w37503083_Prof_Commitment_Form.pdf

PDF 169 KB Posted

Attached to
CEI - O. C. Phillips Road Over Brushy Creek Bridge Replacement - LAP Project Financial Project ID number 430468-1-68-01 & Federal Funds D319 049 B
Solicitation number
24-25. 060
Issued by
Escambia County, Florida

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This is a Professional Services Commitment Form from the Florida Department of Transportation (FDOT) used for documenting consultant team composition and Disadvantaged Business Enterprise (DBE) participation on state and local contracts. The form requires prime consultants and subconsultants to declare their work categories, contract fee percentages, and DBE or non-DBE small business status. The document serves as a submission requirement for Requests for Proposals or must be completed at the time an Expanded Letter of Response is due. All line items across prime and subconsultant/subvendor entries must total 100 percent of the overall contract amount. The form requires certification by an authorized representative with their title and date of submission.

The form mandates that the number one ranked firm must enter DBE participation data into FDOT's Equal Opportunity Compliance (EOC) System following contract award and for any subsequent contract amendments or task work orders. FDOT provides verification resources including a DBE Directory for checking DBE status, a Small Business Certification Report for non-professional services firms, and an Internet Reports system for professional services firm small business status. These verification tools enable consultants and procurement officials to confirm the legitimacy of claimed business designations and ensure compliance with minority and disadvantaged business enterprise participation goals.

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STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION

PROFESSIONAL SERVICES COMMITMENT FORM

375-030-83

PROCUREMENT

10/24

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

(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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https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Ffdotwww.blob.core.windows.net%2Fsitefinity%2Fdocs%2Fdefault-source%2Fprocurement%2Fpdf%2Frule-14-75-990746854.pdf%3Fsfvrsn%3D41be1c2c_2&data=04%7C01%7CStephanie.Kutchinski%40dot.state.fl.us%7C337fb188ea8d4b7b0e0608d999552a3a%7Cdb21de5dbc9c420c8f3f8f08f85b5ada%7C0%7C0%7C637709413321806279%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=lqWvb8kdEy10kPWwYss8j8aDVzAawCGzRJt68%2B798%2FI%3D&reserved=0 https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Ffdotwww.blob.core.windows.net%2Fsitefinity%2Fdocs%2Fdefault-source%2Fprocurement%2Fpdf%2Frule-14-75-990746854.pdf%3Fsfvrsn%3D41be1c2c_2&data=04%7C01%7CStephanie.Kutchinski%40dot.state.fl.us%7C337fb188ea8d4b7b0e0608d999552a3a%7Cdb21de5dbc9c420c8f3f8f08f85b5ada%7C0%7C0%7C637709413321806279%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=lqWvb8kdEy10kPWwYss8j8aDVzAawCGzRJt68%2B798%2FI%3D&reserved=0

375-030-83

(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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https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Ffdotwww.blob.core.windows.net%2Fsitefinity%2Fdocs%2Fdefault-source%2Fprocurement%2Fpdf%2Frule-14-75-990746854.pdf%3Fsfvrsn%3D41be1c2c_2&data=04%7C01%7CStephanie.Kutchinski%40dot.state.fl.us%7C337fb188ea8d4b7b0e0608d999552a3a%7Cdb21de5dbc9c420c8f3f8f08f85b5ada%7C0%7C0%7C637709413321806279%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=lqWvb8kdEy10kPWwYss8j8aDVzAawCGzRJt68%2B798%2FI%3D&reserved=0

375-030-83

(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) 0

Total percent for Prime and Subs remaining to be committed:

(Note to Consultants: should be 0% when submitted to FDOT) 100

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:

https://gcc02.safelinks.protection.outlook.com/?url=https%3A%2F%2Ffdotwww.blob.core.windows.net%2Fsitefinity%2Fdocs%2Fdefault-source%2Fprocurement%2Fpdf%2Frule-14-75-990746854.pdf%3Fsfvrsn%3D41be1c2c_2&data=04%7C01%7CStephanie.Kutchinski%40dot.state.fl.us%7C337fb188ea8d4b7b0e0608d999552a3a%7Cdb21de5dbc9c420c8f3f8f08f85b5ada%7C0%7C0%7C637709413321806279%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=lqWvb8kdEy10kPWwYss8j8aDVzAawCGzRJt68%2B798%2FI%3D&reserved=0 https://fdotxwp02.dot.state.fl.us/EqualOpportunityOfficeBusinessDirectory/CustomSearch.aspx https://ssrs.fdot.gov/Reports/report/PDA%20Reports/Public%20Reports/EOOSmallBusinessCertificationReport https://www.fdot.gov/procurement/InternetReports.shtm#qual

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