Attachment D - CDOT FORM - 1416 (Instructions).pdf

CDOT Form No. 1416 Instructions [7/23] Page 1

COLORADO DEPARTMENT OF TRANSPORTATION

Good Faith Effort Report (CDOT Form 1416)

Form Instructions

Section A: Prime Contractor and Project Information

1. Project (S/A) Number or PCN Number (5 digit #) – list the project CDOT subaccount number (ex:

12345) or PCN Number

2. FHWA Project # or Subaward Agreement # from COTRAMS (FTA projects) – For FHWA-funded projects, list the federal project number. This is the hyphenated alpha numeric code provided in the announcement. (ex. NHPP-0001-003). For FTA projects, list the Subaward Agreement # from

COTRAMS

3. Project Name – enter the name of the project

4. Name of Bidder/Prime Contractor – enter the name of the Bidder (if prior to award) or Prime

Contractor (after award) making the request

5. Bidder/Prime Contractor’s Contact Name – enter the first and last name of the

Bidder (if prior to award) or Prime Contractor (after award) contact completing the form

6. Bidder/Prime Contractor’s Contact Title – enter the title of the Bidder/ Prime Contractor contact in

A5

7. Bidder/Prime Contractor’s Contact Phone Number – enter the telephone number of the Bidder/Prime

Contractor contact in A5

8. Bidder/Prime Contractor’s Contact Email - enter the email address of the Bidder/Prime Contractor contact in A5

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

9. Bid/Proposal Amount – enter the dollar amount of the proposal

10. Contract Goal Percentage – enter the contract goal %

11. Contract Goal Dollar Value – enter the dollar amount as calculated by multiplying the goal % (B10) to the Proposal Amount (B9)

Section C: Contract Summary to Date – the information completed in this section SHOULD NOT include amounts for this request. This section is to be completed after project is awarded.

12. Original Contract Amount – enter the amount of the original contract applicable to the contract goal (for FHWA-funded Design-Build projects, for the goal selected in C19)

13. Total Change Orders (to date) – enter the amount of change orders that have been issued to date that adjusted the original contract amount applicable to the contract goal (for FHWA-funded Design-Build projects, for the goal selected in C19)

14. Total Other Adjustments (to date) – enter the amount of other adjustments that may adjust the contract amount applicable to the contract goal

15. Adjusted Contract Amount – the amount (as adjusted) that the contract goal (for FHWA-funded Design-Build projects, for the goal selected in C19) is applied to (prior to this request)

16. Contract DBE Goal (to date) – enter the contract goal (%) and the dollar amount as calculated by multiplying the goal % to the Adjusted Contract Amount (C15)

17. Commitment (to date) – enter the dollar value of the commitment made by the Contractor to date applicable to the contract goal (for FHWA-funded Design-Build projects, for the goal selected in C19) selected in Section A and then calculate the % associated with that commitment by dividing the Commitment $ by the Adjusted Contract Amount (C15)

18. Participation (to date) – enter the amount of eligible participation payments made to date towards the contract goal (for FHWA-funded Design-Build projects, for the goal selected in C19) and calculate the % of participation by dividing the Participation $ by the Adjusted Contract Amount (C15)

CDOT Form No. 1416 Instructions [7/23] Page 2

19. Applicable Small Business Goals (for FHWA-funded Design-Build projects) – select the project goal and enter the applicable contract year that the modification request is applicable to.

Section D: Efforts to Achieve DBE Participation. Complete a narrative 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 meeting 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 the 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.

https://coucp.dbesystem.com/FrontEnd/SearchCertifiedDirectory.asp?XID=8140&TN=coucp

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

25. List the indirect outreach conducted to reach DBEs such as events, publications, and/or communication with minority and other organizations (state date(s), location and audience) (attach any 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.

28. Include any other efforts made 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 – this section is to be completed by the Bidder/Prime Contractor

30. Bidder/Prime Contractor Signature – enter the signature of the Prime Contractor representative in A5.

31. Date – the date of the signature entered in E30

Section F: Determination

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

a. Titles – the CDOT Region Civil Rights Project Specialist and Project Manager will complete their respective information here

b. First & Last Name – enter the first and last name of the respective CDOT Region Civil Rights Project Specialist and Project Manager Representative

c. Signature - enter the signature of the respective CDOT Region Civil Rights Project Specialist and Project Manager

d. Date - enter the date of the signature of the respective CDOT Region Civil Rights Project Specialist and Project Manager

e. Determination – Enter the determination of the respective CDOT Region Civil Rights Project Specialist and Project Manager

33. Comments – the P r o j e c t Ow n e r representatives will provide any comments that are deemed applicable to the request and final determination rendered.

https://coucp.dbesystem.com/FrontEnd/SearchCertifiedDirectory.asp?XID=8140&TN=coucp