<p> Page 1 of 3</p><p>Construction Monitor DBE Activity During Construction</p><p>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.</p><p>Local Public Agency (LPA): LPA Responsible Charge:</p><p>State Project No.: Project Name and Location:</p><p>State Control No.: Date of Review: This Form was Completed By:</p><p>Item Task Description or Completed If No, Define Details or Information Used to Additional Comments # Questions Yes No N/A Corrective Action Verify Content</p><p>Is there a DBE participation goal</p><p>1. on the project?</p><p>Did the DBE firms identified in </p><p>2. the contract do the work?</p><p>Did the DBE firms begin working</p><p>3. on the project on time?</p><p>Did the DBE firms complete </p><p>4. their work on time?</p><p>Did the DBE firms use their own </p><p>5. employees to perform the work?</p><p>Do the DBE’s employees work </p><p>6. for anyone else?</p><p>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</p><p>Did the DBE firms perform their work without assistance from </p><p>7. the prime contractor or a non- DBE subcontractor?</p><p>Did the DBE use equipment it </p><p>8. owns?</p><p>Did the DBE use equipment it </p><p>9. rents or leases?</p><p>Did the DBE firm’s supervisor 10. actually supervise the firm’s employees and their work?</p><p>Is the DBE firm’s supervisor a </p><p>11. full-time employee of the firm?</p><p>Did the DBE firms perform a </p><p>12. Commercially Useful Function?</p><p>Did the DBE firms perform the 13. amount of work committed to them by the prime contractor?</p><p>Was the DBE participation goal </p><p>14. on the project met?</p><p>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</p><p>Does the DBE own its own </p><p>15. trucks?</p><p>16. Does the DBE lease its trucks? </p><p>Did a review of haul tickets for 17. the project indicate the DBE was performing the hauling?</p><p>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</p><p>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?</p><p>19. </p><p>20. </p><p>21. </p><p>12-15, May 2010 Version 1.00 Checklist No. 12-15</p>