country of the business entity's place of business.

Check only if there is NO Interested Party.

Mus t fi le on lin e a t w ww.et hic s.s tat e.t x.u s/F ile

Form 2

Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015

CONFLICT OF INTEREST QUESTIONNAIRE

For vendor doing business with local governmental entity

FORM CIQ

This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session.

This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a).

By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code.

A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor.

OFFICE USE ONLY

Date Received

[TI Name of vendor who has a business relationship with local governmental entity.

Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.)

W

Name of local government officer about whom the information is being disclosed.

Name of Officer

Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer.

Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIQ as necessary.

A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor?

Oves No

B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity?

Oves No

Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent or more.

Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1).

[zJ

Signature of vendor doing business with the governmental entity Date

Form 2

Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015

CONFLICT OF INTEREST QUESTIONNAIRE

For vendor doing business with local governmental entity

A complete copy of Chapter 176 of the Local Government Code may be found at http://www.statutes.legis.state.tx.us/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form.

Local Government Code§ 176.001(1-a): "Business relationship" means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on:

(A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity;

(B) a transaction conducted at a price and subject to terms available to the public; or

(C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency.

Local Government Code§ 176.003(a)(2)(A) and (B):

(a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if:

(2) the vendor:

(A) has an employment or other business relationship with the local government officer or a family member of the officer that results in the officer or family member receiving taxable income, other than investment income, that exceeds $2,500 during the 12-month period preceding the date that the officer becomes aware that

(i) a contract between the local governmental entity and vendor has been executed;

or

(ii) the local governmental entity is considering entering into a contract with the vendor;

(B) has given to the local government officer or a family member of the officer one or more gifts that have an aggregate value of more than $100 in the 12-month period preceding the date the officer becomes aware that:

(i) a contract between the local governmental entity and vendor has been executed; or

(ii) the local governmental entity is considering entering into a contract with the vendor.

Local Government Code§ 176.00G(a) and (a-1)

(a) A vendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and:

(1) has an employment or other business relationship with a local government officer of that local governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A);

(2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1); or

(3) has a family relationship with a local government officer of that local governmental entity.

(a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of:

(1) the date that the vendor:

(A) begins discussions or negotiations to enter into a contract with the local governmental entity; or

(B) submits to the local governmental entity an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or

(2) the date the vendor becomes aware:

(A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a);

(B) that the vendor has given one or more gifts described by Subsection (a); or

(C) of a family relationship with a local government officer.

(FORM 3)

NON-COLLUSION AFFIDAVIT

The undersigned bidder or agent, being duly sworn on oath, says that he/she has not, nor has any other member, representative, or agent of the firm, company, corporation or partnership represented by him, entered into any combination, collusion or agreement with any person relative to the price to be bid by anyone at such letting nor to prevent any person from bidding nor to include anyone to refrain from bidding, and that this bid is made without reference to any other bid and without any agreement, understanding or combination with any other person in reference to such bidding.

He/She further says that no person or persons, firms, or corporation has, have or will receive directly or indirectly, any rebate, fee gift, commission or thing of value on account of such sale.

OATH AND AFFIRMATION

I HEREBY AFFIRM UNDER THE PENALTIES FOR PERJURY THAT THE FACTS

AND INFORMATION CONTAINED IN THE FOREGOING BID FOR

DEPARTMENT OF TRANSPORTATION ARE TRUE AND CORRECT.

Dated this day of , (Name of Organization)

(Title of Person Signing)

(Signature)

ACKNOWLEDGEMENT

STATE OF )

COUNTY OF )

) ss

Before me, a Notary Public, personally appeared the above named and swore that the statements contained in the foregoing document are true and correct.

Subscribed and sworn to me this day of , .

Notary Public Signature

My Commission Expires:

Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352

(See reverse for public burden disclosure)

(Form 4) Approved by OMB

0348-0046

1. Type of Federal Action:

a. contract

b. grant

c. cooperative agreement

d. loan

e. loan guarantee

f. loan insurance

2. Status of Federal Action:

a. bid/offer/application

b. initial award

c. post-award

3. Report Type:

a. initial filing

b. material change

For material change only:

Year quarter Date of last report

4. Name and Address of Reporting Entity:

Prime Subawardee

Tier , if Known:

Congressional District, if known:

5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime:

Congressional District, if known:

6. Federal Department/Agency: 7. Federal Program Name/Description:

CFDA Number, if applicable:

8. Federal Action Number, if known: 9. Award Amount, if known:

10. a. Name and Address of Lobbying Registrant (if individual, last name, first name, MI):

b. Individuals Performing Services (including address if different from No. 10a)

(last name, first name, MI):

11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

Signature:

Print Name:

Title:

Telephone No.: Date:

Federal Use Only Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97)

INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES

This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional information.

1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered Federal action.

2. Identify the status of the covered Federal action.

3. Identify the appropriate classification of this report. If this is a followup report caused by a material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federal action.

4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier.

Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.

5. If the organization filing the report in item 4 checks “Subawardee,” then enter the full name, address, city, State and zip code of the prime Federal recipient. Include Congressional District, if known.

6. Enter the name of the federal agency making the award or loan commitment. Include at least one organizational level below agency name, if known. For example, Department of Transportation, United States Coast Guard.

7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments.

8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitations for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Included prefixes, e.g., “RFP-DE-90-001.”

9. For a covered…