3-OPS-FRM-240.pdf
PDF 151 KB Posted
- Solicitation number
- CIZ26-BCM-3223
- Issued by
- Dallas County, Texas
About this file
This is a Contractor's Affidavit form (OPS-FRM-240) issued by the City of Dallas Office of Procurement Services - Business Enterprise Hub for use in conjunction with design-build services for roof replacement and water infiltration mitigation projects at the Bath House Cultural Center (BHCC) and South Dallas Cultural Center (SDCC). The form functions as a Schedule of Work and Actual Payment document requiring prime contractors and first-tier subcontractors to report work performed, payment details, and subcontractor information. Contractors must list each firm involved, identify the type of work to be performed, provide NAICS or NIGP codes, include firm contact information, and designate whether firms are local (within Dallas County limits) or non-local (outside Dallas County limits).
The form requires documentation of the value of work for each firm, total payments to date, payment amounts for the current period, and percentage of total contract value. All totals and percentages are designed to calculate automatically. The form includes a formal affidavit statement requiring the prime contractor's signature and affirming that the listed subcontractors are intended to be bound by a formal agreement contingent upon contract award. The document explicitly prohibits undocumented changes to the subcontractor list without City approval and warns that failure to comply may result in contract termination, sanctions against the prime contractor, and ineligibility for future City of Dallas contracts. The form was last revised on July 15, 2025.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Attachment C(1)
Project Name Solicitation #:
Contract #:
Instructions:
Column 1: Column7:
Column 2: Column 8:
Column 3: Column 9:
Column 4:
Column 5:
Column 6:
Type of Work NAICS or NIGP Codes
Name and Address of Firm
Contact Name and Number L or N Value of Work ($) Percent
Payments to Date
Payment this
Period ($) [1] [2] [3] [4] [5] [6] [7] [8] [9]
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
$ - #DIV/0!
List firm's contact name and telephone number.
Indicate firm's location as L=local (within Dallas county limits); N=Non-local (Outside Dallas county limits)
Office of Procurement Services - Business Enterprise Hub Cover Memo - Contractor's Affidavit - Schedule of Work and Actual Payment (OPS-FRM-240)
Indicate total payments to date.
Indicate percentage of total contract amount.
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)
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/ List firm's name and address. Indicate payments during current pay period.
List the type of work to be performed by Prime and 1st tier subcontractors.
OPS-FRM-240 Rev. 7/15/2025
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Total Bid Amount: -$ #DIV/0! -$ -$
Title:
Date:
Company Name:
Note: Totals and Percentages will automatically calculate.
Printed Name:
Officer's Signature:
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.
#DIV/0!
OPS-FRM-240 -
File details come from the government source that posted it. Updated .