3-OPS-FRM-240 - Contractors Affidavit - Schedule of Work and Actual Payment.xlsx

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Attached to
Request for Bids – Three Intersections New Construction / Reconstruction – Old Seagoville Rd at N Masters Dr / N Hampton Rd at Leath St / Ferndale Rd at Walnut Hill Ln
Solicitation number
CIZ25-TRN-3193
Issued by
Dallas County, Texas

About this file

The document is a Contractor's Affidavit form (OPS-FRM-240) from the City of Dallas Office of Procurement Services - Business Enterprise Hub, designed to track subcontractor work and payment details for a specific contract. This form is associated with a Department of Transportation and Public Works project involving new traffic signal construction and reconstruction at three intersections: Old Seagoville Road at N Masters Drive, N Hampton Road at Leath Street, and Ferndale Road at Walnut Hill Lane. The bid solicitation is scheduled for release on Friday, September 12, 2025, with bids due by 1:00 p.m. on Friday, September 26, 2025. A pre-bid meeting will be held on Tuesday, September 16, 2025, via Microsoft Teams.

The affidavit form provides a structured template for prime contractors to detail subcontractor information, including work types, NAICS/NIGP codes, firm names, contact details, location (local or non-local), work value, percentage of total contract amount, and payment information. The form emphasizes compliance requirements, noting that any changes to the subcontractor list must be submitted to the City for approval, with potential consequences including contract termination, sanctions, or future contract ineligibility. The bid opportunity will be hosted on the Bonfire platform, with bid openings viewable on the City of Dallas Webcasting Website, and includes call-in information for remote participation.

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OPS-FRM-240

Office of Procurement Services - Business Enterprise Hub
Cover Memo - Contractor's Affidavit - Schedule of Work and Actual Payment (OPS-FRM-240)
Project Name:Solicitation #:
Contract #:

Instructions:

Column 1:List the type of work to be performed by Prime and 1st tier subcontractors.Column7:Indicate percentage of total contract amount.
Column 2:Please provide all NAICS or NIGP codes for each entry. Use a comma to separate each code. To search for NAICS codes visit https://www.census.gov/naics/.Column 8:Indicate total payments to date.
Column 3:List firm's name and address.Column 9:Indicate payments during current pay period.
Column 4:List firm's contact name and telephone number.
Column 5:Indicate firm's location as L=local (within Dallas county limits); N=Non-local (Outside Dallas county limits).
Column 6:Indicate dollar amount of value of work for each firm.
Office of Procurement Services - Business Enterprise Hub
Contractor's Affidavit - Schedule of Work and Actual Payment (OPS-FRM-240)
Type of WorkNAICS or NIGP CodesName and Address of FirmContact Name and NumberL or NValue of Work ($)Percent (%)Payments to Date ($)Payment this Period ($)
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Note: Totals and Percentages will automatically calculate. Total Bid Amount: $ - 0 ERROR:#DIV/0! $ - 0 $ - 0

The undersigned intends to enter into a formal agreement with the subcontractors listed, conditioned upon being awarded the City of Dallas contract. 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 Change of Subcontractor Form. 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.

Officer's Signature: Title:

Printed Name:Date:
Company Name:

OPS-FRM-240 Page &P of &N Rev. 7/15/2025 image1.jpeg

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