2021 - mdot.ms.gov

2021

Table of Contents Notice to Bidders 7 LPA ......................page 1OCR-485-LPA ....................................page 15OCR-481-LPA ....................................page 17OCR-484-LPA ....................................page 19OCR-483-LPA ....................................page 21OCR-482-LPA ....................................page 23OCR-487-LPA ....................................page 25Permission to Sub Form ...................page 27Daily Work Report (DWR)/Diary .......page 34

Table of Contents Notice to Bidders 2611 LPA ................page 1OCR-485-LPA ....................................page 15OCR-481-LPA ....................................page 17OCR-484-LPA ....................................page 19OCR-483-LPA ....................................page 21OCR-482-LPA ....................................page 23OCR-487-LPA ....................................page 25Permission to Sub Form ...................page 27Daily Work Report (DWR)/Diary .......page 34

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Notice to Bidders 2611

The Notice to Bidders 2611 is a part of the contract document that gives an overview of the DBE requirements for the project. The notice to bidders includes information regarding the contractor’s obligations, forms that must be submitted as a condition of award, as well as forms that have to be submitted over the life of the project, and sanctions for not satisfying the DBE goal for the project. The contractor, project engineer, and the city/MPO officials need to become familiar with the information and contract requirements included in the NTB 2611.Because the LPA program is a reimbursement program if sanctions are imposed the amount of the sanctions will be withheld from the payment to the city/MPO.

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MISSISSIPPI DEPARTMENT OF TRANSPORTATION SECTION 904 - NOTICE TO BIDDERS NO. 2611 CODE: (IS) DATE: 05/21/2020 SUBJECT: Disadvantaged Business Enterprises In Federal-Aid Highway Construction This contract is subject to the "Moving Ahead for Progress in the 21st Century Act (MAP-21)" and applicable requirements of "Title 49, Code of Federal Regulations, Part 26." Portions of the Act are set forth in this Notice as applicable to compliance by the Contractor and all of the Act, and the MDOT DBE Program, is incorporated by reference herein. The Department has developed a Disadvantaged Business Enterprise Program that is applicable to this contract and is made a part thereof by reference. Copies of the program may be obtained from: Office of Civil Rights Mississippi Department of Transportation P. O. Box 1850 Jackson, Mississippi 39215-1850 POLICY It is the policy of the Mississippi Department of Transportation to provide a level playing field, to foster equal opportunity in all federally assisted contracts, to improve the flexibility of the DBE Program, to reduce the burdens on small businesses, and to achieve that amount of participation that would be obtained in a non-discriminatory market place. In doing so, it is the policy of MDOT that there will be no discrimination in the award and performance of federally assisted contracts on the basis of race, color, sex, or national origin. ASSURANCES THAT CONTRACTORS MUST TAKE MDOT will require that each contract which MDOT signs with a sub-recipient or a Contractor, and each subcontract the Prime Contractor signs with a Subcontractor, includes the following assurances: “The Contractor, sub-recipient or Subcontractor shall not discriminate on the basis of race, color, sex, or national origin in the performance of this contract. The Contractor shall carry out applicable requirements of 49 CFR 26 in the award and administration of federally assisted contracts. Failure by the Contractor to carry out these requirements is a material breach of this contract, which may result in the termination of this contract or such other remedy as MDOT deems appropriate.”

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- 2 - Notice to Bidders No. 2611 – Cont’d.

DEFINITIONS For purposes of this provision the following definitions will apply: "Disadvantaged Business" means a small business concern: (a) which is at least 51 percent owned by one or more socially and economically disadvantaged individual(s) or in the case of any publicly owned business, at least 51 percent of the stock of which is owned by one or more socially and economically disadvantaged individual(s); and (b) whose management and daily business operations are controlled by one or more of the socially and economically disadvantaged individual(s) who own it. It is important to note that the business owners themselves must control the operations of the business. Absentee ownership or title ownership by an individual who does not take an active role in controlling the business is not consistent with eligibility as a DBE under 49 CFR Part 26.71. CONTRACTOR'S OBLIGATION The Contractor and all Subcontractors shall take all necessary and reasonable steps to ensure that DBE firms can compete for and participate in the performance of a portion of the work in this contract and shall not discriminate on the basis of race, color, sex, or national origin. Failure on the part of the Contractor to carry out the DBE requirements of this contract constitutes a breach of contract and after proper notification the Department may terminate the contract or take other appropriate action as determined by the Department. When a contract has a zero percent (0%) DBE goal, the Contractor still has the responsibility to take all necessary and reasonable steps to ensure that DBE firms can compete for and participate in the performance of the work in the contract. In this case, all work performed by a certified DBE firm is considered to be a “race neutral” measure and the Department will receive DBE credit towards the overall State goals when the DBE firm is paid for their work. If the Prime Contractor is a certified DBE firm, the Department can receive DBE credit only for the work performed by the Prime Contractor’s work force or any work subcontracted to another DBE firm. Work performance by a non-DBE Subcontractor is not eligible for DBE credit. CONTRACT GOAL The goal for participation by DBEs is established for this contract in the attached Supplement. The Contractor shall exercise all necessary and reasonable steps to ensure that participation is equal to or exceeds the contract goal. If the percentage of the contract that is proposed for DBEs is 1% or greater, the Contractor shall agree to meet or exceed the contract goal on the last bid sheet of the proposal. All Bidders shall submit to the Office of Civil Rights Form OCR-481, signed by the Prime Contractor and the DBE Subcontractors, no later than the 3rd business day after opening of the bids.

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Form OCR-481 is available on the MDOT website at www.mdot.ms.gov under the Civil Rights tab, or by calling 601-359-7466. The OCR-481 Form must contain the following information:

The name and address of each certified DBE Contractor / Supplier; The Reference Number, percent of work to be completed by the DBE subcontractor and the dollar amount of each item. If a portion of an item is subcontracted, a breakdown of that item including quantities and unit price must be attached, detailing what part of the item the DBE firm is to perform and who will perform the remainder of the item.

If the DBE Commitment shown on the last bid sheet of the proposal, does not equal or exceed the contract goal, the bidder must submit, to MDOT Contract Administration Division prior to bid opening, information to satisfy the Department that adequate good faith efforts have been made to meet the contract goal. Failure of the lowest bidder to furnish acceptable proof of good faith efforts, submitted to MDOT Contract Administration Division prior to bid opening, shall be just cause for rejection of the proposal. Award may then be made to the next lowest responsive bidder or the project may be re-advertised. GOOD FAITH EFFORTS The following factors are illustrative of matters the Department will consider in judging whether or not the bidder has made adequate good faith effort to satisfy the contract goal.

(1) Whether the bidder attended the pre-bid meeting that was scheduled by the Department to inform DBEs of subcontracting opportunities;

(2) Whether the bidder advertised in general circulation, trade association, and minority-focus

media concerning the subcontracting opportunities;

(3) Whether the bidder provided written notice to a reasonable number of specific DBEs that their interest in the contract is being solicited;

(4) Whether the bidder followed up initial solicitations of interest by contacting DBEs to

determine with certainty whether they were interested;

(5) Whether the bidder selected portions of the work to be performed by DBEs in order to increase the likelihood of meeting the contract goal;

(6) Whether the bidder provided interested DBEs with adequate information about the plans,

specifications and requirements of the contract;

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(7) Whether the bidder negotiated in good faith with interested DBEs and did not reject them as unqualified without sound reasons based on a thorough investigation of their capabilities; and

(8) Whether the bidder made efforts to assist interested DBEs in obtaining any required

bonding or insurance.

(9) Whether the bidder has written notification to certified DBE Contractors soliciting subcontracting for items of work in the contract.

(10) Whether the bidder has a statement of why an agreement was not reached.

(11) Proof of written notification to certified DBE Contractors by certified mail that their

interest is solicited in subcontracting the work defaulted by the previous DBE or in subcontracting other items of work in the contract.

The bidder’s execution of the signature portion of the proposal shall constitute execution of the following assurance:

The bidder hereby gives assurance pursuant to the applicable requirements of "Moving Ahead for Progress in the 21st Century Act (MAP-21)" and applicable requirements of "Title 49, Code of Federal Regulations, Part 26" that the bidder has made a good faith effort to meet the contract goal for DBE participation for which this proposal is submitted.

DIRECTORY A list of “Certified DBE Contractors” which have been certified as such by the Mississippi Department of Transportation and other Unified Certification Partners (UPC) can be found on the Mississippi Department of Transportation website at www.mdot.ms.gov. The list is in the top left corner of the current Letting Calendar under Contracts & Letting. The DBE firm must be certified at the time the project is let and approved by MDOT to count towards meeting the DBE goal. REPLACEMENT If a DBE Subcontractor cannot perform satisfactorily, and this causes the OCR-481 commitment to fall below the contract goal, the Contractor shall take all necessary reasonable steps to replace the DBE with another certified DBE Subcontractor or submit information to satisfy the Mississippi Department of Transportation that adequate good faith efforts have been made to replace the DBE. The good faith efforts outlined previously in this document still apply. The replacement DBE must be a DBE who was on the Department's list of "Certified DBE Contractors" when the job was let, and who is still active. All DBE replacements must be approved by the Department. Under no circumstances shall the Prime or any Subcontractor perform the DBE's work (as shown on the OCR-481) without prior written approval from the Department. See "Sanctions" at the end of this document for penalties for performing DBE's work.

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When a Contractor proposes to substitute/replace/terminate a DBE that was originally named on the OCR-481, the Contractor must obtain a release, in writing, from the named DBE explaining why the DBE Subcontractor cannot perform the work. A copy of the original DBE's release must be attached to the Contractor's written request to substitute/replace/terminate along with appropriate Subcontract Forms for the substitute/replacement/terminated Subcontractor, all of which must be submitted to the DBE Coordinator and approved, in advance, by MDOT. PRE-BID MEETING A pre-bid meeting will be held in the Commission Room on the 1st Floor of the MDOT Administration Building in Jackson, at 2:00 P.M. on the day preceding the date of the bid opening. This meeting is to inform DBE firms of subcontracting and material supply opportunities. Attendance at this meeting is considered of prime importance in demonstrating good faith effort to meet the contract goal. PARTICIPATION / DBE CREDIT Participation shall be counted toward meeting the goal in this contract as follows:

(1) If the Prime Contractor is a certified DBE firm, only the value of the work actually performed by the DBE Prime can be counted towards the project goal, along with any work subcontracted to a certified DBE firm.

(2) If the Contractor is not a DBE, the work subcontracted to a certified DBE Contractor will be

counted toward the goal. (3) The Contractor may count toward the goal a portion of the total dollar value of a contract

with a joint venture eligible under the standards of this provision equal to the percentage of the DBE partner in the joint venture.

(4) Expenditures to DBEs that perform a commercially useful function may be counted toward

the goal. A business is considered to perform a commercially useful function when it is responsible for the execution of a distinct element of the work and carries out its responsibilities by actually performing, managing, and supervising the work involved.

(5) The Contractor may count 100% of the expenditures for materials and supplies obtained from

certified DBE suppliers and manufacturers that produce goods from raw materials or substantially alters them for resale provided the suppliers and manufacturers assume the actual and contractual responsibility for the provision of the materials and supplies. The Contractor may count sixty percent (60%) of the expenditures to suppliers that are not manufacturers, provided the supplier performs a commercially useful function in the supply process. Within 30 days after receipt of the materials, the Contractor shall furnish to the DBE Coordinator invoices from the certified supplier to verify the DBE goal.

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(6) Any work that a certified DBE firm subcontracts or sub-subcontracts to a non-DBE firm will not count towards the DBE goal.

(7) Only the dollars actually paid to the DBE firm may be counted towards the DBE goal. The

participation of a DBE Firm cannot be counted towards the Prime Contractor’s DBE goal until the amount being counted towards the goal has been paid to the DBE.

AWARD Award of this contract to the low bidder will be contingent upon the following conditions:

(1) Concurrence from Federal Highway Administration, when applicable. (2) All Bidders must submit to the Office of Civil Rights for approval, Form OCR-481 (DBE

Commitment) no later than the 3rd business day after opening of the bids to satisfy the Department and that adequate good faith efforts have been made to meet the contract goal. For answers to questions regarding Form OCR-481, contact the MDOT Office of Civil Rights at (601) 359-7466.

(3) Bidder must include OCR-485 information with their bid proposal listing all firms that

submitted quotes for material supplies or items to be subcontracted. OCR-485 information must be signed and included with the bid proposal. If the OCR-485 information is not included as part of bid proposal, your bid will be deemed irregular.

Prior to the start of any work, the bidder must notify the Project Engineer, in writing, of the name of the designated "DBE Liaison Officer" for this project. This notification must be posted on the bulletin board at the project site. DEFAULT If the contract goal established by MDOT in this proposal is 1% or greater, it must be met to fulfill the terms of the contract. The Contractor may list DBE Subcontractors and items that exceed MDOT's contract goal, but should unforeseen problems arise that would prevent a DBE from completing its total commitment percentage, the Contractor will meet the terms of the contract as long as it meets or exceeds MDOT's Contract Goal. For additional information, refer to "Replacement" section of this Notice. DBE REPORTS

(1) OCR-481: Refer to "CONTRACT GOAL" section of this Notice to Bidders for information regarding this form.

(2) OCR-482: At the conclusion of the project, before the final estimate is paid and the project

is closed out, the Prime Contractor will submit to the Project Engineer for verification of quantities and further handling Form OCR-482 whereby the Contractor certifies to the amounts of payments made to all Contractors / Suppliers over the life of the contract. The

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Project Engineer shall submit the completed Form OCR-482 to the DBE Coordinator (Office of Civil Rights). Final acceptance of the project is dependent upon Contract Administration Division's receipt of completed Form OCR-482 which they will receive from the Office of Civil Rights.

(3) OCR-483: The Project Engineer/Inspector will complete Form OCR-483, the

Commercially Useful Function (CUF) Performance Report, in accordance with MDOT S.O.P. No. OCR-03-05-02-483. Evaluations reported on this form are used to determine whether or not the DBE firm is performing a CUF. The Prime Contractor should take corrective action when the report contains any negative evaluations. DBE credit may be disallowed and/or other sanctions imposed if it is determined the DBE firm is not performing a CUF. This form should also be completed and returned to the DBE Coordinator (Office of Civil Rights).

(4) OCR-484: Each month, the Prime Contractor will submit to the Project Engineer OCR-

484 that certifies payments to all Subcontractors and shows all firms even if the Prime Contractor has paid no monies to the firm during that estimate period (negative report). The Project Engineer will attach the form to the monthly estimate before forwarding to the Contract Administration Division for further processing. Failure of the Contractor to submit the OCR-484 will result in the estimate not being processed and paid.

(5) OCR-485: ALL BIDDERS must submit signed form with bid proposal of all firms that

submitted quotes for material supplies or items to be subcontracted. If the OCR-485 information is not included as part of bid proposal, the bid will be deemed irregular.

(6) OCR-487: Only used by Prime Contractors that are certified DBE firms. This form is used

in determining the exact percentage of DBE credit for the specified project. The low Bidder should return this form to MDOT with the OCR-481 form, or can also be returned with the Permission to Subcontract Forms (CAD-720, CAD-725 and CAD-521).

DBE Forms, can be obtained from the Office of Civil Rights Division, MDOT Administration Building, 401 North West Street, Jackson, MS, or at www.mdot.ms.gov under the Civil Rights tab. SANCTIONS The Department has the option to enforce any of the following penalties for failure of the Prime Contractor to fulfill the DBE goal as stated on the OCR-481 form or any violations of the DBE program guidelines:

(1) Disallow credit towards the DBE goal (2) Withhold progress estimate payments

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(3) Deduct from the final estimate or recover an amount equal to the unmet portion of the DBE goal which may include additional monetary penalties as outlined below based on the number of offenses and the severity of the violation as determined by MDOT.

1st Offense 10% of unmet or $5,000 lump or Both portion of goal sum payment 2nd Offense 20% of unmet or $10,000 lump or Both portion of goal sum payment 3rd Offense 40% of unmet or $20,000 lump or $20,000 lump sum portion of goal sum payment payment and debarment

(4) Debar the Contractor involved from bidding on MDOT federally funded projects for a period

of up to 12 months after notification by certified email.

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MISSISSIPPI DEPARTMENT OF TRANSPORTATION SUPPLEMENT TO NOTICE TO BIDDERS NO. 2611 DATE: 05/02/2020 The goal is ? percent for the Disadvantaged Business Enterprise. All Bidders are required to submit Form OCR-481 for all DBEs. Bidders are advised to check the bid tabulation link for this project on the MDOT website at: https://mdot.ms.gov/portal/current_letting Bid tabulations are usually posted by 3:00 pm on Letting Day.

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OCR-485-LPA

Purpose of the form: DBE Regulations as stated in 49 CFR 26.11 require MDOT to create and maintain a comprehensive list of all firms quoting/bidding on prime contracts and subcontracts on federally-funded projects. This form is used to obtain the information.

Submission of the form: The form should be submitted at the time of bid and included in the bid package or the bid should be deemed irregular.

Completion of the form: The form should be completed and signed by the contractor. The contractor should list all firms (DBE and non-DBE) that submit a quote. The form has to be signed or the bid will be irregular.

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OCR-481-LPA

Purpose of the form:

Submission of the form:

Completion of the form:

This form is used to show what DBE firm the contractor commits to use to meet the DBE goal for the project. This form is a condition of award of the contract.

This form is to be submitted to the LPA project Director no later than the third (3) business day after the opening of bids.

This form is to be completed by the prime contractor. The form must be signed by both the prime and DBE subcontractor. In Column A the prime will list the reference number of the item as listed in the bid tab. Column B refers to the percent of work the DBE sub will perform of the item listed in Column A. If the DBE firm is performing all the work then 100% would be entered in the column. If the DBE sub-contractor is not performing 100 % of the work the percentage should be calculated based of the total value of the item and that value will be entered in Column B. If only a portion of the work will be performed by the DBE firm then a breakdown must be submitted with the form. In Column C the prime contractor will enter the amount the DBE firm will be paid for the work referenced in Column A. The project engineer needs to become familiar with what items of work are listed on this form to ensure that the DBE perform the work committed on this form. No other contractor is to perform the work committed to the DBE firm without written permission from MDOT’s Office of Civil Rights.

*It is important to note that the actual subcontract agreement must equal or exceed the totaldollar amount shown in Column C as stated in the instructions at the bottom of the form.This amount can be found on the permission to sub form NRAA-1. The project engineershould verify this information before submitting the NRAA-1 to the LPA official for theirsignature.

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OCR-481-LPA REV. 06/16

LPA PROJECT

DISADVANTAGED BUSINESS ENTERPRISE LISTPROJECT NUMBER : NAME OF DBE FIRM: RACE CONSCIOUS RACE NEUTRALCOUNTY: CITY :

A B CREFERENCE NUMBER OF

ITEMSPERCENT WORK

SUBCONTRACTED , ( SEE NOTE 4 & 5 BELOW )

VALUE OF ITEM ( SUBCONTRACTED ,

MANUFACTURED OR SUPPLIED )

TOTAL PER CENT OF TOTAL BID

*** I ACKNOWLEDGE AND COMMIT TO THE ITEMS AND PRICES STATED ABOVE. ***

SIGNATURE OF DBE SIGNATURE OF PRIME

DATEAPPROVED:

Prime Contractor Firm Name APPROVED BY: LPA Project Director Name (Printed) Submitted By Name

LPA Project Director (Signature) TITLE

I AGREE TO SUBCONTRACT OR PURCHASE MATERIAL FROM THE DBE FIRM LISTED ABOVE AND I MAKETHIS COMMITMENT WITH THE UNDERSTANDING THAT IF I FAIL FOR GOOD REASON TO FULFILL THIS COMMITMENT I HAVE LISTED I WILL FULFILL THE TERMS OF MY CONTRACT AS LONG AS I REACH OR EXCEED THE CONTRACT GOAL OF %.

INSTRUCTIONS : 1. SUBMIT THIS FORM TO THE LPA Project Director FOR THEIR SIGNATURE NO LATER THAN THE

THIRD (3) BUSINESS DAY AFTER THE OPENING OF THE BIDS. 2. 60 % CREDIT IS ALLOWED TOWARD THE DBE GOAL FOR SUPPLIERS.

3. THE ACTUAL SUBCONTRACT AGREEMENT MUST EQUAL OR EXCEED THE DOLLAR AMOUNT SHOWN IN COLUMN “ C “. 4. IF THE DBE FIRM PERFORMS “ ALL OF THE WORK “ PERTAINING TO A SUBCONTRACTED ITEM ENTER 100 % IN COLUMN “ B “. 5. IF THE DBE FIRM PERFORMS “ A PORTION OF THE WORK “ PERTAINING TO A SUBCONTRACTED ITEM THE PERCENTAGE IS CALCULATED BASED ON THE TOTAL VALUE OF THE ITEM AND ENTERED IN COLUMN “ B “. A BREAKDOWN OF THE COST MUST ACCOMPANY THIS SITUATION.

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OCR-484-LPA

Purpose of the form: This form is to certify payments have been made to all subcontractors on the project.

Submission of the form: This form is to be submitted each month attached to the monthly estimate submitted to MDOT for payment. MDOT will not reimburse the LPA if the form is not attached to the estimate. The contractor should submit the form with their invoice to the LPA. The contractor must submit this form each month even if no payments were made during that reporting period. If the contractor fails to submit the form the monthly estimate should be held and no monies paid until the form is submitted to the LPA.

Completion of the form: The prime contractor should list payments made to each subcontractor during each reporting period. The first month or two the form may not reflect any payments because at that time the prime contractor may not have received their payment. The contractor has 15 days from receipt of payment to pay the subcontractors. Once a subcontractor has been listed on the form the firm should remain on the form over the life of the project. If no payments were made during the reporting period then only the paid to date amount should entered for the subcontractor. The prime contractor should not list any payments that have not already been made.

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OCR‐483‐LPA Purpose of the form: This form is to ensure that the DBE firm is performing a

Commercially Useful Function (CUF) by execution of the element of work committed to the DBE firm on the OCR‐481‐LPA by actually managing, performing and supervising the work involved. The prime contractor will only be given DBE credit toward the contract goal if the DBE firm is performing a CUF.

Submission of the form: This form should be submitted by the LPA project director/ project engineer when the work approved for each DBE firm is at or near 50% complete. A form maybe submitted at any time the prime/DBE work practices are discovered or suspected to be out of compliance with the DBE program.

Completion of the form: The forms should be completed and all questions answered. If any questions are answered no then the LPA project director/ project engineer should explain in the section provided. The form must be signed and dated.

Indicators of Non‐Compliance: • The work is supervised by someone else not employed by the DBE firm. • The work is performed by personnel normally employed by another contractor or the prime contractor. • The equipment being used by the DBE belongs to another contractor. • Materials and supplies needed to perform the DBE’s work are delivered to, billed to or paid by the prime or another contractor. • The DBE subcontracts portions of the work committed on the OCR‐481 to a non‐DBE firm. • The DBE is working on the project without an approved subcontract agreement. • A DBE trucking subcontractor uses or rents trucks from the prime contractor.

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OCR-482-LPA

Purpose of the form: This form is to certify payments to all DBE firms over the life of the project. This form is used to verify that the prime contractor met the contract DBE goal.

Submission of the form: The prime contractor should be submitted this form to the LPA Project Director when all work is complete. The form will be included in the final packet submitted to MDOT’s LPA Division. A copy of the form should also be submitted to the MDOT Office of Civil Rights to the attention of the DBE Coordinator.

Completion of the form: The prime contractor should list all DBE firms that work on the project and the total of all payments made to the firm. If the DBE owed money on the final payment the contractor should note the approximate amount due the firm. If the amount paid to the DBE firm is less than committed on the OCR-481-LPA form the contractor should provide an explanation for the under-payment at the bottom of the form.

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OCR-487-LPA

Purpose of the form: This form is used when a DBE prime contractor subcontracts work to a non-DBE firm. The amount paid to non-DBE firms must be recorded to be in compliance with federal reporting requirements.

Submission of the form: The form should be submitted by the DBE prime contractor with the permission to subcontract forms. The LPA Project Director/project engineer must submit the form to the MDOT Office of Civil Rights.

Completion of the form: The form should be completed by the DBE prime contractor. The prime must list the reference number of the item as listed in the bid tab in Column A. The percent of the work to be performed by the subcontractor should be listed in Column B. This should be calculated in the same manner as Column B on the OCR-481-LPA. In Column C the prime contractor should enter the amount the subcontractor will be paid for the work as listed in Column A.

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Request for Permission to Subcontract Forms

• The LPA Project Director is responsible for monitoring that no work is performed by any subcontractor without an approved subcontract request.

• Make sure to verify the amount shown on the NRAA-1 form to the amount on the OCR-

481-LPA. If the amount does not equal or exceed the amount shown on the OCR-481-LPA form the Permission to Subcontract request should not be approved.

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RPS-1 Rev. 6/19

Local Public Agency:

R E Q U E S T F O R P E R M I S S I O N T O S U B C O N T R A C T

Request No. Contract No.

Gentlemen:County

I [We] [the prime contractor] [a subcontractor] propose to subcontract the following items to , named in accordance with Special Provisions providing for subcontracting included in our contract. In the event of your disapproval of this subcontractor or your disapproval of performance of such subcontractor at any time, I [we] agree to perform such items of work with my [our] own organization in full compliance with all applicable terms of our contract. I [we] agree that this procedure will not relieve us of any of the responsibilities under our contract.

It is agreed and understood that the approval or disapproval of the subcontractor and approval or disapproval of the performance of subcontractor does not create or impute any liability or contractual obligation by and between the subcontractor and the Local Public Agency.

I [We] the prime contractor agree that this procedure will not relieve us of any of the responsibilities and obligations of our contract and I [we] shall indemnify and save harmless the Local Public Agency from all claims, demands, suits, damages, costs, and expenses and loss [including attorney's fees] arising or resulting from this subcontract.

I [We] certify that said party is particularly experienced and equipped for such work and that the subcontract is evidenced in writing and that it contains all pertinent provisions and requirements of the prime contract and that all pertinent conditions and requirements of our contract with the Local Public Agency covering this project have been explained to the proposed subcontractor and that when applicable federally required contract provisions are physically incorporated into the agreement furnished to the subcontractor.

I [We] have attached a copy of said subcontract to this request. I [We] have attached the completed LPA forms NRAA-1, and SCC-1 for Federal Aid projects. The prices shown below are the prime contract unit prices:

PRIME CONT.ITEM QUANTITY UNIT UNIT PRICE AMOUNT

$ $$ $$ $$ $$ $$ $$ $$ $

I [We] hereby certify that the persons or firms named above as subcontractors was with the knowledge and consent of the persons or firms named.

Date , 20

Contractor

Total This Request $ = %

Previous Request $ = %

Total To Date $ = %

Quantities Checked:

By: Signature Approval Recommended: , 20

Address:

,

I [We] hereby certify that the use of our names as subcontractors on the above items, was and is with our knowledge and consent.

Date , 20

CE&I Engineer / Architect

Approved: , 20

(Sub) Subcontractor Chief LPA Official (Signature)

Federal Tax ID:

By: Signature

Address:

,

NOTE: The subcontract items of all subcontracts shall not exceed 60% of the total contract amount exclusive of specialty items. Please submit signed original documents on all requests.

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Attachment Page

PRIME CONT. ITEM QUANTITY UNIT UNIT PRICE AMOUNT

Page Total:

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NRAA-1 Rev. 6-19 Local Public Agency:

NOTICE OF REQUIREMENT FOR AFFIRMATIVE ACTION TO ENSURE EQUAL EMPLOYMENT OPPORTUNITY (EXECUTIVE ORDER 11246)

LPA:

County

, Mississippi

Project No.

County

(Sub) Subcontract Request No.

I (We) Prime Contractor on the above captioned project proposing to (sub) subcontract certain items of work to (Sub) Subcontractor, hereby submit the following information regarding the heretofore mentioned (sub) subcontractor to comply with the contract provisions of the NOTICE OF REQUIREMENTFOR AFFIRMATIVE ACTION TO ENSURE EQUAL EMPLOYMENT OPPORTUNITY (EXECUTIVE ORDER 11246).

Name:

P.O. Box and/or Physical Address:

City, State and Zip Code:

Telephone Number: ( )

Employer Identification Number:

Actual Dollar Amount of the Subcontract Agreement:

Estimated Starting Date:

Estimated Completion Date:

Geographical Area: (List County, State and City if any portion of the contract is within the limits of an incorporated area)

Respectfully submitted,

Date , 20

Prime Contractor

By:Signature

Title

(Submit signed original and attach to Request for Permission to Subcontract, Form RPS-1)

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SCC-1 Rev. 06-19

Local Public Agency:

(SUB) SUB-CONTRACT CERTIFICATION FOR FEDERAL AID PROJECTS

Project No.

County

(Sub) Subcontract Request No.

I (We) proposed (Sub) Sub-contractor hereby certify that I (We)

have , have not , participated in a previous contract or subcontract subject to the equal opportunity clause, as required

by Executive Orders 10925, 11114, or 11246, and that I (we) have , have not , filed with the Joint Reporting Committee,

the Director of the Office of Federal Contract Compliance, a Federal Government contracting or administering agency, or the

former President's Committee on Equal Employment Opportunity, all reports due under applicable filing requirements.

Date , 20

(Sub) Sub- Contractor

By: Signature

Title

NOTE:

This certification is required by the Equal Employment Opportunity Regulations of the Secretary of Labor (41 CFR 60-1.7(b) (1)), and must be submitted by bidders and proposed subcontractors only in connection with contracts and subcontracts which are subject to the equal opportunity clause. Contracts and subcontracts which are exempt from the equal opportunity clause are set forth in 41 CFR 60 - 1.5. (Generally only contracts for subcontracts of $10,000 or under are exempt.)

(Currently, Standard Form 100 (EEO-1) is the only report required by the Executive Orders or their implementing regulations.)

Proposed prime contractors and subcontractors who have participated in a previous contract or subcontract subject to the Executive Orders and have not filed the required reports should note that 41 CFR 60 - 1.7 (b) (1) prevents the award of contracts and subcontracts unless such contractor submits a report covering the delinquent period or such other period specified by the Federal Highway Administration or by the Director, Office of Federal Contract Compliance, U.S. Department of Labor.

(Submit signed original and attach to Request for Permission to Subcontract, Form RPS-1)

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DBE Information to be included in the Daily Work Report (DWR)/Diary

• It is important to remember that the DWR/Diary that the project engineer for the LPA maintains is the official/legal diary for the project.

• The project engineer must notify the DBE Coordinator by written memo or email when the DBE subcontractor first reports to work on the project and note it in the Project Diary.

• Each DBE should be noted as such in the DWR/Diary. The number of personnel, hours worked, work performed, and any equipment used on the project should be documented for each contractor.

• Make sure to note any issues regarding DBE firms in the DWR/diary.

If you have questions or need additional information please contact: Stacy Slay, DBE Coordinator

[email protected] Post Office Box 1850 Jackson, MS 39215

Office (601) 359-7934 Fax (601) 576-4504

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DBE Information to be included in the Daily Work Report (DWR)/Diary

It is important to remember that the DWR/Diary that the Project Engineer maintains is the official/legal diary for the project.

The project engineer must notify the DBE Coordinator by written memo or email when the DBE subcontractor first reports to work on the project and note it in the Project Diary.

Each DBE should be noted as such in the DWR/Diary. The number of personnel, hours worked, work performed, and any equipment used on the project should be documented for each contractor.

Make sure to note any issues regarding DBE firms in the DWR/diary.

If you have questions or need additional information please contact: Stacy Slay, DBE Coordinator

[email protected] Post Office Box 1850 Jackson, MS 39215

Office (601) 359‐7934 Fax (601) 576‐4504

2021 - mdot.ms.gov

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