Form OFG-3 Local Agency Resident Engineer Contract Provisions Checklist - California

Form OFG-3 or the "Local Agency Resident Engineer Contract Provisions Checklist" is a form issued by the California Department of Transportation.

The form was last revised in July 1, 2016 and is available for digital filing. Download an up-to-date Form OFG-3 in PDF-format down below or look it up on the California Department of Transportation Forms website.

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STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
LOCAL AGENCY RESIDENT ENGINEER CONTRACT PROVISIONS CHECKLIST
OFG-3 (REV 07/2016)
Page 1 of 2
NOTE: To be completed by the Local Agency Resident Engineer and submitted to the Oversight Resident Engineer for federal-aid projects only.
Local Agency
Federal-aid Project Number
Completed By
Title
or
N
E
Date
Contract Amount
Date Contract Awarded
EA
Type of Work
Location
Project ID
Local Agnecy Resident Engineer - Check the appropriate box to indicate that the required federal contract provisions are included in the construction contract.
Fill in the blanks and provide the page number where the provision is located. If the required federal contract provisions are not included in your contract, execute
a contract change to include the provisions. Failure to include the provisions can result in loss of federal funds for the contract.
Required Federal Contract Provisions
1. FHWA Form 1273, "Required Provisions Federal-Aid Construction Contracts"
Incorporation into contract
Page No.
A copy of FHWA Form 1273, "Required Provisions Federal-aid Construction Contracts,"
has been incorporated into this contract.
2. Certification/Disclosure Forms
Page No.
Equal employment opportunity certification
Noncollusion affidavit
Debarment and suspension certification
Nonlobbying certification for federal-aid contracts
Disclosure of lobbying activities
Federal lobbying restrictions
3. Liquidated Damages
Page No.
Beginning of Work, Time of Completion
Equivalent provisions are included
4. Disadvantaged Business Enterprise Subcontracting
Contract Goal
Race-Conscious Portion
Race-Neutral Portion
Race-conscious and race-neutral portion is obtained from local agency's Disadvantaged Business Enterprise (DBE) liaison officer.
Local agency's DBE liaison officer
Phone
(
)
Page No.
This contract has a specific DBE goal to meet the intent of the DBE program.
This contract has no specific DBE goal because one is not necessary (documentation verifies this determination and is on file).
For individuals with sensory disabilities, this document is available in alternate formats. For information, call (916) 445-1233,
ADA Notice
TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
LOCAL AGENCY RESIDENT ENGINEER CONTRACT PROVISIONS CHECKLIST
OFG-3 (REV 07/2016)
Page 1 of 2
NOTE: To be completed by the Local Agency Resident Engineer and submitted to the Oversight Resident Engineer for federal-aid projects only.
Local Agency
Federal-aid Project Number
Completed By
Title
or
N
E
Date
Contract Amount
Date Contract Awarded
EA
Type of Work
Location
Project ID
Local Agnecy Resident Engineer - Check the appropriate box to indicate that the required federal contract provisions are included in the construction contract.
Fill in the blanks and provide the page number where the provision is located. If the required federal contract provisions are not included in your contract, execute
a contract change to include the provisions. Failure to include the provisions can result in loss of federal funds for the contract.
Required Federal Contract Provisions
1. FHWA Form 1273, "Required Provisions Federal-Aid Construction Contracts"
Incorporation into contract
Page No.
A copy of FHWA Form 1273, "Required Provisions Federal-aid Construction Contracts,"
has been incorporated into this contract.
2. Certification/Disclosure Forms
Page No.
Equal employment opportunity certification
Noncollusion affidavit
Debarment and suspension certification
Nonlobbying certification for federal-aid contracts
Disclosure of lobbying activities
Federal lobbying restrictions
3. Liquidated Damages
Page No.
Beginning of Work, Time of Completion
Equivalent provisions are included
4. Disadvantaged Business Enterprise Subcontracting
Contract Goal
Race-Conscious Portion
Race-Neutral Portion
Race-conscious and race-neutral portion is obtained from local agency's Disadvantaged Business Enterprise (DBE) liaison officer.
Local agency's DBE liaison officer
Phone
(
)
Page No.
This contract has a specific DBE goal to meet the intent of the DBE program.
This contract has no specific DBE goal because one is not necessary (documentation verifies this determination and is on file).
For individuals with sensory disabilities, this document is available in alternate formats. For information, call (916) 445-1233,
ADA Notice
TTY 711, or write to Records and Forms Management, 1120 N Street, MS-89, Sacramento, CA 95814.
STATE OF CALIFORNIA • DEPARTMENT OF TRANSPORTATION
LOCAL AGENCY RESIDENT ENGINEER CONTRACT PROVISIONS CHECKLIST
OFG-3 (REV 07/2016)
Page 2 of 2
If contract has a specific race-conscious goal, complete Section 5 below.
If contract does not have a specific race-conscious goal, complete Section 6 below.
5. Contracts With Specific Goals
(Check if included and indicate page number.)
The following applicable Caltrans standard special provisions (SSPs) or their equivalents are included
in the contract special provisions with page numbers noted (editing may be required).
Page No.
2-1.01, "General," Required listing of proposed subcontractors and required contract assurance statement or equivalent provisions
"Listing of Subcontractors" or equivalent form
2-1.02, "Disadvantaged Business Enterprise (DBE)" or equivalent provisions
2-1.02A, "DBE Goal for This Contract" or equivalent provisions
2-1.02B, "Submission of DBE Information" or equivalent provisions
3, "Award and Execution of Contract" or equivalent provisions
Caltrans SSP 5-1,
"Subcontractor and DBE Records" or equivalent provisions
Caltrans SSP 5-1,
"DBE Certification Status Change" or equivalent provisions
Caltrans SSP 5-1,
"Performance of DBE Subcontractors and Suppliers" or equivalent provisions
Caltrans SSP 5-1,
"Subcontracting" or equivalent provisions *
Caltrans SSP 5-1,
"Prompt Progress Payments to Subcontractors" or equivalent provisions
Caltrans SSP 5-1,
"Prompt Payment of Withheld Funds to Subcontractors" or equivalent provisions
Caltrans "SSP DBE Information Form" or equivalent provisions
6. Contracts Without Specific Goals
(Check if included and indicate page number.)
The following applicable Caltrans standard special provisions (SSPs) or their equivalents are included
in the contract special provisions with page numbers noted (editing may be required).
Page No.
2-1.01, "General," Required listing of proposed subcontractors and required contract assurance statement or equivalent provisions
"Listing of Subcontractors" or equivalent form
2-1.02, "Disadvantaged Business Enterprise (DBE)" or equivalent provisions
3, "Award and Execution of Contract" or equivalent provisions
Caltrans SSP 5-1,
"Subcontractor and DBE Records" or equivalent provisions
Caltrans SSP 5-1,
"DBE Certification Status Change" or equivalent provisions
Caltrans SSP 5-1,
"Subcontracting" or equivalent provisions*
Caltrans SSP 5-1,
"Prompt Progress Payments to Subcontractors" or equivalent provisions
Caltrans SSP 5-1,
"Prompt Payment of Withheld Funds to Subcontractors" or equivalent provisions*
* 6/21/04 update
7. Buy America Specification
Page No.
Caltrans SSP 5-1,
"Buy America Specification"
8. Federal Trainees
(Check appropriate box and indicate page number if requirement applies.)
Page No.
The project has fewer than 100 working days. A federal trainee goal and special provisions are not required.
Analysis of the Engineer's Estimate has a dollar value under $200,000. (Local Assistance Procedure Manual, Section 12-9,
"Required Federal Contract Provisions") A federal trainee goal and special provisions are not required.
The trainee goal is
Caltrans SSP, "Federal Requirement Training Special Provisions," (FR-15 and FR-16)
are included
9. Federal Wage Rates
Page No.
Federal wage rates are physically incorporated in this contract.

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