w37503083_(3).docx

DOCX document 69 KB Posted

Attached to
Sanitary Sewer Evaluation Survey Program On-Call Contractors - Cure-In-Place Pipe (CIPP) Lining State and local contract opportunity
Solicitation number
RSQ 25-094
Issued by
Lee County, Fort Lauderdale City, Florida

About this file

The document is a Professional Services DBE or Small Business Commitment Form issued by the Florida Department of Transportation (FDOT), designed to track Disadvantaged Business Enterprise (DBE) and Small Business participation in a professional services contract. The form provides a template for prime consultants and subconsultants to detail their work types, percentages of overall contract amount, and business classifications (DBE, Small Business, or Non-DBE/Non-Small Business). While the specific project details are not completed, the form is intended to be submitted with a Request for Proposal or Expanded Letter of Response, requiring a comprehensive breakdown of all contracted work parties and their respective contributions.

The form emphasizes FDOT's commitment to promoting diversity and small business participation in state contracts, providing resources for verifying DBE and Small Business status through online directories. Consultants are required to ensure that the percentage breakdown totals 100% for prime and subconsultants, with the number one ranked firm obligated to enter DBE participation in the Equal Opportunity Compliance (EOC) System after contract award. The form is associated with a separate state and local contract opportunity for Sanitary Sewer Evaluation Survey Program On-Call Contractors, specifically seeking multiple Cured-in-Place Pipe (CIPP) Lining Contractors in Florida to provide pipe lining and urgent repair services for various municipal projects.

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2_CFR_Part_200_app_II_(up_to_date_as_of_4-28-2025).pdf PDF
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375-030-31_Affidavit_Regarding_Labor_and_Services.docx DOCX document
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375-030-31_Affidavit_Regarding_Labor_and_Services.docx DOCX document
375-040-84-LAP_PROFESSIONAL_SERVICES_TERMS.pdf PDF
575-060-13-NON-COLLUSION_DECLARATION_AND_COMPLIANCE_WITH_49_CFR_29.pdf PDF
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375-030-34-DISCLOSURE_OF_LOBBYING_ACTIVITIES.pdf PDF
375-040-84-LAP_PROFESSIONAL_SERVICES_TERMS.pdf PDF
525-010-46-LAP_CERTIFICATION_OF_CURRENT_CAPACITY.pdf PDF
575-060-13-NON-COLLUSION_DECLARATION_AND_COMPLIANCE_WITH_49_CFR_29.pdf PDF
FHWA-1273_(10_23)_.pdf PDF
Local_Preference_Affidavit.pdf PDF
275-030-11-DBE_BID_PACKAGE_INFORMATION.pdf PDF
2_CFR_Part_200_app_II_(up_to_date_as_of_4-28-2025).pdf PDF
375-030-34-DISCLOSURE_OF_LOBBYING_ACTIVITIES.pdf PDF
Notice_of_Award.docx DOCX document
SRF_SupplementaryConditions_Construction_Contract_(August_2022).pdf PDF
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Text version

STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION

PROFESSIONAL SERVICES DBE OR

SMALL BUSINESS COMMITMENT FORM

375-030-83

PROCUREMENT

11/17

STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION

PROFESSIONAL SERVICES COMMITMENT FORM

375-030-83

PROCUREMENT

11/21

Submit this form as required in the Request for Proposal or alternatively, at the time of Expanded Letter of Response is due:

Contract/Advertisement No.:
Prime Consultant:
Project Description:
Expected percentage of contract fees to be utilized by DBE(s):%. (Combine DBE Prime and DBE subconsultants, if applicable).
Expected percentage of contract fees to be utilized by Non-DBE Small Businesses%. (Combine Non-DBE Small Business Prime and Non-DBE Small Business subconsultants, if applicable).

The proposed Prime and subconsultants/subvendors’ work is as follows:

Prime
Type of Work

(List each type of work separately, only one type of work per line) of overall contract amount

DBE
Small Business
Non DBE/

Non Small Business

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Subconsultant/Subvendor
Type of Work

(List each type of work separately, only one type of work per line) of overall contract amount

DBE
Small Business
Non

DBE/

Non Small Business

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Total percent for Prime and Subs committed:

(Note to Consultants: should be 100% when submitted to FDOT)

Total percent for Prime and Subs remaining to be committed:

(Note to Consultants: should be 0% when submitted to FDOT)

The percentage column must total 100% for Prime and all subs.

Please note, the number one ranked firm is required to enter DBE Participation in the Equal Opportunity Compliance (EOC) System subsequent to contract award and any future contract amendments or task work orders (if applicable).

DBE status for all firms can be verified by using the DBE Directory:

https://fdotxwp02.dot.state.fl.us/EqualOpportunityOfficeBusinessDirectory/CustomSearch.aspx Small Business status for Non-Professional Services firms can be found here:

https://ssrs.fdot.gov/Reports/report/PDA%20Reports/Public%20Reports/EOOSmallBusinessCertificationReport Small Business status for Professional Services firms is located here:

https://www.fdot.gov/procurement/InternetReports.shtm#qual

By: Title: Date:

File details come from the government source that posted it. Updated .