Form_1._Personal_Professional_Sub-consultant_Disclosure_Form.pdf

PDF 1 MB Posted

Attached to
Downtown Parking Enforcement State and local contract opportunity
Solicitation number
26-043
Issued by
Washington County, Barlow City, Oregon

About this file

This is a Subconsultant Disclosure Form for Personal/Professional Services Contracts issued by the City of Beaverton, Oregon, in connection with the Downtown Parking Enforcement contract opportunity. The form is designed to capture information about all subconsultants that a prime contractor plans to engage for the parking enforcement and compliance services project. The document requires contractors to list subconsultants' complete legal names, addresses, contact information, descriptions of work scope, and dollar values of subcontracts for up to eight subconsultants. The form appears to be a blank template with fields that contractors must complete and submit as part of their bid response.

The form requires contractors to identify and disclose certifications held by subconsultants, including Emerging Small Business (ESB), Minority-owned Business (MBE), Women-Owned Business (WBE), Service-Disabled Veteran-Owned Business (SDV), Disadvantaged Business Enterprise (DBE), and Airport Concessions Disadvantaged Business Enterprise (ACDBE) designations. This disclosure mechanism indicates that the City of Beaverton has established diversity and small business utilization goals or preferences for the Downtown Parking Enforcement contract. The form serves as a transparency and compliance tool to ensure that prime contractors adequately document their supply chain composition and demonstrate commitment to engaging certified disadvantaged and minority-owned businesses as subcontractors on the project.

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Text version

Company Name: ______________________________________ Project Name: _____________________________________________________

LIST ALL SUBCONSULTANTS —CERTIFIED AND NON-CERTIFIED

ALL SUBCONSULTANTS

(Use the Subconsultants complete legal name)

DESCRIPTION OR SCOPE OF WORK

(TYPE OF WORK TO BE PERFORMED)

DOLLAR VALUE OF

SUBCONTRACT

LIST ALL CERTIFICATIONS

(ESB; MBE, WBE, SDV, DBE, ACDBE)

Name ______________________________________

Address ____________________________________

City/St/Zip __________________________________

Phone ______________________________________

Name ______________________________________

Address ____________________________________

City/St/Zip __________________________________

Phone ______________________________________

Name ______________________________________

Address ____________________________________

City/St/Zip __________________________________

Phone ______________________________________

Name ______________________________________

Address ____________________________________

City/St/Zip __________________________________

Phone ______________________________________

*ESB: Emerging Small Business; MBE: Minority-owned Business; WBE: Women-Owned Business; SDV: Service-Disabled Veteran-Owned Business;

DBE & ACDBE Disadvantaged Business Enterprise Rev 5/6/19

CITY OF BEAVERTON

PERSONAL / PROFESSIONAL SERVICES CONTRACT: SUBCONSULTANT DISCLOSURE FORM 1

ALL SUBCONSULTANTS

(Use the Subconsultants complete legal name)

DESCRIPTION OR SCOPE OF WORK

(TYPE OF WORK TO BE PERFORMED)

DOLLAR VALUE OF

SUBCONTRACT

LIST ALL CERTIFICATIONS

(ESB; MBE, WBE, SDV, DBE, ACDBE)

Name ______________________________________

Address ____________________________________

City/St/Zip __________________________________

Phone ______________________________________

Name ______________________________________

Address ____________________________________

City/St/Zip __________________________________

Phone ______________________________________

Name ______________________________________

Address ____________________________________

City/St/Zip __________________________________

Phone ______________________________________

Name ______________________________________

Address ____________________________________

City/St/Zip __________________________________

Phone ______________________________________

*ESB: Emerging Small Business; MBE: Minority-owned Business; WBE: Women-Owned Business; SDV: Service-Disabled Veteran-Owned Business;

DBE & ACDBE Disadvantaged Business Enterprise Rev 5/6/19

CITY OF BEAVERTON

PERSONAL / PROFESSIONAL SERVICES CONTRACT: SUBCONSULTANT DISCLOSURE FORM 1

LIST ALL SUBCONSULTANT—CERTIFIED AND NON-CERTIFIED

Project Name:
Name:
Address:
CityStZip:
Phone:
Name_2:
Address_2:
CityStZip_2:
Phone_2:
Name_3:
Address_3:
CityStZip_3:
Phone_3:
Name_4:
Address_4:
CityStZip_4:
Phone_4:
Name_5:
Address_5:
CityStZip_5:
Phone_5:
Name_6:
Address_6:
CityStZip_6:
Phone_6:
Name_7:
Address_7:
CityStZip_7:
Phone_7:
Name_8:
Address_8:
CityStZip_8:
Phone_8:
Company Name:
DVoS:
Certifications:
SOW:
SOW_2:
SOW_3:
Certifications_3:
Certifications_2:
Certifications_4:
SOW_4:
SOW_5:
SOW_6:
SOW_7:
SOW_8:
Certifications_5:
Certifications_6:
Certifications_7:
Certifications_8:
DVoS_5:
DVoS_6:
DVoS_7:
DVoS_8:
DVoS_2:
DVoS_3:
DVoS_4:

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