7-EXHIBIT V 33-254 - 2091829.pdf

325 KB Posted

Attached to
Lot Scrubbers and Sweeper
Solicitation number
2091829
Issued by
Dallas County, Texas

About this file

Written by GovTribe AI ·

This is an Employee Information Report (DART Form 33.254) submitted to the Dallas Area Rapid Transit Authority in Dallas, Texas, in connection with Solicitation No. 2091829 for Lot Scrubbers and Sweeper services. The form serves as a compliance document requiring contractors to report detailed employment data across all job categories, including officials/managers, professionals, technicians, sales workers, office and clerical staff, craft workers, operatives, laborers, and service workers. The report requires contractors to disaggregate employment figures by gender and racial/ethnic categories, including White (Not of Hispanic Origin), Black (Not of Hispanic Origin), Hispanic, Asian or Pacific Islander, and American Indian or Alaskan Native employees.

The form requires contractors to identify the establishment completing the report, provide the employer identification number, and describe the major activity of the establishment. Contractors must report all permanent full-time and part-time employees, including apprentices and on-the-job trainees, for the relevant payroll period. The form includes a certification section requiring a company official to attest that the report is accurate and prepared in accordance with instructions, along with contact information for the certifying official and the establishment completing the report. This employment data submission is a standard requirement for state and local contract opportunities and is used to monitor contractor compliance with equal employment opportunity and affirmative action requirements.

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Other files

File Type Posted
10-Exhibit L 33-253 2091829.pdf PDF
1-Exhibit I Specifications - 2091829.pdf PDF
6-Exhibit B -B -2091829.pdf PDF
9-Exhibit D - 2091829.pdf PDF
3-Exhibit C -B-2091829.pdf PDF
5-Exhibit A 33.204 - B-2091829.pdf PDF
4-Solicitation Offer and Award -B -2091829.pdf PDF
2-Exhibit F Supply - B-2091829.pdf PDF
8-Exhibit G. -B-2091829.pdf PDF

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Solicitation No.: 2091829

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.: 2091829

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

American Indian or Alaskan Native

White (Not of

Hispanic Origin)

Black (Not of

Hispanic Origin)

Hispanic Asian or Pacific

Islander

American 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

Parent Company Name Address:
Establishment Completing Report Name Address Omit if same as above:
Employer ID Number:
1 What is the major activity of this establishment Be specific ie 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:
Overall Totals Sum of Col B Thru KOfficialsManagers:
White Not of Hispanic OriginOfficialsManagers:
Black Not of Hispanic OriginOfficialsManagers:
HispanicOfficialsManagers:
Asian or Pacific IslanderOfficialsManagers:
America n Indian or Alaskan NativeOfficialsManagers:
White Not of Hispanic OriginOfficialsManagers_2:
Black Not of Hispanic OriginOfficialsManagers_2:
HispanicOfficialsManagers_2:
Asian or Pacific IslanderOfficialsManagers_2:
America n Indian or Alaskan NativeOfficialsManagers_2:
Overall Totals Sum of Col B Thru KProfessionals:
White Not of Hispanic OriginProfessionals:
Black Not of Hispanic OriginProfessionals:
HispanicProfessionals:
Asian or Pacific IslanderProfessionals:
America n Indian or Alaskan NativeProfessionals:
White Not of Hispanic OriginProfessionals_2:
Black Not of Hispanic OriginProfessionals_2:
HispanicProfessionals_2:
Asian or Pacific IslanderProfessionals_2:
America n Indian or Alaskan NativeProfessionals_2:
Overall Totals Sum of Col B Thru KTechnicians:
White Not of Hispanic OriginTechnicians:
Black Not of Hispanic OriginTechnicians:
HispanicTechnicians:
Asian or Pacific IslanderTechnicians:
America n Indian or Alaskan NativeTechnicians:
White Not of Hispanic OriginTechnicians_2:
Black Not of Hispanic OriginTechnicians_2:
HispanicTechnicians_2:
Asian or Pacific IslanderTechnicians_2:
America n Indian or Alaskan NativeTechnicians_2:
Overall Totals Sum of Col B Thru KSales Workers:
White Not of Hispanic OriginSales Workers:
Black Not of Hispanic OriginSales Workers:
HispanicSales Workers:
Asian or Pacific IslanderSales Workers:
America n Indian or Alaskan NativeSales Workers:
White Not of Hispanic OriginSales Workers_2:
Black Not of Hispanic OriginSales Workers_2:
HispanicSales Workers_2:
Asian or Pacific IslanderSales Workers_2:
America n Indian or Alaskan NativeSales Workers_2:
Overall Totals Sum of Col B Thru KOffice Clerical:
White Not of Hispanic OriginOffice Clerical:
Black Not of Hispanic OriginOffice Clerical:
HispanicOffice Clerical:
Asian or Pacific IslanderOffice Clerical:
America n Indian or Alaskan NativeOffice Clerical:
White Not of Hispanic OriginOffice Clerical_2:
Black Not of Hispanic OriginOffice Clerical_2:
HispanicOffice Clerical_2:
Asian or Pacific IslanderOffice Clerical_2:
America n Indian or Alaskan NativeOffice Clerical_2:
Overall Totals Sum of Col B Thru KCraft Workers Skilled:
Overall Totals Sum of Col B Thru KOperatives SemiSkilled:
White Not of Hispanic OriginService Workers:
Black Not of Hispanic OriginService Workers:
HispanicService Workers:
Asian or Pacific IslanderService Workers:
America n Indian or Alaskan NativeService Workers:
White Not of Hispanic OriginService Workers_2:
Black Not of Hispanic OriginService Workers_2:
HispanicService Workers_2:
Asian or Pacific IslanderService Workers_2:
Answer if not consolidated report:
Dates of Payroll Period Used:
Does the establishment employ apprentices:
NameTitle of Certifying Official:
Signature:
Date:
Contact Name:
Address Number Street:
Title:
City State:
Zip Code:
Telephone:
Extension:
Craft Workers:
0:
1:
2:
4:
3:
5:
6:
0:
1:
2:
3:
Operatives (Semi-skilled):
0:
1:
2:
3:
4:
6:
7:
0:
1:
2:
3:
Laborers (Unskilled):
0:
1:
2:
3:
4:
5:
0:
1:
2:
3:
4:
Overall Totals: Laborers (Unskilled):
Overall Totals: Service Workers:
Total:
Total Male: White Not of Hispanic Origin:
Total Male: Black Not of Hispanic Origin:
Total Male: Hispanic:
Total Male : Asian or Pacific Islander:
Total Male: American Indian or Alaskan Native:
Total Female: American Indian or Alaskan NativeWhite (Not of Hispanic Origin):
Total Female: Black Not of Hispanic OriginTOTAL_2:
Total Female: Hispanic:
Total Female: Asian or Pacific Islander:
Total Female: America n Indian or Alaskan Native:
Female: American Indian or Alaskan NativeService Workers:
Section E- Certification: Off
Type of reporting unit for which this copy of the form is submitted: Off

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