Attachment D - CDOT FORM - 1416 .pdf

COLORADO DEPARTMENT OF TRANSPORTATION

GOOD FAITH EFFORT REPORT (CDOT Form 1416) Section A. Bidder/Prime Contractor and Project Information

1. Project (S/A) No.

or PCN Number (5 digit #):

2. FHWA Project #, Subaward Agreement # from

COTRAMS (FTA

projects), or PO # (for CM/GC-CM contracts):

3. Project Name:

4. Name of Bidder/Prime Contractor:

5. Bidder/Prime Contractor's Contact Name:

6. Bidder/Prime Contractor's Contact Title:

7. Bidder/Prime Contractor's Contact Phone #:

8. Bidder/Prime Contractor's Contact Email Address

Section B. Bid/Proposal Information (to be completed ONLY if submitted at bid time)

9. Bid/Proposal $Amount:

10. Contract Goal %Percentage

11. Contract Goal Dollar $Value:

Section C. Contract Summary to Date (not including this request) (to be completed after project is awarded)

12. Original Contract Amount:

13. Total Change $Orders (to date):

14. Total Other Adjustments $(to date):

15. Adjusted Contract Amount (applicable to $the DBE goal):

16. Contract DBE Goal (to $ %date):

17. Commitment (to date): $ % 18. Participation (to date): $ %

19. Applicable Small Business Goals DBE Design Goal DBE Construction Goal (To be completed ONLY for FHWA-funded Design-Build contracts) Applicable Contract Year: (July 1, - June 30, )

Section D. Efforts to Achieve DBE Participation. Complete the questions below and provide any supporting documentation which demonstrates the Bidder/Prime Contractor's good faith efforts. Attach additional page(s) as necessary.

20. Describe the overall plan or approach to meet the contract goal.

21. List the amount and the type of work the Bidder/Prime Contractor intends to self-perform on the contract.

22. List the amount and the type of work the Bidder/Prime Contractor intends to subcontract.

23. List the amount and type of work for all subcontracting opportunities for DBEs. Using the DBE Directory, include the number of DBEs that are certified in the specific NAICS codes for each contracting area.

"Previous editions are obsolute and may not be used." CDOT Form No. 1416 [09/23] Page 1

Section D. Efforts to Achieve DBE Participation (continued...) Describe the efforts to obtain DBE participation (i.e. how the Bidder/Contractor attempted to execute the plan or approach to meeting the contract goal). Cost alone shall not be a reason to reject a DBE and will be considered in the evaluation. Attach additional page(s) if necessary.

24. List the direct outreach conducted (state the name of the DBE solicited, date(s) and method of outreach - phone, email, or fax) (attach all supporting documentation for the direct outreach conducted).

25. List the indirect outreach conducted to contact DBEs such as events, publications, and/or communication with minority and other organizations. Include date(s), location, and audience of each event, and attach all supporting documentation for the indirect outreach conducted.

26. List other efforts made to assist DBEs in competing for or obtaining contracts (accepting quotes from DBEs that may be higher than other subcontractors, modifications to contract scopes, unbundling, mentoring, etc.).

27. List and describe any obstacles encountered in assisting or contracting with DBEs.

"Previous editions are obsolute and may not be used." CDOT Form No. 1416 [09/23] Page 2

28. Include any other efforts made by the Contractor to obtain DBE participation.

29. If the eligible participation submitted on the Form 1414 was miscalculated, determined to be invalid, or otherwise did not meet the contract goal, provide the justification for such deficiencies and the remedies that were taken to avoid the issue in the future. If the Bidder has obtained any additional commitments since submission of the bid, attach the Form 1415(s) and the reason why such commitments were not obtained prior to the proposal due date. (To be completed ONLY if submitted at proposal time)

Section E. Affidavit of Good Faith Efforts The Bidder/Contractor must show that it took all necessary and reasonable steps to achieve the DBE contract goal, which by their scope, intensity, and appropriateness to the objective could reasonably be expected to obtain sufficient DBE participation, even if not fully successful. 49 CFR Part 26, Appendix A sets forth examples and guidance for good faith efforts. The Bidder/Contractor is not limited to the examples provided in 49 CFR Part 26, Appendix A and may provide any documentation that demonstrates good faith efforts to obtain DBE participation on this contract.

If, at any time, CDOT has reason to believe that any person or firm has willfully and knowingly provided incorrect information or made false statements, CDOT may initiate suspension or debarment proceedings against the person or firm under 49 CFR Part 26, take enforcement action under 49 CFR Part 31, Program Fraud and Civil Remedies, and/or refer the matter to the Department of Justice or Office of the Inspector General for criminal prosecution under 18 U.S.C. 1001, which prohibits false statements in Federal programs.

By signing below, the Bidder/Contractor hereby affirms that it has made good faith efforts and has documented all such efforts on this form and through the attached supporting documentation.

30. Bidder/Prime Contractor Signature: 31. Date:

Section F. Determination

32. Project Owner Representatives (CDOT or Subrecipient/Local Agency)

Pre-Award ONLY CDOT Civil Rights Business Resource Center (CRBRC):

Approve

Reject

b. First & Last Name

Recommend for Approval

Recommend for Rejection

Approve

Reject

a. Title

Post- Award ONLY CDOT Region Civil

Rights Specialist (for post-award):

Post-Award ONLY Project

Engineer/Manager:

c. Signature d. Date e. Determination

33. Comments:

"Previous editions are obsolute and may not be used." CDOT Form No. 1416 [09/23] Page 3