Contract Final DBE 17f1e.xlsx
XLSX spreadsheet 22 KB Posted
- Solicitation number
- RFQ 2026-10
- Issued by
- California
About this file
This document is a Caltrans Exhibit 17-F1 form for the Final Report-Utilization of Disadvantaged Business Enterprises (DBE) for Architecture and Engineering (A&E) On-Call Contracts. The form provides detailed instructions for reporting DBE participation in state and local government contracts, specifically for on-call consulting services. The template is designed to capture critical information including contract numbers, agency details, contract amounts, task order specifics, and DBE firm contributions.
The form serves as a comprehensive tracking mechanism for DBE involvement, requiring prime consultants to document their DBE subconsultant utilization, including firm names, certification numbers, contract payments, work completion dates, and final payment dates. It mandates certification by both the consultant representative and a local agency representative, with spaces for signatures, contact information, and an explanation box for any discrepancies between original DBE commitment and actual utilization. The form is part of California's Local Assistance Procedures Manual and is specifically linked to an on-call materials testing and geotechnical consultant services opportunity for the City of Hanford, which seeks to establish contracts with up to three qualified consulting firms for geotechnical engineering services.
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Other files
| File | Type | Posted |
|---|---|---|
| Exhibit10-A.pdf | ||
| Exhibit 10-H.pdf | ||
| Exhibit 10-U.docx | DOCX document | |
| Exhibit 10-Q.pdf | ||
| RFQ 2026-10 On Call Geotech Testing Services.pdf | ||
| Attachment A - Exhibit 10R.pdf | ||
| Exhibit 10-K.pdf | ||
| aashto-internal-control-questionnaire.pdf | ||
| Attachment C - City of Hanford QAP-2024.pdf |
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Text version
Instructions
INSTRUCTIONS – FINAL REPORT-UTILIZATION OF DISADVANTAGED BUSINESS ENTERPRISES (DBE)
FOR ON-CALL CONTRACTS AND FIRST-TIER SUBCONSULTANTS
| 1. | Local Agency Contract Number - Enter the Local Agency contract number or identifier. |
| 2. | Local Agency - Enter the name of the local or regional agency that is funding the contract. |
| 3. | Caltrans District - Enter the appropriate Caltrans District number as 1 through 12. |
| 4. | Contract Completion Date - Enter the date the contract was completed. |
| 5. | Consultant - Enter the consultant’s firm name. |
| 6. | Business Address - Enter the consultant’s business address. |
| 7. | Orig. Contract Amount - Enter the original on-call contract amount. |
| 8. | Final Contract Amount - Enter the total final amount for the contract. |
| 9. | Task Order Number - Enter task order or work order number. |
| 10. | Federal Project Number - Enter 7 digit Federal Project Number that corresponds to task order. |
| 11. | Task Order DBE Firm – Enter the DBE consultant’s firm name and certification number for each task order. |
| 12. | Task Order Description - Enter the description of the task order. |
| 13. | Contract Payments - Enter all non-DBE and DBE actual total payment amounts. |
| 14. | Date Work Completed - Enter the date the subconsultant’s item work was completed. |
| 15. | Date of Final Payment - Enter the date when the prime consultant made the final payment to the subconsultant for the portion of work listed as being completed. |
| 16. | Total - Verify autosum of the “Contract Payments” Non-DBE and DBE columns. |
| 17. | Original DBE Commitment Amount – Enter the estimate from the Exhibit 10-O2 for the contract. |
| 18. | Explanation Box: If original DBE commitment does not match or exceed actual utilization, please explain. |
| 19. | Consultant Representative’s Signature - Enter the name of the person preparing and signing the form. |
| 20. | Consultant Representative’s Name - Enter the name of the person preparing and signing the form. |
| 21. | Phone - Enter the area code and telephone number of the person signing the form. |
| 22. | Date - Enter the date the form is signed by the consultant’s preparer. |
| 23. | Local Agency Representative’s Signature - A Local Agency Representative must sign their name to certify that the contracting records of the DBE(s) has been monitored. |
| 24. | Local Agency Representative’s Name - Enter the name of the Local Agency Representative signing the form. |
| 25. | Phone - Enter the area code and telephone number of the person signing the form. |
| 26. | Date - Enter the date the form is signed by the Local Agency Representative. |
&"Arial,Regular"&8Local Assistance Procedures Manual &"Arial,Regular"&8Exhibit 17-F1 A&&E On-Call Final Report-Utilization of Disadvantaged Business Enterprises (DBE) for On-Call Contracts
&"Arial,Regular"&8Page &P of &N January 2023
17-F1 EXHIBIT 17-F1: FINAL REPORT-UTILIZATION OF DISADVANTAGED BUSINESS ENTERPRISES (DBE) FOR A&E ON-CALL CONTRACTS
1. Local Agency Contract Number 2. Local Public Agency 3. Caltrans District 4. Contract Completion Date
5. Consultant 6. Business Address 7. Orig. Contract Amount ($) 8. Final Contract Amount ($)
| 9. Task Order Number | 10. Federal Project Number | 11. Task Order DBE Firm | 12. Task Order Description | 13. Contract Payments ($) | 14. Date Work Completed | 15. Date of Final Payment | ||
| Name | Cert. # | Non-DBE | DBE |
| 16. TOTAL for Task Orders: | $0.00 | $0.00 | $0.00 | |||
| 17. ORIGINAL DBE COMMITMENT AMOUNT: | Estimate from 10-O2. | |||||
| List actual amount paid to all DBEs and non-DBEs for all task orders. If actual DBE utilization percentage (or item of work) was less than that approved at the time of award, provide comments in Explanation Box. | ||||||
| 18. Explaination Box: | ||||||
| I CERTIFY THAT THE ABOVE INFORMATION IS COMPLETE AND CORRECT | ||||||
| 19. Consultant Representative’s Signature | 20. Consultant Representative’s Name | 21. Phone | 22. Date |
| I CERTIFY THAT THE CONTRACTING RECORDS OF THE DBE(S) HAS BEEN MONITORED | |||
| 23. Local Agency Representative’s Signature | 24. Local Agency Representative’s Name | 25. Phone | 26. Date |
DISTRIBUTION: Original – Local Agency, Copy – Caltrans District Local Assistance Engineer, include with Final Report of Expenditures.
&"Arial,Regular"&8Local Assistance Procedures Manual &"Arial,Regular"&8Exhibit 17-F1 A&&E On-Call Final Report-Utilization of Disadvantaged Business Enterprises (DBE) for On-Call Contracts
&"Arial,Regular"&8Page 1 of 1 &K000000January 2023
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