New Jersey Department of Transportation
Request for Approval to Sublet on Projects Utilizing the 2007 Specifications
To be Completed by Contractor and Subcontractor
Note: Forward One Original and Three Copies

Date:	     	

Part I

In accordance with terms of our contract,	
	
(Contractor)	     	(Vendor ID#)	     	, Contractor for the construction of 	
					
     		
( Project Description or Route & Section, Federal Project #, DP #)	requests approval to sublet to 	
		
(Subcontractor)	     	
		
(Address)	     	
		
(Phone)	     	(Fax)	     	(E-mail)	     	
						
(Federal Employer ID #)	     	(Incorporation Date)	     	
				
(Subcontractor Vendor ID, if known)	     	, the following contract item(s): 	
     
Item No.
	Quantity	Item	Bid Unit Price	Total	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
Attach additional sheets if needed	Subtotal from above	$     	
	Subtotal from additional sheets	$     	
	Total Subcontract Amount at Contract Unit Prices	$     	

Part II

Certification of Inclusion of Required Contract Provisions

The undersigned contractor hereby certifies that all applicable Required Contract Provisions including, but not limited to, 
the following:

Federal Projects	
Fully State Funded Projects	
•	Required Contract Provisions for Federal Aid Construction Contracts (FHWA 1273 Rev. 1994)	•	State of NJ Equal Employment Opportunity for Contracts Funded by Fully State Funded Projects	
•	Standard Federal Equal Employment Opportunity Construction Contract Specifications (Executive Order #11246)	•	Payroll Requirements for 100% State Projects	
•	Notice of Requirements for Affirmative Action to Ensure Equal Opportunity for Contracts Funded by FHWA	•	Small Business Enterprise Utilization Attachment for 100% Sate Funded Contracts (March 2004)	
•	State of NJ Equal Employment Opportunity for Contracts Funded by FHWA	•	Minority/Female Outreach & Training Program for Fully State Funded Projects	
•	Disadvantaged Business Enterprise Utilization Attachment – FHWA Funded Contracts or Emerging Small Business Enterprise Utilization Attachment	•	Americans with Disabilities Act 100% State Funded Contracts	
•	Equal Employment Opportunity Special Provisions	•	Equal Employment Opportunity Special Provisions Construction Contracts Funded by Fully State Funded Projects	
•	Special Contract Provisions for Investigating, Reporting, and Resolving Employment Discrimination and Sexual harassment Complaints	•	Training Reimbursement	
•	Incentive Program Disadvantaged Business Enterprise Utilization – Attachment for FHWA Funded Contracts	•	NJDOT Code of Ethics for Vendors	
•	Training Special Provisions	•	Section 107 of the said Standard Specifications as amended or supplemented.	
•	General Wage Determinations Issued Under the Davis-Bacon and Related Acts		
•	NJ Department of Labor Prevailing Wage Rate Determination		
•	NJDOT Code of Ethics for Vendors		
•	Section 107 of the said Standard Specifications as amended or supplemented		
		
have been included in, and made binding part of, a written, signed agreement represented by this Form DC-18 between the Contractor and the Subcontractor.	
	
In addition, the following information pertinent to this subcontract is submitted:	

Estimated Subcontract Work Start Date	     	/	     	/	     	
	month	day	year	
	
Estimated Subcontract Work Completion Date	     	/	     	/	     	
	month	day	year	

Part III

For DBE/ESBE/SBE Subcontracts Only

The Contractor will utilize the DBE/ESBE/SBE’s listed for goal attainment. In the event that a DBE/ESBE/SBE is unable to or unwilling to perform, the Contractor shall notify the Resident Engineer in writing and include documentation to justify the substitution, including a statement from the DBE/ESBE/SBE to be replaced acknowledging the substitution. The Contractor shall make a good faith effort to replace DBE/ESBE/SBE that is unable to perform with another DBE/ESBE/SBE. No substitution of a DBE/ESBE/SBE shall be made without the written consent of the Division of Civil Rights/Affirmative Action.	

To Be Completed For DBE/ESBE Program Sublet Approval Requests for Federal Projects

1) Total Project DBE/ESBE Goal	     	%	
					
2) Subcontractor percentage this sublet =	Actual subcontract amount = $	     	X 100 = 	     	%	
			Total $ contract bid amount		
					
3) Previous Project DBE/ESBE participation	     	% + Line 2	     	% =	Accumulative DBE/ESBE % participation 	
						
	this project 	     	%				
							
4) Previous targets DBE/ESBE sub actual $	     	+ $	     	= Total Current Actual DBE/ESBE $	     	
		     Actual subcontract amount		

To Be Completed For SBE Program Sublet Approval Requests For 100% State Funded Projects

1) Project targets SBE Category 4	     	% , SBE Category 5	     	%	
	
2) Subcontractor % this sublet 	Actual subcontract amount	= $	     	X 100 =	     	%	
	Total $ contract bid amount						
	
3) Previous SBE Category 4 participation	     	% + Line 2	     	% = Accumulative SBE Category 4	     	%	
	
     Previous SBE Category 5 participation	     	% + Line 2	     	% = Accumulative SBE Category 5	     	%	
	
4) Previous SBE Category 4 sub actual $	     	+ $	     	= Total Current Actual SBE Category 4 $	     	
		Actual subcontract amount		
	
    Previous SBE Category 5 sub actual $	     	+ $	     	= Total Current Actual SBE Category 5 $	     	
		Actual subcontract amount		

Part IV

Post Award Minority Certification

The Contractor Hereby Certifies, in Accordance with the Department’s Provisions for Utilization of DBE/ESBE/SBE Business Enterprises That:

1)	Said Contractor Notified the Resident Engineer in Writing on 	     	/	     	/	     	of the Type of	
	Work Subject to Sublet and the Approximate Value thereof.							
	
2)	Said Contractor gave DBE/ESBE/SBE Firms at least Equal consideration with Non-minority Firms in Negotiations for any such	
	Subcontract.	
3)	Pending Approval, said Contractor intends to Sublet, the Items on Page 1, with the Actual Amount of  	     	
	under an agreement reached with the Subcontractor.	

Part V
Acknowledgement and Agreement with Subcontracting Specifications

The Contractor and the Subcontractor, both, shall certify that the Subcontractor is fully acquainted with the Standard and Supplementary Specifications, as amended, and Special Provisions issued by the Department in accordance with which a contract was awarded for the construction of the project named in Part I and particularly with Division 100 – General Provisions of the said Standard Specifications, which provides (in part):  

Consent of the Department to allow work to be subcontracted, as specified in 108.01, does not relieve the Contractor of its responsibility for the Work, nor does it relieve the Surety of its obligations under the bond. The Contractor is responsible for the work of subcontractors. Ensure that the work performed by subcontractors conforms to the Contract. The Department's consent to subcontract any part of the Work shall not be construed as approval of the subcontract or its terms, but only as approval of the Contractor's request to subcontract to its chosen subcontractor.  Pursuant to the above, the contractor further certifies that if the Subcontractor enters into a Subcontract with the Contractor of the project named in Part I, for the performance of a part of the Work covered by the said Contract then the Subcontractor shall be bound by all provisions of the said Contract and further agrees that the Subcontractor is barred from making claims against the Department, its agents, officers, or employees. 

Part VI
Certification Regarding Debarment, Suspension, Disqualification, Ineligibility, and Voluntary Exclusion

The Contractor is barred from subcontracting to firms and individuals suspended or debarred by the Department or included in the State of New Jersey Consolidated Debarment Report maintained by the Department of the Treasury, Division of Building and Construction, Bureau of Contractor Prequalification. The Contractor and Subcontractor must certify that neither the individual, partnership, corporation, or limited liability corporation applying to do subcontract work nor any of its corporate officers, stockholders, partners, or members are collectively or individually suspended, debarred, proposed for debarment, disqualified, declared ineligible, or voluntarily excluded from doing business by this or any other State or sub-division thereof or listed in the Federal Government's General Services Administration document, List of Parties Excluded from Federal Procurement and Nonprocurement Programs (GSA List). 

Part VII
For Federally Funded Contracts Only, Certification of Inclusion of Contract Provisions

The Contractor and Subcontractor shall both certify that the Subcontractor has received the applicable required Contract Provisions, Federal Aid Contracts, as stated in Part II, have been made part of the proposed Subcontract, which is to be executed with the Contractor. The provisions in the Notice to Prospective Direct Federal and Federal Aid Contractor and Subcontractors, Equal Employment Opportunity have been received, if included in the Project’s Specifications and have been made a part of the proposed Subcontract, which is to be executed with the Contractor.

Part VIII
Certification with Regard to the Performance of Previous Contracts or Subcontracts Subject to the Equal Opportunity Clause and the Filing or Required Reports

      The Contractor and the Subcontractor shall both certify that the Subcontractor     	has  	has not (check one) participated in 	
	a previous Contract or Subcontract to the Equal Opportunity clause, as required by Executive Orders 10925, 11114, or 11246, and 	
	that it   	has  	has not	(check one) filed with the Joint Reporting Committee, the Director of the Office of Federal	
	Government Contracting or administering agency, or the former President’s Committee on Equal Opportunity, all reports due under the applicable filing requirements.	

Part IX
For Federally Funded Contracts and Subcontracts Exceeding $100,000 Only, Certification Regarding the use of Contract Funds for Lobbying

The Contractor and Subcontractor shall both certify that the Subcontractor is in compliance as referenced in:	
•	23 CFR 635.112(g)	
•	49 CFR 20

	
	
The undersigned hereby furnishes and certifies that all of the information in Parts I – IX for the Subcontract represented by the attached Form DC-18 is true and correct:	
	
Sworn and subscribed to before me on this	     	day of	     	/	     	.	

						
Notary Public			
(Not an Officer of the Firm)		Contractor

	       By		
			Signature of an Officer	
				
			Print Name of an Officer	

                                                                                                                      AFFIX CORPORATE SEAL

	
Sworn and subscribed to before me on this	     	day of	     	/	     	.	

Notary Public			
(Not an Officer of the Firm)		Subcontractor

	       By		
			Signature of an Officer	
				
			Print Name of an Officer	

                                                                                                                       AFFIX CORPORATE SEAL 

Checklist

Part I	
•	Contractor Name, Address, Vendor ID, and Project Description
•	Subcontractor Name, Address, and Vendor ID
•	Item Numbers with Descriptions, Unit Price, and Total
	
Part II	
•	Estimated Start and Completion Dates
	
Part III	
•	Complete ONLY IF THE SUBMITTED FIRM IS A DBE/ESBE/SBE, etc. AND is being used to satisfy the applicable participation percentage of the project.
•	If Federally Funded, complete top portion.
•	Line 1 is goal established in Contract and Bond.
•	Line 2 is actual amount divided by the total contract bid amount as a percentage.
•	Line  3 is an accumulation of prior line 2 percentages,
•	Line 4 is prior DBE/ESBE dollars added to this actual amount and accumulated.
•	If 100% State Funded, then complete bottom portion with the appropriate SBE dollars and sum as above.
	
Part IV	
•	Complete ONLY FOR SUBCONTRACTOR not included on the Original Form A submitted by the Contractor prior to Award.
•	Date Resident Engineer notification.
•	Actual amount of Subcontract.
	
Part VIII	
•	For Federally Funded contracts, check Equal Opportunity Clause participation.	
	
Contractor, Have You?	
•	Attached proof of your Subcontractor’s valid business registration issued by the Division of Revenue in the NJ Department of Treasury, pursuant to P.L. 2001, c134 (N.J.S. 52:32-44).
•	Submitted the Original and Two Copies.
•	Attached proof of your Subcontractor’s permits/licensing/certifications registry required by law. Current effected work types are electrical, blasting, asbestos abatement, landscaping, and lead abatement.
•	Attached proof of Pesticide Applicator Business and designated Licensed Commercial Pesticide Applicator is required for Contractor performing any combinations of Landscape work, per NJDEP Pesticide Control Program N.J.C.A 7:30-1.13.
•	Attached proof of Subcontractor’s current Public Work’s Contractor Registration issued by the NJ Department of Labor, Division of Labor & Wage Compliance, pursuant to P.L. 2003, c. 91 (N.J.S. 34:11-56.48
•	And your Subcontractor completed the signatory page w/ notarization and affixed corporate seals.