3-Form OEPP-Add-1-fillable.pdf

Oregon Department of Transportation

US101/OR540 ADA Curb Ramps (Coos Bay/North Bend), Phase 2 Form OEPP Key No. K22570/C15578

Form OEPP - 1 Addendum 1

Form OEPP

Part 2 - Design, Quality Management and Professional Services Commitment Plan

Subconsultant [insert name]

Type of Work %DBE Credit

DBE

Subconsultant Price

% DBE

Commitment of Design, Quality Management and Professional Services

Total Design, Quality Management and Professional Services – DBE Commitment Amount

Total Design, Quality and Professional Services Contract Cost $

Part 3 - Construction Services

Subcontractor (Named Firms)

Type of Work % DBE Credit

DBE $

Construction

% DBE

Commitment

DBE Subtotal to Named Firms $ %

TO BE SELECTED ITEMS

To Be Selected Type of Work DBE Credit

DBE Contract Amount

DBE

Commitment

To Be Selected % $ % To Be Selected % $ % To Be Selected % $ % DBE Subtotal “To Be Selected” Items % $ %

Total Construction Projected DBE Selection $ % Total Construction Price $

Oregon Department of Transportation

US101/OR540 ADA Curb Ramps (Coos Bay/North Bend), Phase 2 Form OEPP Key No. K22570/C15578 Form OEPP - 2 Addendum 1

Proposer acknowledges and certifies that this form accurately represents receipt of and consent from the DBE firms listed in the “Design and Quality Management Services Commitment Plan” section of Form OEPP to provide the identified services for the performance of the above referenced project. Proposer certifies that the COBID Certification Directory was reviewed to confirm that the listed firm are certified as DBEs as of the date of the Proposal. These acknowledgements and certifications shall be deemed a part of the resulting Contract. At award, both Design-builder and committed DBE firms may be required to sign the Final OEPP and affirm these certifications.

Proposer/Design-Builder

Signature Name

Title Date