Form_1._Personal_Professional_Sub-consultant_Disclosure_Form.pdf

1 MB Posted

Attached to
Brownfields Community Wide Assessment Grant – Environmental Consulting Services (QEP)
Solicitation number
26-059
Issued by
Washington County, Barlow City, Oregon

About this file

Written by GovTribe AI ·

This is a Subconsultant Disclosure Form for the City of Beaverton's Personal/Professional Services Contract related to the Brownfields Community Wide Assessment Grant for Environmental Consulting Services. The form is designed to capture comprehensive information about all subconsultants—both certified and non-certified—that a prime contractor intends to utilize on the project. The document provides space for listing up to eight subconsultants, with required fields for each subconsultant's complete legal name, address, city/state/zip code, and phone number. For each subconsultant listed, the form requires documentation of the description and scope of work to be performed, the dollar value of the subcontract, and all relevant certifications held by the subconsultant.

The form identifies specific certification categories that must be disclosed, 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 Concession Disadvantaged Business Enterprise (ACDBE). The disclosure form serves as a transparency and accountability mechanism for the City of Beaverton to track subconsultant participation, ensure compliance with small business and diversity objectives, and verify that proposed subcontract work aligns with the overall project scope for the EPA Brownfields CommunityWide Assessment Grant, which encompasses site assessments, environmental characterization, community engagement, and cleanup and reuse planning for prioritized areas including Downtown Beaverton, Allen Boulevard, and the West Five Employment District.

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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 .