Form 4109 "Commercially Useful Function (Cuf) Review" - Michigan

What Is Form 4109?

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

Form Details:

  • Released on April 1, 2018;
  • The latest edition provided by the Michigan 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 4109 by clicking the link below or browse more documents and templates provided by the Michigan Department of Transportation.

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Clear Form
COMMERCIALLY USEFUL FUNCTION (CUF) REVIEW
Michigan Department
Page 1 of 3
of Transportation
4109 (04/18)
A CUF review is required on each DBE firm working on any federally-funded construction project, regardless of whether there is a DBE goal. This review
should be conducted while the DBE is actually working on the project. Federal regulation 49 CFR 26.55 states: “A DBE performs a commercially useful
function when it is responsible for execution of the work on the contract and is carrying out its responsibilities by actually performing, managing, and
supervising the work involved…” This form is for the purpose of monitoring DBEs compliance with the CUF requirements for obtaining DBE credit on
projects. CUF definition and violation red flags can be found on the back of this form. For more information, contact OBD at (313) 965-2326 or at
MDOT-
CUF@michigan.gov. Additional guidance on material suppliers are included as pages 2 & 3 of this form. Additional FHWA CUF guidance can
be found at: www.fhwa.dot.gov/federal-aidessentials/commusefunction.pdf.
REVIEWER’S NAME (Print clearly)
REVIEWER’S AGENCY
REVIEWER’S PHONE NUMBER
PROJECT NUMBER (ID)
CONTRACTOR THAT THE DBE FIRM IS WORKING FOR
DBE FIRM BEING REVIEWED
FIELD INSPECTION DATE
DESCRIBE DBE’S SCOPE OF WORK. [Review DBE Commitment form 0178 (blue sheet), subcontract, trucking worksheet (Form 4101)
and/or purchase order(s), truck ticket(s), etc., to assist in determination of CUF compliance.]
SUBCONTRACTS AND PURCHASE ORDERS
YES
NO
N/A
Are purchase orders, subcontracts and/or trucking tickets, bills of lading, etc., on file in the project office?
EMPLOYEES
Does the DBE firm have employees on the job?
Do they appear on the DBE firm’s payroll? If no, provide details below.
Do they appear on any other contractor’s payroll?
Does the DBE firm employ a supervisor or foreman who is onsite directing their work? If so, provide their name below.
PERFORMANCE
Has any other contractor performed any of the DBE’s work? If yes, explain below.
TRUCKERS Please note on the IDR the trucks on site for the date of review (e.g., 3 trucks labeled XYZ Company, 2 from ABC Company).
Does a review of the load tickets indicate that hauling is being done by the DBE (must check for off-site trucking)? If no, explain.
If leased, does the driver have the lease agreement (MDOT Form 4111) in their truck and does it identify the DBE?
MATERIAL SUPPLIERS Please note on the IDR the delivery trucks seen on site for the date of review.
Does the DBE's name appear on invoices, delivery tickets, bills of lading, purchase orders, etc.? If no, explain below.
If delivery of material was observed, did the DBE use the delivery equipment listed on the blue sheet? If no, explain below.
Identify the basis for acceptance of the materials the DBE provides (e.g., visual inspection, tested stock, general certification,
approved manufacturer, etc.)
EQUIPMENT
Does the Prime's name appear on any equipment used by the DBE firm?
CUF
Does it appear the DBE is performing a CUF? (See CUF explanation card)
COMMENTS / EXPLANATIONS
The signature below is verification that the reviewer observed the DBE performing its commercially useful function. Any CUF problems were
documented (form 4109, IDR, report, etc.), addressed, and reported to the Office of Business Development (OBD).
SIGNATURE OF PROJECT ENGINEER / P.E.’S DESIGNEE
DATE
INSTRUCTIONS FOR SUBMISSION
Within 10 days of signature, save a copy of this completed form to ProjectWise and/or to the appropriate project office file.
If a follow up is needed by OBD: (ProjectWise users) Advance the workflow and OBD staff will be notified; (Non-ProjectWise Users) e-mail this form
to
MDOT-CUF@michigan.gov
(please be sure to indicate the Region where the project is located in the subject l ine of the email). Questions, contact OBD
at (313) 965-2326 or at MDOT-CUF@michigan.gov.
Clear Form
COMMERCIALLY USEFUL FUNCTION (CUF) REVIEW
Michigan Department
Page 1 of 3
of Transportation
4109 (04/18)
A CUF review is required on each DBE firm working on any federally-funded construction project, regardless of whether there is a DBE goal. This review
should be conducted while the DBE is actually working on the project. Federal regulation 49 CFR 26.55 states: “A DBE performs a commercially useful
function when it is responsible for execution of the work on the contract and is carrying out its responsibilities by actually performing, managing, and
supervising the work involved…” This form is for the purpose of monitoring DBEs compliance with the CUF requirements for obtaining DBE credit on
projects. CUF definition and violation red flags can be found on the back of this form. For more information, contact OBD at (313) 965-2326 or at
MDOT-
CUF@michigan.gov. Additional guidance on material suppliers are included as pages 2 & 3 of this form. Additional FHWA CUF guidance can
be found at: www.fhwa.dot.gov/federal-aidessentials/commusefunction.pdf.
REVIEWER’S NAME (Print clearly)
REVIEWER’S AGENCY
REVIEWER’S PHONE NUMBER
PROJECT NUMBER (ID)
CONTRACTOR THAT THE DBE FIRM IS WORKING FOR
DBE FIRM BEING REVIEWED
FIELD INSPECTION DATE
DESCRIBE DBE’S SCOPE OF WORK. [Review DBE Commitment form 0178 (blue sheet), subcontract, trucking worksheet (Form 4101)
and/or purchase order(s), truck ticket(s), etc., to assist in determination of CUF compliance.]
SUBCONTRACTS AND PURCHASE ORDERS
YES
NO
N/A
Are purchase orders, subcontracts and/or trucking tickets, bills of lading, etc., on file in the project office?
EMPLOYEES
Does the DBE firm have employees on the job?
Do they appear on the DBE firm’s payroll? If no, provide details below.
Do they appear on any other contractor’s payroll?
Does the DBE firm employ a supervisor or foreman who is onsite directing their work? If so, provide their name below.
PERFORMANCE
Has any other contractor performed any of the DBE’s work? If yes, explain below.
TRUCKERS Please note on the IDR the trucks on site for the date of review (e.g., 3 trucks labeled XYZ Company, 2 from ABC Company).
Does a review of the load tickets indicate that hauling is being done by the DBE (must check for off-site trucking)? If no, explain.
If leased, does the driver have the lease agreement (MDOT Form 4111) in their truck and does it identify the DBE?
MATERIAL SUPPLIERS Please note on the IDR the delivery trucks seen on site for the date of review.
Does the DBE's name appear on invoices, delivery tickets, bills of lading, purchase orders, etc.? If no, explain below.
If delivery of material was observed, did the DBE use the delivery equipment listed on the blue sheet? If no, explain below.
Identify the basis for acceptance of the materials the DBE provides (e.g., visual inspection, tested stock, general certification,
approved manufacturer, etc.)
EQUIPMENT
Does the Prime's name appear on any equipment used by the DBE firm?
CUF
Does it appear the DBE is performing a CUF? (See CUF explanation card)
COMMENTS / EXPLANATIONS
The signature below is verification that the reviewer observed the DBE performing its commercially useful function. Any CUF problems were
documented (form 4109, IDR, report, etc.), addressed, and reported to the Office of Business Development (OBD).
SIGNATURE OF PROJECT ENGINEER / P.E.’S DESIGNEE
DATE
INSTRUCTIONS FOR SUBMISSION
Within 10 days of signature, save a copy of this completed form to ProjectWise and/or to the appropriate project office file.
If a follow up is needed by OBD: (ProjectWise users) Advance the workflow and OBD staff will be notified; (Non-ProjectWise Users) e-mail this form
to
MDOT-CUF@michigan.gov
(please be sure to indicate the Region where the project is located in the subject l ine of the email). Questions, contact OBD
at (313) 965-2326 or at MDOT-CUF@michigan.gov.
MDOT 4109 (04/18)
Page 2 of 3
What Constitutes a Commercially Useful Function (CUF)?
In order for a contractor to receive DBE credit on Michigan Department of Transportation projects the DBE must perform a CUF. To
perform a CUF a DBE must carry out all contract responsibilities by performing, managing, and supervising its work while utilizing their
own equipment. Also, the DBE must be paid in accordance with Michigan Department of Transportation guidelines.
Five Key Areas to Monitor for CUF Compliance.
1.
DBE Firm Management
2.
DBE Equipment Handling
3.
DBE Workforce
4.
DBE Contractually Supplied Materials
5.
DBE Performance
CUF Violation Red Flags
Management
Supervision of DBE employees done by another contractor.
The DBE provides little or no supervision of contracted work.
The DBE’s superintendent is not a regular, full-time, exclusive employee of the DBE.
Supervision is performed by personnel associated with another company.
The DBE hasn’t been issued a subcontract, purchase order or other contractual document.
DBE firm's owner is not aware of the status of the work, the employees and/or the performance of the business.
DBE firm owners or superintendents are rarely or never seen on the project.
Equipment
Payments are deducted by the prime contractor for equipment used by the DBE firm on the project.
The equipment used by the DBE firm belongs to the Prime contractor or another contractor with no formal long term lease
agreement (large, highly specialized equipment, such as a Crane, is an exception).
Magnetic equipment signs and/or markings cover another company logo or other information (TRUCKING ONLY).
Workforce
Movement of DBE's employee(s) to/from other contractors.
DBE's employee(s) paid by the prime.
DBE's employee(s) working for another company on the project.
DBE's employee(s) not familiar with DBE firm's owner/supervisors/key personnel.
Materials
Materials for the DBE are ordered, billed to, and/or paid for by the Prime contractor or another company other than the DBE.
Joint (2 party) checks are sent directly to the suppliers of the DBE firm without the knowledge or consent of the DBE.
The DBE does not deliver the agreed to joint (2-party) check to its supplier(s).
Invoices for the materials do not indicate that the DBE is the customer and/or list the Prime's e mployee as the contact person.
The prime places requirements on the DBE regarding where to purchase project materials.
The source of the materials comes from the Prime contractor or an affiliate of the Prime Contractor.
Records/Documents to review for material suppliers: Invoices, Delivery tickets or Bills of lading, Purchase orders, Cancelled
checks, Joint check agreement (if applicable).
Performance
Some of the DBE work is being done jointly with another contractor.
The work to be performed is outside of the DBE's known experience or capability (DBE certifications/prequalification categories
The DBE performs work without a subcontract, purchase order or other signed contractual document.
A DBE subcontracts more of its work than is customary or standard industry practice (50%).
DBE participation on a project is less than the prime’s commitment on MDOT form 0178 (blue sheet).
Lack of evidence of ownership, control and/or independence of the DBE.
The DBE works for only one prime contractor or a large portion of the DBE’s contracts are with one contractor.
Note: Noting a red flag does not automatically mean there is a CUF violation. However, notice of red flag(s) should be documented and
reported to the Office of Business Development (OBD).
MDOT 4109 (04/18)
Page 3 of 3
Guidance for Monitoring DBE Material Suppliers
1.
DBE supplier monitoring by the project offices and corresponding completion of 4109 reports require that the prime
submit documentation that the project office staff can refer to, especially in cases where products are delivered off-site.
2.
When there is a commitment for DBE supplier participation on a federal project, the project office staff and the successful
bidder or prime should establish what supporting documentation will be acceptable and sufficient for monitoring purposes.
This can be done during the pre-construction meeting and/or prior to the delivery of the supply items.
Supporting
documentation should be submitted to the project office as it becomes available. Some of this documentation may include:
Materials certifications, purchase orders, invoices, bills, joint check agreements, verifications of payment by the DBE to the
manufacturer, payments by the contractor to the DBE supplier (i.e., checks/bank statements, 2124 reports/MERS, etc.),
delivery tickets, bills of lading, etc.
3.
Project office staff should be sure their instructions to the successful bidder or prime regarding documentation
submittal is recorded in the pre-construction meeting minutes.
4.
Prime contractors cannot take regular dealer or manufacturer credit when they fail to provide documentation of DBE supplier
participation requested by the project office. Notify the Office of Business Development via the 4109 report when prime
contractors fail or refuse to provide requested DBE supplier documentation and information.
5.
Project office staff should notify the Office of Business Development via the 4109 report when documentation provided
indicates vendors or contractors other than the DBE suppliers are providing materials that were supposed to be secured by
the DBE suppliers.
6.
Whenever possible and practical, project office staff should visibly monitor deliveries of materials provided by DBE
suppliers, noting company names on vehicles, etc.
7.
Project office staff are encouraged to take pictures when questionable activities are observed, such as materials being
dropped off in the manufacturers’ vehicles or delivered by contractors and vendors other than the DBE supplier. Provide this
information to the Office of Business Development as soon as possible along with a 4109 report:
MDOT-CUF@michigan.gov
or (313) 965-2326.
Page of 3