Texas
Department
of Transportation
REQUEST FOR PROPOSALS (RFP)
FOR THE
TEXAS DEPARTMENT OF TRANSPORTATION
MAINTENANCE DIVISION
MMS FUNCTIONAL REQUIREMENTS DEFINITION
RFP 47-5XXPA001
ISSUED BY THE
TEXAS DEPARTMENT OF TRANSPORTATION
MAINTENANCE DIVISION
Proposals must be submitted no later than:
5:00 P.M. Central Daylight Time on Friday, March 11, 2005
LATE PROPOSALS WILL BE REJECTED
Date issued: February 11, 2005
1.
GENERAL INFORMATION...................................................................................................... 3
1.1
Background...................................................................................................................... 3
1.2
Quantity ........................................................................................................................... 3
1.3
Regulations ...................................................................................................................... 3
1.4
Consulting Contracts – Prohibition on Follow-On Contracts ............................................. 3
1.5
Procuring and Contracting Agency ................................................................................... 3
1.5.1
Point of Contact........................................................................................................ 3
1.5.2
Contract Administration ............................................................................................ 3
1.6
Definitions ........................................................................................................................ 4
1.7
Clarification of the Specifications and Requirements ........................................................ 4
1.8
Contract Term .................................................................................................................. 4
1.9
Expenses ......................................................................................................................... 4
1.10 Insurance ......................................................................................................................... 5
2. PREPARING AND SUBMITTING A PROPOSAL .................................................................... 5
2.1
Evaluation and Selection.................................................................................................. 5
2.2
Incurring Costs ................................................................................................................. 5
2.3
Submitting the Proposal ................................................................................................... 5
2.4
Proposal Organization and Format .................................................................................. 6
2.5
Interviews ........................................................................................................................ 6
3. PROPOSAL SELECTION AND AWARD PROCESS ............................................................... 6
3.1
Proposal Scoring and Selection ....................................................................................... 6
3.2
Evaluation Criteria............................................................................................................ 6
3.2.1
Proposals ................................................................................................................. 6
3.2.2
Interviews ................................................................................................................. 7
3.3
Award and Final Offers .................................................................................................... 7
3.4
Right to Reject Proposals and Negotiate Contract Terms ................................................ 7
4. GENERAL PROPOSAL REQUIREMENTS ............................................................................. 7
4.1
Organizational Capabilities .............................................................................................. 7
4.2
Staff Qualifications ........................................................................................................... 8
4.2.1
Minimum Skill Qualifications ..................................................................................... 8
4.2.2
Preferred Skills Qualifications ................................................................................... 8
4.3
Schedule Adherence........................................................................................................ 8
5. TECHNICAL SPECIFICATIONS .............................................................................................. 8
5.1
General Project Description ............................................................................................. 8
5.2
Project Oversight ............................................................................................................. 9
5.3
Project Deliverables ......................................................................................................... 9
6. COST PROPOSAL .................................................................................................................. 9
6.1
General Instructions on Preparing Cost Proposals ........................................................... 9
6.2
Format for Submitting Cost Proposals.............................................................................. 9
6.3
Fixed Price Period.......................................................................................................... 10
7. CONSULTANT RESPONSIBILITIES ..................................................................................... 10
8. REPLACEMENT PERSONNEL ............................................................................................. 10
9. TXDOT RESPONSIBILITIES ................................................................................................. 10
10.
WORK HOURS AND LOCATION ...................................................................................... 10
11.
STANDARD CONTRACT TERMS, CONDITIONS, AND REQUIREMENTS ...................... 11
12.
REQUIRED FORMS .......................................................................................................... 11
ATTACHMENT A ………………………………………………………………………………….12
ATTACHMENT B ………………………………………………………………………………….13
CERTIFICATE OF INSURANCE ………………………………………………………………..14
CHILD SUPPORT STATEMENT……………………………………………………………… 16
RFP 47-5XXPA001
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1. GENERAL INFORMATION
This procurement is made under Government Code, Chapter 2254, Subchapter B.
1.1 Background
The Maintenance Division of the Texas Department of Transportation currently
supports an application, Maintenance Management Information System (MMIS). This
application was developed in the late 80's and fully implemented statewide in 1990. It
was developed as a mainframe application requiring daily data entries to the MMIS
database by the maintenance sections and/or the district offices. It is not a true
management system, it is simply a cost reporting system. The intent of the Division is
to procure a consultant to develop and document functional requirements for each
module within the Maintenance Management Cycle at each management level. The
Division has defined the Maintenance Management Cycle as consisting of the
following 6 modules: Planning, Budgeting, Scheduling, Performing, Reporting, and
Evaluating. The four management levels are Maintenance Section, Area Office,
District, and Division. Based on the requirements, the consultant will also propose and
document alternative solutions. The requirements and alternative solutions will be
used to determine the feasibility of replacing the current MMIS with a new system
which will extend the functionality of the existing application. If it is determined to be
feasible, phase 2 of the project will consist of the implementation of a new
maintenance management system.
1.2 Quantity
The Department anticipates selecting one (1) private firm to provide this service.
1.3 Regulations
All work must be performed in compliance with applicable federal and state
regulations.
1.4 Consulting Contracts – Prohibition on Follow-On Contracts
No person, firm, or subsidiary thereof who has been awarded a consulting services
contract may submit a bid for, nor be awarded a contract for, the provision of services,
procurement of goods or supplies, or any other related action which is required,
suggested, or otherwise deemed appropriate in the end product of the consulting
services contract.
1.5 Procuring and Contracting Agency
1.5.1 Point of Contact
The Texas Department of Transportation issues this Request-For-Proposal
(RFP), and is the sole point of contact for the State of Texas during the
selection process.
1.5.2 Contract Administration
The Maintenance Division of the Texas Department of Transportation will
administer the contract resulting from this RFP. The contract administrator
will be Brandye Payne, Maintenance Division, Texas Department of
RFP 47-5XXPA001
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7/1/2016
Transportation, 125 East 11th Street, Austin, Texas 78701-2483. Fax (512)
416-2941.
1.6 Definitions
The following definitions are used in this RFP:




“Consultant” means the firm selected from this RFP.
“Department” or “TxDOT” means the Texas Department of Transportation.
“Division” means the Maintenance Division.
“Proposer” means a firm submitting a proposal in response to this RFP.
1.7 Clarification of the Specifications and Requirements
If additional information is necessary to assist the Proposer in interpreting these
specifications, questions will be accepted by:
Brandye Payne
Email: MNT_DIV@dot.state.tx.us
Subject: MMS Project RFP 47-5XXPA001
Questions must be received by email by February 18, 2005 by 5:00 p.m. Central
Daylight Time (CDT) to receive a response. All responses to submitted questions will
be posted in the Texas Register and on the Department's web page for the
Maintenance Division by the date listed below in the timetable:
http://www.dot.state.tx.us/mnt/contract/rfp.htm.
Timetable
The timetable for the RFP process is:
Event
Date
RFP issued
February 11, 2005
Proposers send questions (received by)
February 18, 2005
All Proposers questions answered (sent by)
February 25, 2005
WRITTEN PROPOSALS RECEIVED
BY TXDOT, MNTDIVISION, AUSTIN
5 PM CDT
March 11, 2005
Evaluation complete (estimated)
May 13, 2005
Proposer notification (estimated)
May 14, 2005
Contract awarded (estimated)
May 14, 2005
1.8 Contract Term
Length of contract shall be approximately 9 months. The contract may be extended no
more than 4 times for periods of 6 months each. Proposals may vary from these
guidelines by no more than 30 percent.
1.9 Expenses
Covered expenses will be paid on a reimbursement basis in accordance with this RFP.
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1.10 Insurance
Prior to beginning work the successful Proposer shall have on file with TxDOT’s
Contract Services Office the attached, completed TxDOT Certificate of Insurance form
covering worker's compensation, commercial general liability, and business auto.
2. PREPARING AND SUBMITTING A PROPOSAL
2.1 Evaluation and Selection
The evaluation and selection of a Consultant will be based on the information
submitted in the proposal, references, and interviews. Proposers should respond
clearly and completely to all requirements. Failure to respond completely may be the
basis for rejecting a proposal.
Elaborate proposals (e.g., expensive artwork) beyond that sufficient to present a
complete and effective proposals are not necessary or desired.
2.2 Incurring Costs
The Texas Department of Transportation is not liable for any cost incurred by
Proposers in replying to this RFP.
2.3 Submitting the Proposal
The Proposer must submit one (1) original plus five (5) copies of the proposal to the
Division. All proposals must be packaged, sealed, and have the following written
information on the outside of the package:
1. Proposer's Name and Address;
2. "Proposal for Maintenance Division MMS Requirements; “ and
3. Proposal Due Date, (March 11, 2005).
The proposal packages must be delivered to:
Via USPS:
Brandye Payne
Texas Department of Transportation
Maintenance Division
125 E. 11th Street
Austin, TX 78701-2483
Via Courier or Overnight Delivery:
Brandye Payne
Texas Department of Transportation
Maintenance Division
150 E. Riverside Drive
Austin, TX 78704
The Department must receive all proposals no later than 5:00 P.M. CDT on March
11, 2005. Proposers mailing their proposals must allow sufficient time for delivery of
their proposal by the time and date specified. Late proposals will not be accepted.
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2.4 Proposal Organization and Format
Proposal should be submitted on 8.5 by 11-inch paper bound securely. Proposals
must be organized with the following headings and subheadings. Each heading and
subheading should be separated by tabs or otherwise clearly marked.
The RFP must contain:
1. Request for Proposal Signature Cover Page
2. Introduction
3. Response to General Proposal Requirements
a. Organizational Qualifications
b. Staff Qualifications
c. Project Schedule
4. Technical Specifications
5. Cost Proposal
6. Proposer Data Sheet
(Attachment A)
7. Reference Data Sheet
(Attachment B)
2.5 Interviews
Interviews will be conducted with the top scoring Proposers by the review panel to
clarify and verify the written proposals. These interviews will be held subsequent to the
initial receipt and scoring of the proposal to provide an opportunity for the respondent
to clarify the proposal. The Department will schedule a time and location for each
interview it requests. Should a proposer refuse to honor the request for interview, this
may result in rejection of the proposal.
3. PROPOSAL SELECTION AND AWARD PROCESS
3.1 Proposal Scoring and Selection
A review panel composed of representatives from the Texas Department of
Transportation staff will make the selection. The panel will review and rank all
proposals received. Proposers that are reasonably apt to be awarded the contract,
based on evaluation of the written proposals will be requested to interview with the
review panel. Preference will be given, all other considerations being equal, to a
consultant whose principal place of business is within the State of Texas or who will
manage the contracted project entirely from its office within the State of Texas.
3.2 Evaluation Criteria
3.2.1 Proposals
All proposals submitted in response to this RFP will be evaluated based on the
following criteria:


Criteria
General Quality and Adequacy of Response
o Completeness and Thoroughness
o Understanding of the Project
o Responsiveness to Terms and Conditions
Weight
10%
Organization, Personnel, and Experience
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o
o
o
o


Qualifications of Personnel
Experience of Personnel
40%
Experience of Firm
Familiarity with transportation agency policies and procedures
Technical Approach - Quality of Package Provided
o Approach to Problem Analysis
o Clarity and Organization in Concept Development
o Quality and Quantity of Services to be Rendered
o Proposed Schedule
Cost
Maximum Score
35%
15%
100%
3.2.2 Interviews
The team will make a decision based on the interview results. Each proposer will be
asked the same questions and scored based on responses to the questions.
3.3 Award and Final Offers
The award will be granted based on the results of the interview and references.
3.4 Right to Reject Proposals and Negotiate Contract Terms
TxDOT reserves the right to reject any and all proposals. TxDOT reserves the right to
negotiate the terms of the contract, including the reimbursement rates, with the
selected Proposer prior to entering into a contract. If contract negotiations cannot be
concluded successfully with the highest scoring Proposer, TxDOT may negotiate a
contract with the next highest scoring Proposer and so on until an agreement is
reached.
4. GENERAL PROPOSAL REQUIREMENTS
The Proposer should respond to the following proposal requirements:
4.1 Organizational Capabilities


Business Organization –
o Give name and address of submitting organization and State in which
incorporated or chiefly located.
o Identify a designated contact in your organization and list telephone
number, fax number, and e-mail address.
Understanding of Project –
o Illustrate your understanding of the scope of work and related project
activities.
o Describe your involvement in projects concerning functional
requirements development and project planning.
o Describe your involvement in projects that included transportation
agencies.
o Be specific and identify project dates and results.
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4.2 Staff Qualifications
The proposal must identify specific staff to be committed to this project. Describe their
experience as related to the following qualifications and indicate what their role(s) in
the project will be. Key personnel will need to meet the following qualifications.
Document their charges relative to this project, and the number of hours to be
committed.
4.2.1 Minimum Skill Qualifications
4.2.1.1 Work experience within the last 5 years:





With highway maintenance management
With functional requirements definitions and analysis
With project development methodologies
With business process analysis
With automated maintenance management systems
4.2.1.2 Excellent written and oral communication skills with people of all technical levels.
4.2.2 Preferred Skills Qualifications
4.2.2.1 Work experience within the last 5 years:
 With government agencies
 With DOT and/or DOT environments
 With systems and technology integration
 With systems selection
4.3 Schedule Adherence
Proposers shall indicate their ability to begin work on this project within 30 days of
contract award, and propose a schedule of milestones for each deliverable. The firm's
history in completing all deliverables on schedule should be documented. Likewise,
experience in aggressive project start-up should be noted.
5. TECHNICAL SPECIFICATIONS
5.1 General Project Description
1. The Consultant will become familiar with the TxDOT Maintenance operations
and develop a comprehensive description of functional requirements at each
management level for each module within the Maintenance Management Cycle.
2. The Consultant will meet with each level of management in order to determine
what the needs are for each office and maintenance section. The consultant
will travel to the division office and a sample of district offices, area offices, and
RFP 47-5XXPA001
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maintenance sections in order to become familiar with TxDOT’s current
maintenance operations.
3. The Consultant will document alternative solutions to be considered during
phase 2 of the project.
5.2 Project Oversight
Throughout the course of the project, the Proposer will work with Division staff who will
review all materials developed by the Proposer and provide project oversight.
5.3 Project Deliverables
Project plan and schedule
Status reports
Conceptual Process Model of existing processes
Business Requirements document
Stakeholder identification and analysis
Conceptual Process Models of proposed solutions
Comparative advantages and disadvantages of each proposed solution
6. COST PROPOSAL
6.1 General Instructions on Preparing Cost Proposals
The cost proposal will be scored using a standard quantitative calculation where the
most points will be awarded to the proposal with the lowest cost. Various costing
methodologies and models may be used to analyze the cost information submitted to
determine the lowest costs to the Department.
6.2 Format for Submitting Cost Proposals
For purposes of evaluation, Proposers should estimate their costs for the Project.
The cost proposal shall include a ‘fixed-price’ budget that lists total cost and
anticipated expenditures by the following line items:
1. Labor Costs, By Individual - List estimated hours, hourly rate, and total cost.
2. Overhead - Show as a percentage of labor.
3. Other Direct Expenses - Transportation, Housing and Per Diem, Materials,
Communications, Etc.
4. Fee.
5. Total Cost.
Eligible transportation costs will be reimbursed at the prevailing state travel rates.
Currently these are as follow:
Meal Expenses - $30.00 per day maximum
In-State Lodging Rate - $80.00 per day maximum
Mileage Reimbursement Rate - 35 cents per mile
Airfare - Coach
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Rental Car - Mid-size or smaller.
6.3 Fixed Price Period
All prices, costs, and conditions outlined in the proposal shall remain fixed and valid for
acceptance for ninety (90) days starting on the due date for proposals.
7. CONSULTANT RESPONSIBILITIES
The consultant is responsible for Federal and State Unemployment Insurance
coverage and Standard Workers Compensation Insurance coverage. Consultant shall
comply with all Federal and State tax laws and withholding requirements.
8. REPLACEMENT PERSONNEL

Replacement of the selected consultant shall require the approval of TxDOT.

If TxDOT determines that the selected consultant is unable to perform
satisfactorily or to communicate effectively, TxDOT may cause their immediate
removal from the contract.

Replacement personnel shall have comparable qualifications and be provided
at the contracted rate.

Any request by the consultant to replace the selected consultant shall be done
in writing to TxDOT. A resume for the proposed replacement shall be submitted
to TxDOT. TxDOT may reject the proposed replacement if qualifications,
references or past working performance are questionable or unfavorable.

If the consultant is removed, and TxDOT did not initiate the request, the vendor
has five working days to provide a replacement. There shall be no charge to
TxDOT for the first five working days of the replacement.
9. TXDOT RESPONSIBILITIES
TxDOT will provide:




TxDOT networked workstation at the primary work location with standard
productivity software.
Office space at the primary work location and related equipment for limited
personnel.
Access to TxDOT Intranet and applications.
All equipment provided by TxDOT will be returned to TxDOT at the completion
of the contract.
10. WORK HOURS AND LOCATION


Services shall be provided during normal business hours unless otherwise
approved and coordinated with TxDOT.
Normal business hours are Monday through Friday from 8:00 am through 5:00
PM, excluding state holidays.
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


The consultant may be required to work on weekends, evenings, and holidays.
TxDOT will not pay an overtime rate for this service. All hours shall be billed at
the hourly rate quoted.
The primary work location(s) for limited personnel will be at the TxDOT
Maintenance Division facility, located at 150 E. Riverside Drive, Austin, Texas.
Any and all commuting expenses shall be at the vendor’s expense.
TXDOT will provide pre-approved, written authorization for travel for any
services to be performed away from the primary work location. Pre-approved
travel expenses are limited to the rates and comply with the rules prescribed by
the State of Texas for travel by its classified employees, including any
requirements for original receipts.
11. STANDARD CONTRACT TERMS, CONDITIONS, AND
REQUIREMENTS
The successful Proposer and TXDOT will enter into a contract for the services
described in this RFP. Failure of the successful Proposer to accept the obligations of a
contractual agreement may result in a cancellation of the award.
12. REQUIRED FORMS
The following forms must be completed and submitted with the proposal.
Placed in Front Section Before the RFP Document:
1. Submission letter signed by authorized member of the organization
2. Proposer Data Sheet (Attachment A)
Placed in the Back Section After the RFP Document:
1. Reference Data Sheet (Attachment B) 3 references required
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ATTACHMENT A - PROPOSER DATA SHEET
1. Proposing Company Name: __________________________________________
City _____________________________________State __________________________
Federal Employer Identification Number: ______________________________________
OR social Security Number (if sold proprietorship):
Corporation: Yes
No
2. Proposal Contact Person
Name: ____________________________________________________________
Title: ______________________________________________________________
Phone: ________________________ Fax Phone: _________________________
E-mail _____________________________________________________________
3. Mailing address where reimbursements are to be mailed and person the department
should contact concerning billings.
Name: ____________________________________________________________
Title: ______________________________________________________________
Phone: ________________________ Fax Phone: _________________________
E-mail _____________________________________________________________
4. Is the firm submitting this proposal an individual?
Yes
No
5. If yes, has the individual been employed by a state agency at any time during the past
two years?
Yes
No
6. If yes, in compliance with Texas Government Code §2254.033, please attach a
separate sheet to explain:
A. The nature of the previous employment with the state
B. The date the employment was terminated
C. The annual rate of compensation for the employment at the time of its
termination.
Attachment A
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ATTACHMENT B - REFERENCE DATA SHEET
PROVIDE AT LEAST THREE REFERENCES
REPRODUCE: SHEET AS NECESSARY
PROPOSER
Provide client name, location, contact person, telephone number, and appropriate
information on contracted services that are similar to this solicitation document.
Client: ______________________________________________________________
City: ________________________
State: ________________________________
Contact Person: _____________________ Title: ____________________________
Phone Number: __________________________________________________________
Project Begin & End Date: __________________________________________________
Services Provided: (Be sure to describe your involvement in the project: principal firm,
multi-firm collaboration, subconsultant)
Attachment B
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7/1/2016
Texas
Department
of Transportation
NOTE: Copies of the endorsements listed
below are not required as
attachments to this certificate.
Form 20.102-CSO
Professional Provider Insurance
(Rev 05/2002)
Page 1 of 2
CERTIFICATE OF INSURANCE
The named contractor shall not commence work until he/she has obtained the minimum insurance specified in Section II, below. The
contractor must obtain the following endorsements: the Texas Department of Transportation as an Additional Insured for policies 3 and 4, and a Waiver
of Subrogation in favor of the same department under policies 2, 3 and 4. Only certificates of insurance published by this department are acceptable
as proof of insurance. Commercial carriers’ certificates are unacceptable.
SECTION I - IDENTIFICATION DATA
1.1 Insured Contractor’s Name
1.2 Street/Mailing Address
1.3 City
1.4 State
1.6. Phone Number
Area Code (
)
1.5 Zip
-
1.7 Vendor Identification Number
-
Ext.
SECTION II - TYPE OF INSURANCE
Type
2.
Policy
Number:
Expiration
Date:
Limits of Liability
Not Less Than:
WORKERS’ COMPENSATION
2.1
3.
Effective
Date:
2.2
2.3
Statutory - Texas
Endorsed with a Waiver of Subrogation in favor of the Texas Department of Transportation.
COMMERCIAL GENERAL LIABILITY
Bodily Injury/Property
Damage
$325,000 combined
single limit each
occurrence and in the
aggregate
Endorsed with the Texas Department of Transportation as an Additional Insured and endorsed with a Waiver of
Subrogation in favor of the Texas Department of Transportation.
4.
3.1
3.2
3.3
TEXAS BUSINESS AUTOMOBILE POLICY
A. Bodily Injury
4.1
4.2
4.3
$100,000 ea. person
$300,000 ea. occurrence
B. Property Damage
4.4
4.5
4.6
$25,000 ea. occurrence
Endorsed with the Texas Department of Transportation as an Additional Insured and endorsed with a Waiver of
Subrogation in favor of the Texas Department of Transportation.
5.
UMBRELLA POLICY (If Applicable)
5.1
5.2
5.3
$
SECTION III - CERTIFICATION
This Certificate of Insurance neither affirmatively or negatively amends, extends, or alters the coverage afforded by the above insurance policies issued
by the insurance company named below.
Cancellation of the insurance policies shall not be made until THIRTY DAYS AFTER the undersigned agent or his/her company has sent written notices
by certified mail to the contractor and the Texas Department of Transportation.
THIS IS TO CERTIFY that the insurance policies above meet all the requirements stipulated above and such policies are in full force and effect. If this
form is sent by facsimile machine (fax), the sender adopts the document received by TxDOT as a duplicate original and adopts the signature produced
by the receiving fax machine as the sender’s original signature.
The Texas Department of Transportation maintains the information collected through this form. With few exceptions, you are entitled on request to be
informed about the information that we collect about you. Under sections 555.021 and 553.023 of the Texas Government Code, you also are entitled to
receive and review the information. Under section 559.004 of the Government Code, you are also entitled to have us correct information about you
that is incorrect.
6.1 Name of Insurance
7.1 Name of Authorized Agent
6.2 Company Add ress
7.2 Agent’s Addr ess
6.3 City
6.4 State
7.6 Authorized Agent’s Phone No.
Area Code (
)
-
6.5 Zip
-
7.3 City
7.4 State
7.5 Zip
-
Original Signature of Authorized Agent
Ext.
Date
Certificate of Insurance
Page 14
7/1/2016
Form 20.102-CSO
Professional Provider Insurance
(Rev 05/2002
Page 2 of 2
Texas Department of Transportation
NOTES TO AGENTS:
Agents must provide all requested information then either fax or mail this form directly to the address listed below.
Pre-printed limits are the minimum required, if higher limits are provided by the policy, enter the higher limit amount and strike-through or cross out
the pre-printed limit.
To avoid work suspension, an updated insurance form must reach the address listed below one business day
prior to the expiration date. Insurance must be in force in order to perform any work.
Binder numbers are not acceptable for policy numbers.
12.1.1.1.1.1.1.1 The certificate of insurance, once on file with the department, is adequate for subsequent
department contracts provided adequate coverage is still in effect. Do not refer to specific projects/contracts on this
form.
The TxDOT certificate of insurance form is the only acceptable proof of insurance for department contracts.
List the contractor’s legal company name, including the DBA (doing business as) name as the insured or list both the contractor and staff leasing
service as insured when a staff leasing service is providing insurance.
Over-stamping and/or over-typing entries on the certificate of insurance are not acceptable if such entries change
the provisions of the certificate in any manner.
This form may be reproduced.
The SIGNATURE of the agent is required. Stamped/typed/printed signatures are not acceptable.
CERTIFICATE OF INSURANCE REQUIREMENTS:
WORKERS’ COMPENSATION INSURANCE:
The contractor is required to have Workers’ Compensation Insurance if the contractor has any employees including
relatives.
The word STATUTORY, under limits of liability, means that the insurer would pay benefits allowed under the Texas
Workers’ Compensation Law.
GROUP HEALTH or ACCIDENT INSURANCE is not an acceptable substitute for Workers’ Compensation.
COMPREHENSIVE GENERAL LIABILITY INSURANCE or COMMERCIAL GENERAL LIABILITY INSURANCE:
If policies are specified separately, they must be at least these amounts:
Bodily Injury
Property Damage
$300,000 each occurrence
$25,000 each occurrence
$25,000 for aggregates
MANUFACTURERS’ or CONTRACTOR LIABILITY INSURANCE is not an acceptable substitute for Comprehensive General Liability Insurance or
Commercial General Liability Insurance.
COMPREHENSIVE AUTOMOBILE LIABILITY INSURANCE or TEXAS BUSINESS AUTOMOBILE POLICY:
The coverage amount for a Texas Business Automobile Policy or Comprehensive Automobile Liability may be shown as a minimum of $325,000
Combined Single Limit by a typed or printed entry and deletion of the specific amounts listed for Bodily Injury and Property Damage.
BASIC AUTOMOBILE LIABILITY INSURANCE is not an acceptable substitute for Comprehensive Automobile Liability
Insurance or Texas Business Automobile Policy.
MAIL ALL CERTIFICATES TO:
Texas Department of Transportation
Contract Services Office
125 E. 11th St.
Austin, TX 78701-2483
(512) 936-1970 (V), (512) 936-1971(F)
Certificate of Insurance
Page 15
7/1/2016
CHILD SUPPORT STATEMENT FOR THE
TEXAS DEPARTMENT OF TRANSPORTATION
FOR NEGOTIATED CONTRACTS AND GRANTS
Under Family Code, Section 231.006, ______________________________________ (name of
individual) certifies that ______________________________________ (name of business)
_______________________________ (vendor #) as of ___________________, 20___
(date) is eligible to receive a grant, loan, or payment and acknowledges that any contract
may be terminated and payment may be withheld if this certification is inaccurate.
List below the name and social security number of the individual or sole proprietor and each
partner, shareholder, or owner with an ownership interest of at least 25% of the business
entity submitting the bid or application. This form must be updated whenever any party
obtains a 25% ownership interest in the business entity.
Name (Please Print Legibly)
Social Security Number
Family Code, Section 231.006, specifies that a child support obligor who is more than thirty
(30) days delinquent in paying child support and a business entity in which the obligor is a
sole proprietor, partner, shareholder, or owner with an ownership interest of at least 25%
percent is not eligible to receive payments from state funds under a contract to provide
property, materials, or services; or receive a state-funded grant or loan.
A child support obligor or business entity ineligible to receive payments described above
remains ineligible until all arrearage have been paid or the obligor is in compliance with a
written repayment agreement or court order as to any existing delinquency.
Except as provided by Family Code, Section 231.302(d), a social security number is
confidential and may be disclosed only for the purposes of responding to a request for
information from an agency operating under the provisions of Subchapters A and D of Title IV
of the federal Social Security Act (42 U.S.C. Sections 601 et seq. and 651 et seq.)
The Texas Department of Transportation maintains the information collected through
this article. With few exceptions, you are entitled on request to be informed about the
information that we collect about you. Under Sections 552.021 and 552.023 of the
Texas Government Code, you also are entitled to receive and review the information.
Under Section 559.004 of the Government Code, you are also entitled to have us
correct information about you that is incorrect.
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Please send this form to Texas Department of Transportation, Office of General Counsel (OGC) - Contract
Services Section, 125 E. 11th Street, Austin, Texas 78701-2483, (512) 936-1970 (V), (512) 936-1971(F).
Child Support Statement
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