5-15 Exhibit V.pdf
PDF 337 KB Posted
- Attached to
- 10 Gig Xtran Modules
- Solicitation number
- 2093213
- Issued by
- Dallas County, Texas
About this file
This is an Employee Information Report form (DART Form 33.254) submitted to the Dallas Area Rapid Transit Authority (DART) in Dallas, Texas, in connection with Solicitation No. 2093213 for the purchase of 10 Gigabit XTran transport cards and SFP modules. The form is a standardized reporting document used to collect employment demographic data from contractors and vendors. The document is designed to accommodate single-establishment employers as well as multi-establishment employers, with options for consolidated, headquarters unit, or individual establishment reporting. Respondents must complete sections covering company identification, establishment information detailing the major activity of the business, and detailed employment data organized by job categories and demographic classifications including gender and race/ethnicity.
Section D of the form requires reporting of all permanent full-time and part-time employees, apprentices, and on-the-job trainees across nine job categories: Officials/Managers, Professionals, Technicians, Sales Workers, Office & Clerical, Craft Workers (Skilled), Operatives (Semi-Skilled), Laborers (Unskilled), and Service Workers. The form mandates demographic breakdown by gender and five racial/ethnic categories. Respondents must also indicate payroll period dates and whether the establishment employs apprentices. The form requires certification by an authorized official confirming accuracy and compliance with submission instructions, along with contact information for verification purposes. This reporting requirement is typical for DART procurement activities to ensure compliance with equal employment opportunity and affirmative action obligations.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 11-01 Offer Award Cover 33-201.pdf | ||
| 2-03 Exh A.pdf | ||
| 9-11 Exhibit L 33-253PF.pdf | ||
| 8-10 Exhibit I.pdf | ||
| 1-02 Bid Schedule.pdf | ||
| 10-06 Exhibit-D.pdf | ||
| 7-08 Exhibit G, SBC 33-215.pdf | ||
| 6-04 Exhibit-B.pdf | ||
| 4-07 Exhibit F. Supply 33-301.pdf | ||
| 3-05 Exhibit C.pdf |
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Text version
Solicitation No. 2093213
DART Form 33.254(04/04) Page 1 of 2
DALLAS AREA RAPID TRANSIT AUTHORITY
DALLAS, TX
EXHIBIT V
EMPLOYEE
INFORMATION REPORT
SECTION A - TYPE OF REPORT
Indicate by marking in the appropriate box the type of reporting unit for which this copy of the form is submitted (MARK ONLY ONE BOX).
Single Establishment Employer Report Multi-Establishment Employer, Consolidated Report (Required) Multi-Establishment Employer, Headquarters Unit Report (Required) Multi-Establishment Employer, Individual Establishment Report (submit one for each establishment with 50 or more employees) Multi-Establishment Employer, Special Report
Total number of reports being filed by this company (answer only if consolidated report).
SECTION B-COMPANY IDENTIFICATION
(To be answered by all)
Parent Company Name & Address:
Establishment Completing Report Name & Address (Omit if same as above)
Employer ID Number:
SECTION C - ESTABLISHMENT INFORMATION
(Omit on the Consolidated Report)
1. What is the major activity of this establishment? (Be specific, i.e., manufacturing steel castings, retail grocer, wholesale plumbing supplies, title insurance, etc. Include the specific type of product or type of service provided, as well as the principal business or industrial activity.)
Solicitation No. S-2093213
DART Form 33.254(04/04) Page 2 of 2
SECTION D-EMPLOYMENT DATA
Employment at this establishment -- Report all permanent full-time and part-time employees including apprentices and on-the-job trainees unless specifically excluded as set forth in the instructions. Enter the appropriate figures on all lines and in all columns. Blank spaces will be considered zeros.
JOB
CATEGORIES
NUMBER OF EMPLOYEES
Overall Totals
(Sum of Col. B
Thru K)
MALE
FEMALE
White (Not of
Hispanic Origin)
Black (Not of
Hispanic Origin)
Hispanic Asian or Pacific
Islander
America n Indian or Alaskan Native
White (Not of
Hispanic Origin)
Black (Not of
Hispanic Origin)
Hispanic Asian or Pacific
Islander
America n Indian or Alaskan Native
Officials/Managers Professionals Technicians Sales Workers Office & Clerical Craft Workers (Skilled)
Operatives (Semi-Skilled)
Laborers (Unskilled)
Service Workers
TOTAL
Answer if not consolidated report: Dates of Payroll Period
Used
Does the establishment employ apprentices?
SECTION E - CERTIFICATION
(See Instructions concerning certification in Exhibit G)
Check One: All reports are accurate and were prepared in accordance with the instructions (check on consolidated only)
This report is accurate and was prepared in accordance with the instructions.
Name/Title of Certifying Official
Signature Date:
Contact Name
Address (Number & Street)
Title City & State
Zip Code Telephone Extension
File details come from the government source that posted it. Updated .