HUBSCO Informal Project
(Complete for all projects between $30,000 and $500,000)
All information with bullets must be completed
1. Project Information
- Project Number (PO #) _______
Contract No. ______
- Project Name______
Notice to Proceed______
Project Completion Date______
- Construction Method Used (Check one)
Design BuildSeparate Prime
Dual biddingSingle Prime
Force AccountOther
- Type of Project (Check one)
NewRepair/Renovation
- Location of Project (County) ______
- Total Square Footage______(enter 0 if not applicable)
- Original Project Value ______
Final Design Related Services Value______
Miscellaneous Cost______
Final Project Value______
- Project Includes State Appropriation or State Grant Funds (Check one)
Yes No
Verifiable Percent Goal 10%
2. Design Related Services-General Information (This section does not apply for in-house design)
Fill section 2 for each prime designer. (use multiple sheets if necessary)
- Prime Designer Name______
- Type of Service (Check one)
Architectural
Engineering
Construction Management Agent
Other Design Related Service
- Discipline (Check one)
Asbestos ConsultantMuseum Consultant
Acoustic SoundParking/Deck
ArchitecturalPlumbing
Civil EngineerProgramming/Design
Cost ConsultantSprinkler Consultant
Environmental EngineerSpecial Services
Electrical EngineerStructural Engineer
Food ServiceSite Concepts
Mechanical EngineerTrack Layout Services
LandscapingRadio Tower
Tract EngineerConstruction Manager
- Ownership Category (Check one)
Non-minority Hispanic White Female
Black Asian/AmericanSocially and Economically Disadvantaged
- Ownership is Minority Female (Check one)
Yes No
- Source of Ownership Category (Check one)
Not Applicable State of NC HUB State of NC DOT
Local Agency Federal Agency Out of State Agency
Self Identified Unknown
- Original Contract Value______
Final Contract Value______
- Method of Solicitation (Check one)
VerbalWritten (including fax, email or letter)Both Verbal and Written
3. Construction Contract – General Information
- Construction contractor used:
- Contract Description: ______
- Contract Method of Advertisement: (Check one)
Not Applicable
Published
Electronic
Both Published and Electronic
Contract Date: ______
Notice to Proceed: ______
Contract Completion Date: ______
4. Construction Contractors Contacted Directly (1 of 3)
- Contract Description/ID______
- Firm Name______
- Address______
- City______
- State______
- Zip______
- Telephone #:______Ext.______
- Ownership Category (Check one)
Non-minority Hispanic White Female
Black Asian/AmericanSocially and Economically Disadvantaged
- Ownership is Minority Female (Check one) yes no
- Source of Ownership Category (Check one)
Not Applicable State of NC HUB State of NC DOT
Local Agency Federal Agency Out of State Agency
Self Identified Unknown
- Primary Type of Work (Check one)
ConcreteGeneral ConstructionGeneral Requirements
Conveying SystemsMasonryMechanical
Doors and windowsPlumbingSite Construction
ElectricalSpecialtiesWood and Plastics
EquipmentThermal and Moisture Protection
FinishesFurnishings
- Date Contacted______
- Method of Contact
VerbalWritten (including fax, email or letter)Both Verbal and Written
- Response Due Date______
- Specifications Provided (Check one)
VerbalWritten (including fax, email or letter)Both Verbal and Written
- Was Quote Received: (Check one) yes no
Sub-Contractor (If Applicable)
Subcontracted to: ______
- Contract Description/ID______
- Firm Name: ______
- City: ______
County (if State is North Carolina) ______
- State______
Reason for Out-of-State Selection (Check one)
Note ApplicableLowest Bid Disqualified
Lowest BidBetter Quality Workmanship
Other
- Primary Type of Work Performed (Check one):
ConcreteGeneral ConstructionGeneral Requirements
Conveying SystemsMasonryMechanical
Doors and windowsPlumbingSite Construction
ElectricalSpecialtiesWood and Plastics
EquipmentThermal and Moisture Protection
FinishesFurnishings
- Ownership Category (Check one)
Non-minority Hispanic White Female
Black Asian/AmericanSocially and Economically Disadvantaged
- Source of Ownership Category (Check one)
Not Applicable State of NC HUB State of NC DOT
Local Agency Federal Agency Out of State Agency
Self Identified Unknown
- Original Contract value: ______
Final Contract Value______
- Contract Date______
Notice to Proceed/Contract Start Date: ______, Contract Completion Date: ______
Construction Contractors Contacted Directly (2 of 3)
- Contract Description/ID______
- Firm Name______
- Address______
- City______
- State______
- Zip______
- Telephone #:______Ext.______
- Ownership Category (Check one)
Non-minority Hispanic White Female
Black Asian/AmericanSocially and Economically Disadvantaged
- Ownership is Minority Female (Check one) yes no
- Source of Ownership Category (Check one)
Not Applicable State of NC HUB State of NC DOT
Local Agency Federal Agency Out of State Agency
Self Identified Unknown
- Primary Type of Work (Check one)
ConcreteGeneral ConstructionGeneral Requirements
Conveying SystemsMasonryMechanical
Doors and windowsPlumbingSite Construction
ElectricalSpecialtiesWood and Plastics
EquipmentThermal and Moisture Protection
FinishesFurnishings
- Date Contacted______
- Method of Contact
VerbalWritten (including fax, email or letter)Both Verbal and Written
- Response Due Date______
- Specifications Provided (Check one)
VerbalWritten (including fax, email or letter)Both Verbal and Written
- Was Quote Received: (Check one) yes no
Sub-Contractor (If Applicable)
Subcontracted to: ______
- Contract Description/ID______
- Firm Name: ______
- City: ______
County (if State is North Carolina) ______
- State______
Reason for Out-of-State Selection (Check one)
Note ApplicableLowest Bid Disqualified
Lowest BidBetter Quality Workmanship
Other
- Primary Type of Work Performed (Check one):
ConcreteGeneral ConstructionGeneral Requirements
Conveying SystemsMasonryMechanical
Doors and windowsPlumbingSite Construction
ElectricalSpecialtiesWood and Plastics
EquipmentThermal and Moisture Protection
FinishesFurnishings
- Ownership Category (Check one)
Non-minority Hispanic White Female
Black Asian/AmericanSocially and Economically Disadvantaged
- Source of Ownership Category (Check one)
Not Applicable State of NC HUB State of NC DOT
Local Agency Federal Agency Out of State Agency
Self Identified Unknown
- Original Contract value: ______
Final Contract Value______
- Contract Date______
Notice to Proceed/Contract Start Date: ______, Contract Completion Date: ______
Construction Contractors Contacted Directly (3 of 3)
- Contract Description/ID______
- Firm Name______
- Address______
- City______
- State______
- Zip______
- Telephone #:______Ext.______
- Ownership Category (Check one)
Non-minority Hispanic White Female
Black Asian/AmericanSocially and Economically Disadvantaged
- Ownership is Minority Female (Check one) yes no
- Source of Ownership Category (Check one)
Not Applicable State of NC HUB State of NC DOT
Local Agency Federal Agency Out of State Agency
Self Identified Unknown
- Primary Type of Work (Check one)
ConcreteGeneral ConstructionGeneral Requirements
Conveying SystemsMasonryMechanical
Doors and windowsPlumbingSite Construction
ElectricalSpecialtiesWood and Plastics
EquipmentThermal and Moisture Protection
FinishesFurnishings
- Date Contacted______
- Method of Contact
VerbalWritten (including fax, email or letter)Both Verbal and Written
- Response Due Date______
- Specifications Provided (Check one)
VerbalWritten (including fax, email or letter)Both Verbal and Written
- Was Quote Received: (Check one) yes no
- Sub-Contractor (If Applicable)
Subcontracted to: ______
- Contract Description/ID______
- Firm Name: ______
- City: ______
County (if State is North Carolina) ______
- State______
Reason for Out-of-State Selection (Check one)
Note ApplicableLowest Bid Disqualified
Lowest BidBetter Quality Workmanship
Other
- Primary Type of Work Performed (Check one):
ConcreteGeneral ConstructionGeneral Requirements
Conveying SystemsMasonryMechanical
Doors and windowsPlumbingSite Construction
ElectricalSpecialtiesWood and Plastics
EquipmentThermal and Moisture Protection
FinishesFurnishings
- Ownership Category (Check one)
Non-minority Hispanic White Female
Black Asian/AmericanSocially and Economically Disadvantaged
- Source of Ownership Category (Check one)
Not Applicable State of NC HUB State of NC DOT
Local Agency Federal Agency Out of State Agency
Self Identified Unknown
- Original Contract value: ______
Final Contract Value______
- Contract Date______
Notice to Proceed/Contract Start Date: ______, Contract Completion Date: ______
- Project Manager: ______
- Date: ______
Notes: All information with bullets must be completed before signed and dated by PM.
- All information requested in bold needs to be filled out by Project Manager at contract initiation. Other information will be requested by HUBSCO Coordinator.
Go to HUBSCO Site to locate HUBSCO businesses.
- Go to Licensing Board site to verify contractor is licensed in specific trade.
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