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[]
[null,"Instructions for Completing the DBE Identification Submittal Form ECR-100"]
[]
[]
[null,"Fill out this form on the 'Data Entry' Worksheet per the instructions below.  You will then need to go to the 'Printed_Form' Worksheet to Review and save the file as a PDF by using the button provided. The File should open in your default PDF application where you will then need to apply your Digital Signature.  "]
[]
[null,"Submit this form with your bid or to the External Civil Rights Division no later than 4:00 p.m. on the 3rd working day after the bid\nopening. Only DBE's listed on MoDOT's Missouri Regional Certification Committee (MRCC) directory may be used towards\nobtaining the DBE goal on the project. DBE firm must be certified with the appropriate North American Industrial Classification\nSystem (NAICS) code for the type of work being utilized to perform. The MRCC directory is available at the following link:"]
[null,"https://www.modot.org/mrcc-directory"]
[]
[]
[null,"(A) Insert Bid Line Item in the same order as it appears in the bid document."]
[null,"(B) Insert the result from multiplying the unit price for the bid line item by the quantities listed in column (A); a lump sum, if\napplicable, may also be inserted.\n\n"]
[null,"(C) Insert the percentage of column (B) that the DBE will perform. If the DBE is a supplier as that term is defined in 49 CFR Part 26.55, then only 60% of the value in column (B) can be applied towards the contract specific goal. If the DBE is a manufacturer, 100% of the value can be applied.  If the DBE is furnishing and installing the line item, then 100% of the value can be applied."]
[null,"(D) Autocalculated ( result from dividing columns (B) and C))."]
[null,"(E) Autocalculated (result from dividing column (D) from the total bid line item amount.)"]

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["Missouri Department of Transportation"]
["DBE Identification Submittal Form "]
[]
["Contract ID:",null,null,null,null,null,null,null,"Job Number:"]
[]
["Route:",null,null,null,null,null,null,null,"County:"]
[]
["Prime Contractor:",null,null,null,null,null,null,null,"Contract Amount:"]
[]
[]
["Identification of Participating DBE's: Provide the requested information below for each DBE participating on the project. Submit this information with your bid or to the External Civil Rights Division (ECR) no later than 4:00 p.m. on the 3rd working day after the bid opening.  Fax or email transmittal is permitted. The fax number is (573) 526-0558 and the email address is dbe@modot.mo.gov. Contact ECR at (573) 526-2978 for questions and assistance on completion. This document must be received for each DBE utilized on the project.\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,true]
["All information must be provided."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,false]
["If awarded the contract for this project, the undersigned will use the following DBE to perform or furnish the work, supplies, and/or services as shown below:"]
[]
[]
["DBE Name:",null,null,null,null,null,null,null,"Address:"]
[]
[]
["If DBE is supplying material to a subcontractor, list name of subcontractor here:"]
[]
[]
[]
[]
[null,"Company Name (Prime Contractor)"]
[]
[]
[]
[]
[null,"Signed (Prime Contractor)"]
[]
[null,"(A)",null,"(B)",null,null,"(C)",null,null,"(D)",null,null,"(E)"]
[null,"Line No.",null,"Dollar Value of DBE Work**\n( Unit Price x Quantity of the Item in (A), or Lump Sum)",null,null,"Dollar value applicable to DBE Goal**\nSelect 60% or 100% from the pick list",null,null,"Dollar amount applicable to DBE Goal\n(B x C)",null,null,"\"Percent of total contract amount for line item\n(D divided by total contract amount)\"\t\t\n\t\t\n\t\t"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Column1"]
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["Missouri Department of Transportation"]
["DBE Identification Submittal Form"]
[]
["Contract ID:",null,{"$f":"IF('Data entry'!C4:G4=0,\" \",'Data entry'!C4:G4)","v":" "},null,null,null,null,"Job Number:",null,null,{"$f":"IF('Data entry'!K4:O4=0,\" \",'Data entry'!K4:O4)","v":" "}]
[]
["Route:",null,{"$f":"IF('Data entry'!C6:G6=0,\" \",'Data entry'!C6:G6)","v":" "},null,null,null,null,null,"County:",null,{"$f":"IF('Data entry'!K6:O6=0,\" \",'Data entry'!K6:O6)","v":" "}]
[]
["Prime Contractor:",null,null,{"$f":"IF('Data entry'!D8:H8=0,\" \",'Data entry'!D8:H8)","v":" "},null,null,null,null,"Contract Amount:",null,null,{"$f":"IF('Data entry'!L8:O8=0,\" \",'Data entry'!L8:O8)","v":" "}]
[]
["Identification of Participating DBE's: Provide the requested information below for each DBE participating on the project. Submit this information with your bid or to the External Civil Rights Division (ECR) no later than 4:00 p.m. on the 3rd working day after the bid opening.  Fax or email transmittal is permitted. The fax number is (573) 526-0558 and the email address is dbe@modot.mo.gov. Contact ECR at (573) 526-2978 for questions and assistance on completion. This document must be received for each DBE utilized on the project."]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,true]
[]
["All information must be provided.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,true]
[]
["If awarded the contract for this project, the undersigned will use the following DBE to perform or furnish the work, supplies, and/or services as shown below:",null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"'Data entry'!P18","v":false}]
[]
[]
["DBE Name:",null,{"$f":"IF('Data entry'!C22:G22=0,\" \",'Data entry'!C22:G22)","v":" "},null,null,null,null,null,"Address:",null,{"$f":"IF('Data entry'!K22:O22=0,\" \",'Data entry'!K22:O22)","v":" "}]
[null,null,null,null,null,null,null,null,null,null,{"$f":"IF('Data entry'!K23:O23=0,\" \",'Data entry'!K23:O23)","v":" "}]
[]
["If DBE is supplying material to a subcontractor, list name of subcontractor here: ",null,null,null,null,null,null,null,null,null,null,{"$f":"IF('Data entry'!L25:O25=0,\" \",'Data entry'!L25:O25)","v":" "}]
[null,"Respectfully submitted:"]
[]
[null,{"$f":"IF('Data entry'!B27:G29=0,\" \",'Data entry'!B27:G29)","v":" "}]
[]
[]
[null,"Company Name (Prime Contractor)"]
[]
[]
[]
[]
[null,"Signed (Prime Contractor)"]
[]
[]
[null,"DBE Identification Submittal Form"]
[null,"Line No.",null,"Dollar Value of DBE Work**\n( Unit Price x Quantity of the Item in (A), or Lump Sum)",null,null,"Dollar value applicable to DBE Goal**\nEnter either 100% or 60%",null,null,"Dollar amount applicable to DBE Goal\n(B x C)",null,null,"Percent of total contract amount for line item\n(D divided by total contract amount)"]
[]
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[null,{"$f":"'Data entry'!B55:C55","v":0},null,{"$f":"IF('Data entry'!D55>1,'Data entry'!D55,\" \")","v":" "},null,null,{"$f":"IF('Data entry'!G55>0.000001,'Data entry'!G55,\" \")","v":" "},null,null,{"$f":"IF('Data entry'!J55>0.000001,'Data entry'!J55,\" \")","v":" "},null,null,{"$f":"'Data entry'!M55:O55","v":""}]
[null,"**Cannot exceed bid amount for given item of work.",null,null,null,null,null,null,"DBE Total",null,null,{"$f":"SUM(J41:J55)","v":0},"Total % This Page",null,{"$f":"SUM(M41:M55)","v":0}]
[null,"Trucking services credited at 100% if the DBE owns the trucks or is leasing from a DBE firm. ",null,null,null,null,null,null,"DBE Total all Pages",null,null,{"$f":"$L$224+$L$168+$L$56+$L$112","v":0},"Total % all Pages",null,{"$f":"$O$224+$O$168+$O$56+$O$112","v":0}]
[null,"Allowed amount of participation will be in accordance with 49 CFR Part 26."]
[null,"Brokered services will only receive credit for fees."]
["Contract ID:",null,{"$f":"C4","v":" "},null,null,null,null,"Job Number:",null,null,{"$f":"K4","v":" "}]
[]
[null,null,null,"--Items Continued--"]
[]
[null,"DBE Identification Submittal Form"]
[null,"Line No.",null,{"$f":"$D$39","v":"Dollar Value of DBE Work**\n( Unit Price x Quantity of the Item in (A), or Lump Sum)"},null,null,{"$f":"$G$39","v":"Dollar value applicable to DBE Goal**\nEnter either 100% or 60%"},null,null,{"$f":"$J$39","v":"Dollar amount applicable to DBE Goal\n(B x C)"},null,null,{"$f":"$M$39","v":"Percent of total contract amount for line item\n(D divided by total contract amount)"}]
[]
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[null,{"$f":"'Data entry'!B99:C99","v":0},null,{"$f":"IF('Data entry'!D99>1,'Data entry'!D99,\" \")","v":" "},null,null,{"$f":"IF('Data entry'!G99>0.000001,'Data entry'!G99,\" \")","v":" "},null,null,{"$f":"IF('Data entry'!J99>0.000001,'Data entry'!J99,\" \")","v":" "},null,null,{"$f":"'Data entry'!M99:O99","v":""}]
[null,{"$f":"'Data entry'!B100:C100","v":0},null,{"$f":"IF('Data entry'!D100>1,'Data entry'!D100,\" \")","v":" "},null,null,{"$f":"IF('Data entry'!G100>0.000001,'Data entry'!G100,\" \")","v":" "},null,null,{"$f":"IF('Data entry'!J100>0.000001,'Data entry'!J100,\" \")","v":" "},null,null,{"$f":"'Data entry'!M100:O100","v":""}]
[null,"**Cannot exceed bid amount for given item of work.",null,null,null,null,null,null,"DBE Total",null,null,{"$f":"SUM(J67:J111)","v":0},"Total % This Page",null,{"$f":"SUM(M67:M111)","v":0}]
[null,"Trucking services credited at 100% if the DBE owns the trucks or is leasing from a DBE firm. ",null,null,null,null,null,null,"DBE Total all Pages",null,null,{"$f":"$L$224+$L$168+$L$56+$L$112","v":0},"Total % all Pages",null,{"$f":"$O$224+$O$168+$O$56+$O$112","v":0}]
[null,"Allowed amount of participation will be in accordance with 49 CFR Part 26."]
[null,"Brokered services will only receive credit for fees."]
["Contract ID:",null,{"$f":"C60","v":" "},null,null,null,null,"Job Number:",null,null,{"$f":"K60","v":" "}]
[]
[null,null,null,"--Items Continued--"]
[]
[null,"DBE Identification Submittal Form"]
[null,"Line No.",null,"Dollar Value of DBE Work**\n( Unit Price x Quantity of the Item in (A), or Lump Sum)",null,null,"Dollar value applicable to DBE Goal**\nChoose either 100% or 60%",null,null,"Dollar amount applicable to DBE Goal\n(Bx C)",null,null,"Percent of total contract amount for line item\n(DI total contract amount)"]
[]
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[null,{"$f":"'Data entry'!B144:C144","v":0},null,{"$f":"IF('Data entry'!D144>1,'Data entry'!D144,\" \")","v":" "},null,null,{"$f":"IF('Data entry'!G144>0.000001,'Data entry'!G144,\" \")","v":" "},null,null,{"$f":"IF('Data entry'!J144>0.000001,'Data entry'!J144,\" \")","v":" "},null,null,{"$f":"'Data entry'!M144:O144","v":""}]
[null,{"$f":"'Data entry'!B145:C145","v":0},null,{"$f":"IF('Data entry'!D145>1,'Data entry'!D145,\" \")","v":" "},null,null,{"$f":"IF('Data entry'!G145>0.000001,'Data entry'!G145,\" \")","v":" "},null,null,{"$f":"IF('Data entry'!J145>0.000001,'Data entry'!J145,\" \")","v":" "},null,null,{"$f":"'Data entry'!M145:O145","v":""}]
[null,"**Cannot exceed bid amount for given item of work.",null,null,null,null,null,null,"DBE Total",null,null,{"$f":"SUM(J123:J167)","v":0},"Total % This Page",null,{"$f":"SUM(M123:M167)","v":0}]
[null,"Trucking services credited at 100% if the DBE owns the trucks or is leasing from a DBE firm. ",null,null,null,null,null,null,"DBE Total all Pages",null,null,{"$f":"$L$224+$L$168+$L$56+$L$112","v":0},"Total % all Pages",null,{"$f":"$O$224+$O$168+$O$56+$O$112","v":0}]
[null,"Allowed amount of participation will be in accordance with 49 CFR Part 26."]
[null,"Brokered services will only receive credit for fees."]
["Contract ID:",null,{"$f":"C116","v":" "},null,null,null,null,"Job Number:",null,null,{"$f":"K116","v":" "}]
[]
[null,null,null,"--Items Continued--"]
[]
[null,"DBE Identification Submittal Form"]
[null,"Line No.",null,"Dollar Value of DBE Work**\n( Unit Price x Quantity of the Item in (A), or Lump Sum)",null,null,"Dollar value applicable to DBE Goal**\nChoose either 100% or 60%",null,null,"Dollar amount applicable to DBE Goal\n(Bx C)",null,null,"Percent of total contract amount for line item\n(DI total contract amount)"]
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[null,{"$f":"'Data entry'!B190:C190","v":0},null,{"$f":"IF('Data entry'!D190>1,'Data entry'!D190,\" \")","v":" "},null,null,{"$f":"IF('Data entry'!G190>0.000001,'Data entry'!G190,\" \")","v":" "},null,null,{"$f":"IF('Data entry'!J190>0.000001,'Data entry'!J190,\" \")","v":" "},null,null,{"$f":"'Data entry'!M190:O190","v":""}]
[null,"**Cannot exceed bid amount for given item of work.",null,null,null,null,null,null,"DBE Total",null,null,{"$f":"SUM(J179:J223)","v":0},"Total % This Page",null,{"$f":"SUM(M179:M223)","v":0}]
[null,"Trucking services credited at 100% if the DBE owns the trucks or is leasing from a DBE firm. ",null,null,null,null,null,null,"DBE Total all Pages",null,null,{"$f":"$L$224+$L$168+$L$56+$L$112","v":0},"Total % all Pages",null,{"$f":"$O$224+$O$168+$O$56+$O$112","v":0}]
[null,"Allowed amount of participation will be in accordance with 49 CFR Part 26."]
[null,"Brokered services will only receive credit for fees."]