For DBE Trucking/Hauling Firms Only
Total Page：16
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Construction Monitor DBE Activity During Construction
Instructions for Use: This checklist is not intended to assure that all conditions defined by the contract are met. This checklist is a tool used for each project built with Federal Aid Funds, to document minimum quality assurance activities that are performed by the LPA and/or NDOR at critical times during construction. This form should be completed by the LPA RC and/or the NDOR State Representative intermittently throughout the construction of the process. The LPA RC and/or NDOR State Representative is responsible for adding a copy of the completed checklist to the project correspondence log in SiteManager.
Local Public Agency (LPA): LPA Responsible Charge:
State Project No.: Project Name and Location:
State Control No.: Date of Review: This Form was Completed By:
Item Task Description or Completed If No, Define Details or Information Used to Additional Comments # Questions Yes No N/A Corrective Action Verify Content
Is there a DBE participation goal
1. on the project?
Did the DBE firms identified in
2. the contract do the work?
Did the DBE firms begin working
3. on the project on time?
Did the DBE firms complete
4. their work on time?
Did the DBE firms use their own
5. employees to perform the work?
Do the DBE’s employees work
6. for anyone else?
12-15, May 2010 Version 1.00 Checklist No. 12-15 Page 2 of 3 Item Task Description or Completed If No, Define Details or Information Used to Additional Comments # Questions Yes No N/A Corrective Action Verify Content
Did the DBE firms perform their work without assistance from
7. the prime contractor or a non- DBE subcontractor?
Did the DBE use equipment it
8. owns?
Did the DBE use equipment it
9. rents or leases?
Did the DBE firm’s supervisor 10. actually supervise the firm’s employees and their work?
Is the DBE firm’s supervisor a
11. full-time employee of the firm?
Did the DBE firms perform a
12. Commercially Useful Function?
Did the DBE firms perform the 13. amount of work committed to them by the prime contractor?
Was the DBE participation goal
14. on the project met?
For DBE Trucking/Hauling Firms only: Item Task Description or Completed If No, Define Details or Information Used to Additional Comments # Questions Yes No N/A Corrective Action Verify Content
Does the DBE own its own
15. trucks?
16. Does the DBE lease its trucks?
Did a review of haul tickets for 17. the project indicate the DBE was performing the hauling?
12-15, May 2010 Version 1.00 Checklist No. 12-15 Page 3 of 3 Item Task Description or Completed If No, Define Details or Information Used to Additional Comments # Questions Yes No N/A Corrective Action Verify Content
If the DBE supplied material, did a review of the haul tickets or 18. bills of lading indicate the material was actually supplied by the DBE?
19.
20.
21.
12-15, May 2010 Version 1.00 Checklist No. 12-15