7-15 Exhibit V 33-254.pdf
PDF 136 KB Posted
- Attached to
- IDIQ for MOXA Devices
- Solicitation number
- 2097807
- Issued by
- Dallas County, Texas
About this file
This is an Employee Information Report (DART Form 33.254) submitted by the Dallas Area Rapid Transit Authority in Dallas, Texas, in connection with Solicitation No. 2097807. The form serves as a standard employment data collection document required for state and local contract opportunities. The report requires contractors to provide comprehensive employment information organized by job categories, including officials and managers, professionals, technicians, sales workers, office and clerical staff, craft workers, operatives, laborers, and service workers. Data must be disaggregated by gender and ethnicity, covering White (non-Hispanic), Black (non-Hispanic), Hispanic, Asian or Pacific Islander, and American Indian or Alaskan Native populations. The form requests establishment identification details, payroll period dates, information regarding apprentice employment, and certification by an authorized official confirming accuracy and compliance with submission instructions.
The Employee Information Report does not contain pricing terms, set-asides, incumbent information, funding sources, or contract award details. Instead, it functions as a compliance and equal employment opportunity documentation tool required during the procurement process. Contractors must complete all sections with accurate employment data or face potential disqualification. The form includes spaces for contact information of the certifying official responsible for verification and submission accuracy. This particular form is associated with an IDIQ contract for MOXA devices and industrial Ethernet switches to support the agency's operational technology and transportation infrastructure needs in Texas.
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Text version
Solicitation No. 2097807
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. 2097807
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 .