Form_1._Personal_Professional_Sub-consultant_Disclosure_Form.pdf
PDF 1 MB Posted
- Attached to
- Public Works Asset Management Replacement
- Solicitation number
- 26-062
- Issued by
- Washington County, Barlow City, Oregon
About this file
This is a Personal/Professional Services Contract Subconsultant Disclosure Form issued by the City of Beaverton, Oregon for use in connection with the Public Works Asset Management Replacement project. The form serves as a template for prime contractors to disclose all subconsultants—both certified and non-certified—who will participate in the contract performance. The disclosure form accommodates up to eight subconsultants and requires documentation of each subconsultant's complete legal name, address, city, state, zip code, and phone number, along with a detailed description or scope of work for each entity and the corresponding dollar value of each subcontract.
The form requires identification of all relevant business 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 is designed to provide transparency regarding the composition of the contractor team and ensure accountability regarding the utilization of certified and disadvantaged business enterprises in the fulfillment of the City's asset management system replacement requirements. The form was last revised on May 6, 2019, and represents a standard compliance requirement for personal and professional services contracting with the City of Beaverton.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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: |
File details come from the government source that posted it. Updated .