Form_1._Personal_Professional_Sub-consultant_Disclosure_Form.pdf

PDF 1 MB Posted

Attached to
Beaverton Safe Parking RFP
Solicitation number
27-003
Issued by
Washington County, Barlow City, Oregon

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Written by GovTribe AI ·

This is a Subconsultant Disclosure Form for personal and professional services contracts issued by the City of Beaverton, Oregon, in connection with the Beaverton Safe Parking Program. The form requires the prime contractor to disclose all subconsultants—both certified and non-certified—engaged to provide services on the project. The contractor must provide each subconsultant's complete legal name, address, city/state/zip code, and phone number, along with a detailed description of the scope of work to be performed and the dollar value of each subcontract. The form allows for the disclosure of up to eight subconsultants and requires identification of all applicable certifications held by each subconsultant.

The form identifies applicable certifications as 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). The Beaverton Safe Parking Program RFP allocates $58,000 for program case management and an additional $15,000 in flexible funds, with the City providing supplementary infrastructure funding. This disclosure requirement ensures transparency regarding subcontracted services and enables the City to track utilization of certified minority, women-owned, and veteran-owned businesses in fulfilling the program's case management and support service needs for individuals experiencing homelessness.

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Other files

File Type Posted
Beaverton_Safe_Parking_RFP.pdf PDF
FORM_-_3_Personal-Professional_Contract_-_Monthly_Sub-consultant_Payment_and_Utilization_Report_.pdf PDF
Sample_Contract.pdf PDF

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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:

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