Form CEM-2405 "Disabled Veteran Business Enterprise (Dvbe) Substitution Request to the Department of General Services (Dgs)" - California

What Is Form CEM-2405?

This is a legal form that was released by the California Department of Transportation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2019;
  • The latest edition provided by the California Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CEM-2405 by clicking the link below or browse more documents and templates provided by the California Department of Transportation.

ADVERTISEMENT
ADVERTISEMENT

Download Form CEM-2405 "Disabled Veteran Business Enterprise (Dvbe) Substitution Request to the Department of General Services (Dgs)" - California

802 times
Rate (4.6 / 5) 53 votes
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
DISABLED VETERAN BUSINESS ENTERPRISE (DVBE)
SUBSTITUTION REQUEST TO THE DEPARTMENT OF GENERAL SERVICES (DGS)
CEM-2405 (REV 08/2019)
GENERAL INFORMATION
1. Awarding Department Name:
2. DVBE Advocate Name:
3. DVBE Advocate Email:
4. DVBE Advocate Phone:
Department of Transportation
Pat Maloney
business.support.unit@dot.ca.gov
(916) 654-3501
5. Contracting Official Name:
6. Contracting Official Email:
7. Contracting Official Phone:
CONTRACT INFORMATION
8. Contract Classification:
9. Contract Description:
10. Contract Number:
11. Contract Amount:
Public Works
12. Advertised Date of Contract:
13. Award Date of Contract:
14. Contract Start of Work Date:
15. Contract Term/Working Days:
16. Amount of DVBE Subcontractor Commitment:
17. Prime Contractor:
18. Department of Industrial Relations Registration Number:
19. Contractors State License Board Number:
20. Original Listed DVBE:
21. Department of Industrial Relations Registration Number:
22. Contractors State License Board Number:
23. Certification Number:
SUBSTITUTION INFORMATION
24. Date Substitution Requested:
25. Date Notice Sent to DVBE:
26. Date of DVBE Written Objection (if any):
27. Date of Notice of Substitution Hearing to Prime
28. Date of Substitution Hearing (if applicable):
and DVBE (required for objection):
29. Reason for Substitution:
Choose an item
30. Replacement DVBE or Small Business:
31. Certification Number:
Check all attachments:
Contractor's written request for substitution
Certified DVBE Summary
Correspondence
Written objection submitted by DVBE
Written substitution notice to DVBE
Written hearing notice to DVBE
DVBE subcontract agreement
Copies of communication with area DVBE advocates
(For substitution with small business only)
Other
32. Comments:
33. DVBE Advocate Signature:
34. Date:
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
DISABLED VETERAN BUSINESS ENTERPRISE (DVBE)
SUBSTITUTION REQUEST TO THE DEPARTMENT OF GENERAL SERVICES (DGS)
CEM-2405 (REV 08/2019)
GENERAL INFORMATION
1. Awarding Department Name:
2. DVBE Advocate Name:
3. DVBE Advocate Email:
4. DVBE Advocate Phone:
Department of Transportation
Pat Maloney
business.support.unit@dot.ca.gov
(916) 654-3501
5. Contracting Official Name:
6. Contracting Official Email:
7. Contracting Official Phone:
CONTRACT INFORMATION
8. Contract Classification:
9. Contract Description:
10. Contract Number:
11. Contract Amount:
Public Works
12. Advertised Date of Contract:
13. Award Date of Contract:
14. Contract Start of Work Date:
15. Contract Term/Working Days:
16. Amount of DVBE Subcontractor Commitment:
17. Prime Contractor:
18. Department of Industrial Relations Registration Number:
19. Contractors State License Board Number:
20. Original Listed DVBE:
21. Department of Industrial Relations Registration Number:
22. Contractors State License Board Number:
23. Certification Number:
SUBSTITUTION INFORMATION
24. Date Substitution Requested:
25. Date Notice Sent to DVBE:
26. Date of DVBE Written Objection (if any):
27. Date of Notice of Substitution Hearing to Prime
28. Date of Substitution Hearing (if applicable):
and DVBE (required for objection):
29. Reason for Substitution:
Choose an item
30. Replacement DVBE or Small Business:
31. Certification Number:
Check all attachments:
Contractor's written request for substitution
Certified DVBE Summary
Correspondence
Written objection submitted by DVBE
Written substitution notice to DVBE
Written hearing notice to DVBE
DVBE subcontract agreement
Copies of communication with area DVBE advocates
(For substitution with small business only)
Other
32. Comments:
33. DVBE Advocate Signature:
34. Date:
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
DISABLED VETERAN BUSINESS ENTERPRISE (DVBE)
SUBSTITUTION REQUEST TO THE DEPARTMENT OF GENERAL SERVICES (DGS)
CEM-2405 (REV 08/2019)
Instructions
Complete the form and submit the original to Headquarters Division of Construction, labor compliance program manager. Include copies of all
applicable attachments. Submit a copy to the district labor compliance manager.
GENERAL INFORMATION
Boxes 1 – 4 contain fixed information and may not be altered.
CONTRACT INFORMATION
8.
Contract Classification
This box is fixed with the text "Public Works" and may not be altered.
9.
Contract Description
Provide a description of the contract work. For example - HMA overlay, construction of bridges in two locations, etc.
10. Contract Number
Provide the contract number assigned to the awarded contract.
11. Contract Amount
Provide the dollar value of the awarded contract.
12. Advertised Date of Contract
Provide the date the contract was released to the public.
13. Award Date of Contract
Provide the date the contract was awarded.
14. Contract Start of Work Date
Provide the date work started on the contract.
15. Contract Term/Working Days
Provide the total number of working days of the contract.
16. Amount of DVBE Subcontractor Commitment
Provide the dollar amount for the listed DVBE commitment as approved at award of the contract. This information is found on the Certified
DVBE Summary.
17. Prime Contractor
Provide the name of the prime contractor.
18. Department of Industrial Relations Registration Number
19. Contract State Licensing Board Number
20. Original Listed DVBE
Provide the name of the original listed DVBE who is the subject of the substitution request.
21. Department of Industrial Relations Registration Number
22. Contract State Licensing Board Number
23. Certification Number
Provide the certification number of the original listed DVBE.
SUBSTITUTION INFORMATION
24. Date Substitution Requested
Provide the date the prime contractor requested the substitution of the original listed DVBE.
25. Date Notice Sent to DVBE
Provide the date the notice of the substitution request was sent to the original listed DVBE.
26. Date of DVBE Written Objections (if any)
Provide the date the DVBE submitted written objections and a request for a hearing, if any.
27. Date of Notice of Substitution Hearing to Prime and DVBE (required for objection)
Provide the date the notice of the scheduled substitution hearing was sent to the prime contractor and DVBE, if applicable.
28. Date of Substitution Hearing (if applicable)
Provide the date the substitution hearing was held, if applicable.
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
DISABLED VETERAN BUSINESS ENTERPRISE (DVBE)
SUBSTITUTION REQUEST TO THE DEPARTMENT OF GENERAL SERVICES (DGS)
CEM-2405 (REV 08/2019)
29. Reason for Substitution
Use the drop down box to choose the number that applies for this substitution request. The drop down contains only those reasons
provided in 2 CCR section 1896.73 (d). No other reasons may be used.
30. Replacement DVBE or Small Business
Provide the name of the replacement DVBE or small business entity, if applicable.
31. Certification Number
Provide the certification number of the replacement DVBE or small business entity, if applicable
32. Comments
Provide any comments related to the substitution request
33. DVBE Advocate Signature
34. Date
Headquarter Division of Construction will provide the date of the Caltrans DVBE advocate signature.
ATTACHMENTS
Check all applicable attachments related to the substitution request.
For individuals with sensory disabilities, this document is available in alternate formats. For alternate format information, contact the Forms
ADA Notice
Management Unit at (916) 445-1233, TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.

Browse Form CEM-2405 by Year

Page of 3