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+----------------------------------------------------------+---+---+---+
| ## State Transportation Agency (STA) Responsibilities    | # | # | # |
|                                                          | # | # | # |
|                                                          |   |   |   |
+----------------------------------------------------------+---+---+---+
| **Subpart A: General**                                   | * | * | * |
|                                                          | * | * | * |
|                                                          | Y | N | ? |
|                                                          | e | o | * |
|                                                          | s | * | * |
|                                                          | * | * |   |
|                                                          | * |   |   |
+----------------------------------------------------------+---+---+---+
| 1.  Does your DBE Program create and maintain a bidders  |   |   |   |
|     list of all firms who bid or quote and captures the  |   |   |   |
|     age and average gross receipts of the firms? (49 CFR |   |   |   |
|     26.11 (c))                                           |   |   |   |
+----------------------------------------------------------+---+---+---+
| 2.  Do all financial agreements, prime contracts, and    |   |   |   |
|     subcontracts have the required DBE program assurance |   |   |   |
|     statements incorporated? (49 CFR 26.13(a) (b))       |   |   |   |
+----------------------------------------------------------+---+---+---+
| **Subpart B: Administrative Requirements**               |   |   |   |
+----------------------------------------------------------+---+---+---+
| 1.  Does your FHWA approved DBE program currently        |   |   |   |
|     incorporate all USDOT regulatory requirements and    |   |   |   |
|     guidance as amended? (49 CFR 26.21(b))               |   |   |   |
+----------------------------------------------------------+---+---+---+
| 2\. Is the DBE program document with a policy statement  |   |   |   |
| distributed internally and externally? (49 CFR 26.23)    |   |   |   |
+----------------------------------------------------------+---+---+---+
| 3\. Does your DBE Liaison Officer have independent       |   |   |   |
| program implementation authority and independent         |   |   |   |
| (direct) access to the CEO?(49 CFR 26.25)                |   |   |   |
+----------------------------------------------------------+---+---+---+
| 4\. Does the STA have a prompt payment/retainage         |   |   |   |
| provision in its contract that requires prime            |   |   |   |
| contractors to pay subcontractors within 30 days? (49    |   |   |   |
| CFR 26.29 (a) (1))                                       |   |   |   |
+----------------------------------------------------------+---+---+---+
| 5\. Does the STA have a prompt payment/retainage         |   |   |   |
| provision in its contract that identifies one of three   |   |   |   |
| options? (49 CFR 26.29(b)(1)(2)(3))                      |   |   |   |
+----------------------------------------------------------+---+---+---+
| 6\. Does your DBE program provide for specific contract  |   |   |   |
| administration monitoring that ensures prompt payment    |   |   |   |
| (Consideration: contract clause, receipt of cancelled    |   |   |   |
| check) and appropriate means to enforce prompt payment   |   |   |   |
| and return of retainage? (49 CFR 26.29(d)(e))            |   |   |   |
+----------------------------------------------------------+---+---+---+
| 7\. Is the STA's DBE directory maintained and updated?   |   |   |   |
| (Consideration: monthly) (49 CR 26.31)                   |   |   |   |
+----------------------------------------------------------+---+---+---+
| 8\. Does the STA DBE program have a method to address    |   |   |   |
| over-concentration? (49 CFR 26.33)                       |   |   |   |
+----------------------------------------------------------+---+---+---+
| 9\. Does the STA conduct compliance reviews, audits      |   |   |   |
| and/or assessments of all program participants, (e.g.,   |   |   |   |
| contractors, and other state and local                   |   |   |   |
| governments/agencies)? (49 CFR 26.37(a))                 |   |   |   |
+----------------------------------------------------------+---+---+---+
| 10\. Does your DBE program include mechanism(s) for      |   |   |   |
| monitoring and enforcement of DBE contract awards and    |   |   |   |
| payments and a running tally of actual DBE attainments?  |   |   |   |
| (49 CFR 26.37(b)(c))                                     |   |   |   |
+----------------------------------------------------------+---+---+---+
| 11\. Does your DBE program apply to all federal-aid      |   |   |   |
| highway funds expended on contracts? (Consideration,     |   |   |   |
| construction, professional services, management          |   |   |   |
| services, etc.) (49 CFR 26.3(a)(1)), 26.5                |   |   |   |
+----------------------------------------------------------+---+---+---+
| **Subpart C: Goals/Good Faith Efforts/Counting:**        | # | # |   |
|                                                          | # | # |   |
|                                                          |   |   |   |
+----------------------------------------------------------+---+---+---+
| 1\. To establish the Step 1 base figure, do you use data |   |   |   |
| source(s) such as DBE directory, bidders list, disparity |   |   |   |
| study, and /or census bureau data? (49 CFR 26.45(c))     |   |   |   |
+----------------------------------------------------------+---+---+---+
| 2\. Does your Step 2 adjustment of your base figure      |   |   |   |
| indicate types of evidence such as current capacity,     |   |   |   |
| statistical disparities in DBE financing, etc.? (49 CFR  |   |   |   |
| 26.45 (d))                                               |   |   |   |
+----------------------------------------------------------+---+---+---+
| 3\. When you submit your annual overall goal by August 1 |   |   |   |
| of each year, does it include: methodology, summary      |   |   |   |
| listing of evidence, and projections for race neutral    |   |   |   |
| and race conscious goal attainment? (49 CFR              |   |   |   |
| 26.45)(f)(1)(3); also (49 CFR 26.51) (c)(d))             |   |   |   |
+----------------------------------------------------------+---+---+---+
| 4\. Does the STA have a currently approved DBE overall   |   |   |   |
| annual goal for the current fiscal year? (49 CFR 26.45)  |   |   |   |
| & (49 CFR 26.47)                                         |   |   |   |
+----------------------------------------------------------+---+---+---+

+-----------------------------------------------------------+---+---+---+
| **Subpart C: Goals/Good Faith Efforts/Counting            | # | # | * |
| (*continued*)**                                           | # | # | * |
|                                                           |   |   | ? |
|                                                           | Y | N | * |
|                                                           | E | O | * |
|                                                           | S |   |   |
+-----------------------------------------------------------+---+---+---+
| 5\. If you are a recipient of any of the three operating  |   |   |   |
| administrations (FHWA, FAA, and FTA), do you set separate |   |   |   |
| goals for each? (49 CFR 26.45) (e)(1)(2)                  |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 6\. In establishing your overall goal, do you provide for |   |   |   |
| public participation to include consultation with         |   |   |   |
| minority, women and general contractor groups, etc.? (49  |   |   |   |
| CFR 26.45) (g)(1))                                        |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 7\. Do you publish a notice announcing your proposed      |   |   |   |
| overall goal for 30 days and informing the public of the  |   |   |   |
| 45 day comment period? (49 CFR 26.45) (g)(2))             |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 8\. Do you attempt to meet the maximum portion of your    |   |   |   |
| overall goal by race neutral means? (49 CFR 26.51(a))     |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 9\. Do you count as race neutral, contracts won by DBEs   |   |   |   |
| as primes through customary competitive procedures, DBE   |   |   |   |
| subcontracts when there is no contract goal, and          |   |   |   |
| subcontracts with primes that do not consider DBE status? |   |   |   |
| (49 CFR 26.51(a))                                         |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 10\. As a means of achieving race neutral participation,  |   |   |   |
| does the STA utilize options such as encouraging primes   |   |   |   |
| to subcontract work they would normally perform,          |   |   |   |
| unbundling large contracts, providing technical           |   |   |   |
| assistance, implementing supportive services, etc.? (49   |   |   |   |
| CFR 26.51(b)(1-9))                                        |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 11\. Does the STA establish contract goals based upon     |   |   |   |
| factors such as type of work, location, and DBE           |   |   |   |
| availability that cumulatively results in meeting only    |   |   |   |
| the portion of the overall goal that cannot be met        |   |   |   |
| through race-neutral means? (49 CFR 26.51(e)(2))          |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 12\. Do the STA contract provisions incorporate the good  |   |   |   |
| faith effort guidance in Appendix A of the DBE program    |   |   |   |
| requirements? (49 CFR 26.53(a)(2))                        |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 13\. Does the STA reduce or eliminate contract goals when |   |   |   |
| it is determined that the overall goal will be exceeded?  |   |   |   |
| (49 CFR 26.51(f)(2))                                      |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 14\. Does the STA in its running tally capture DBE        |   |   |   |
| participation on all contracts with or without contract   |   |   |   |
| goals? (49 CFR 26.51(g))                                  |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 15\. When a DBE goal has been established, are bidders    |   |   |   |
| required to submit DBE information, i.e. name,            |   |   |   |
| description of                                            |   |   |   |
|                                                           |   |   |   |
| work, and dollar amount at any time before the STA        |   |   |   |
| commits to the performance of the contract? (49 CFR       |   |   |   |
|                                                           |   |   |   |
| 26.53(b)(3))                                              |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 16\. Does the STA require as a condition of award, the    |   |   |   |
| submission of the DBE information including the name,     |   |   |   |
|                                                           |   |   |   |
| description of work, dollar amount, written documentation |   |   |   |
| of commitment, and written confirmation from the DBE that |   |   |   |
| it is participating in the contract? (49 CFR              |   |   |   |
| 26.53(b)(2)&(c)).                                         |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 17\. Does the evidence provided by the bidder document    |   |   |   |
| efforts to meet the goal, even though the goal was not    |   |   |   |
| met? (49 CFR 26.53(a)(2))                                 |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 18\. Are reconsideration decisions made by an official    |   |   |   |
| who did not take part in the original good faith effort   |   |   |   |
| determinations? (49 CFR 26.53(d)(2))                      |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 19\. If a goal has been established in a design-build,    |   |   |   |
| turnkey project, does the recipient maintain oversight of |   |   |   |
| the master contractor goals and other requirements? (49   |   |   |   |
| CFR 26.53) (e)                                            |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 20\. Does the STA have a procedure that requires the      |   |   |   |
| contractor to make good faith effort and receive the      |   |   |   |
| STA's prior written consent to substitute and/or replace  |   |   |   |
| DBE subcontractors for any reason? (49 CFR 26.53(f)(1) &  |   |   |   |
| (2))                                                      |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 21\. Do STA contract provisions include administrative    |   |   |   |
| remedies that will be invoked if prime contractors fail   |   |   |   |
| to comply with good faith efforts? (49 CFR 26.53 (f)(3))  |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 22\. Does the STA count toward contract goals the value   |   |   |   |
| of work only if the DBE performs a Commercially Useful    |   |   |   |
| Function (CUF) , when a DBE is responsible for a distinct |   |   |   |
| element of the contract work and it carries out its       |   |   |   |
| responsibilities by actually performing, managing and     |   |   |   |
| supervising the work involved? (49 CFR 26.55(c)1))        |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 23\. Does the STA count toward contract goals the value   |   |   |   |
| of work performed by DBE's own forces? )Considerations:   |   |   |   |
| does not count equipment leased and/or material purchased |   |   |   |
| from the prime contractor) (49 CFR 26.55(a)(1))           |   |   |   |
+-----------------------------------------------------------+---+---+---+

+------------------------------------------------------------+---+---+---+
| **Subpart C: Goals/Good Faith Efforts/Counting**           | # | # | * |
| *(Continued)*                                              | # | # | * |
|                                                            |   |   | ? |
|                                                            | Y | N | * |
|                                                            | e | o | * |
|                                                            | s |   |   |
+------------------------------------------------------------+---+---+---+
| 24\. When a DBE subcontracts part of his/her work to a     |   |   |   |
| non-DBE, does the STA count only the portion conducted by  |   |   |   |
| the DBE in the overall contract goal? (49 CFR              |   |   |   |
| 26.55)(a)(3))                                              |   |   |   |
+------------------------------------------------------------+---+---+---+
| 25\. In a joint venture, does the STA count only the       |   |   |   |
| defined portion of work a DBE performs with his/her own    |   |   |   |
| forces? (49 CFR 26.55(b))                                  |   |   |   |
+------------------------------------------------------------+---+---+---+
| 26\. Does the STA's DBE program require the DBE to perform |   |   |   |
| at least 30% of their work? (Does not allow DBEs to serve  |   |   |   |
| as an extra participant in the contract) (49 CFR           |   |   |   |
| 26.55(c)(2)(3))                                            |   |   |   |
+------------------------------------------------------------+---+---+---+
| 27\. Does the STA count (towards the contract goal) the    |   |   |   |
| value of materials and supplies used on the contract only  |   |   |   |
| if the DBE is responsible for paying for the materials and |   |   |   |
| supplies? (factor -- joint checks) (49 CFR                 |   |   |   |
| 26.55)(c)(1)(2))                                           |   |   |   |
+------------------------------------------------------------+---+---+---+
| 28\. When a STA presumes that a DBE is not performing a    |   |   |   |
| CUF, do they allow the DBE to present evidence to rebut    |   |   |   |
| this presumption? (49 CFR 26.55)(c)(4))                    |   |   |   |
+------------------------------------------------------------+---+---+---+
| 29\. Does the STA's DBE program incorporate procedures to  |   |   |   |
| appropriately count DBEs and non-DBE truckers toward the   |   |   |   |
| goal? (49 CFR 26.55)(3)(4)(5))                             |   |   |   |
+------------------------------------------------------------+---+---+---+
| 30\. Does the STA's DBE program allow for appropriate      |   |   |   |
| counting for manufacturers, regular dealers and packagers  |   |   |   |
| and brokers? (49 CFR 26.55)(e)(1)(i) & (2)(i)              |   |   |   |
+------------------------------------------------------------+---+---+---+
| 31\. If a DBE firm's certification eligibility is removed  |   |   |   |
| during performance of a subcontract, does the STA deduct   |   |   |   |
| that subcontract amount from the overall goal? (49 CFR     |   |   |   |
| 26.55)(f)(g))                                              |   |   |   |
+------------------------------------------------------------+---+---+---+
| 32\. Does the STA have a process to ensure a contractor's  |   |   |   |
| DBE obligations are met based on payment to DBEs? (49 CFR  |   |   |   |
| 26.55)(h))                                                 |   |   |   |
+------------------------------------------------------------+---+---+---+
| **Subpart D: Certification Standards**                     |   |   |   |
+------------------------------------------------------------+---+---+---+
| 1\. Does your UCP require individuals who are not presumed |   |   |   |
| to be socially and economically disadvantaged to prove to  |   |   |   |
| you by a preponderance of evidence that they are socially  |   |   |   |
| and economically disadvantaged? (49 CFR 26.61)(d))         |   |   |   |
+------------------------------------------------------------+---+---+---+
| 2\. Does your UCP consider all the facts in the record     |   |   |   |
| viewed as a whole when making determinations concerning an |   |   |   |
| individual's or firm's eligibility, (i.e., ownership,      |   |   |   |
| membership, control, etc.)? (49 CFR 26.61(e))              |   |   |   |
+------------------------------------------------------------+---+---+---+
| 3\. When questioning an individual's claim of membership   |   |   |   |
| in a particular group, does your UCP provide written       |   |   |   |
| explanation of your reasons, and request additional        |   |   |   |
| information consistent with that asked of all groups? (49  |   |   |   |
| CFR 26.63)(a)(2)(3))                                       |   |   |   |
+------------------------------------------------------------+---+---+---+
| 4\. Does your UCP in making membership group               |   |   |   |
| determinations consider: whether a person has held himself |   |   |   |
| out to be a member over a long period of time; whether a   |   |   |   |
| person is regarded as a group member by relevant           |   |   |   |
| community, etc.? (49 CFR 26.63)(b))                        |   |   |   |
+------------------------------------------------------------+---+---+---+
| 5\. Does your UCP allow individual demonstration of social |   |   |   |
| and economic disadvantage for persons claiming membership  |   |   |   |
| in a presumed disadvantaged group but who you determined   |   |   |   |
| not to be a member? (49 CFR 26.63(b)(1))                   |   |   |   |
+------------------------------------------------------------+---+---+---+
| 6\. Does your UCP deny certification to firms who meet the |   |   |   |
| SBA size requirements but who exceed the 3 year average    |   |   |   |
| annual gross receipts under the USDOT size limit           |   |   |   |
| threshold? (49 CFR 26.65(b))                               |   |   |   |
+------------------------------------------------------------+---+---+---+
| 7\. Are all rebuttably presumed disadvantaged group        |   |   |   |
| members required to submit a signed, notarized             |   |   |   |
| certification that each disadvantaged owner is socially    |   |   |   |
| and economically disadvantaged? (49 CFR 26.67) (a))        |   |   |   |
+------------------------------------------------------------+---+---+---+
| 8\. Does your UCP require a personal net worth statement   |   |   |   |
| and supporting documentation from each individual owner    |   |   |   |
| applying to participate as a DBE, and whose ownership and  |   |   |   |
| control are relied upon for DBE certification? (49 CFR     |   |   |   |
| 26.67)(2)(i)(ii))                                          |   |   |   |
+------------------------------------------------------------+---+---+---+
| 9\. In determining an individual's personal net worth,     |   |   |   |
| does your UCP: (1) exclude ownership interest in the       |   |   |   |
| applicant firm; (2) exclude equity in primary residence;   |   |   |   |
| (3) does not use contingent liability; and (4) include     |   |   |   |
| only present value held in vested pension plans? (49 CFR   |   |   |   |
| 26.67(2)(iii)(A)(B)(C)(D))                                 |   |   |   |
+------------------------------------------------------------+---+---+---+
| 10\. Does your UCP release an individual's personal net    |   |   |   |
| worth statement and supporting documentation only to US    |   |   |   |
| DOT in certification appeal proceedings? (49 CFR           |   |   |   |
| 26.67(2)(iv))                                              |   |   |   |
+------------------------------------------------------------+---+---+---+
| 11\. When an individual has exceeded the personal net      |   |   |   |
| worth threshold (\$750,000), does your UCP deem his/her    |   |   |   |
| economic disadvantaged status to be rebutted? (49 CFR      |   |   |   |
| 26.67(b)(1))                                               |   |   |   |
+------------------------------------------------------------+---+---+---+
| 12\. When determining ownership, does your UCP evaluate    |   |   |   |
| the 51% ownership of: firm's ownership interest; each      |   |   |   |
| class of voting stock, each class of partnership interest, |   |   |   |
| and each member interest? (49 CFR 26.69(b)(1)(2)(3))       |   |   |   |
+------------------------------------------------------------+---+---+---+

+-----------------------------------------------------------+---+---+---+
| **Subpart D: Certification Standards** *(Continued)*      | # | # | * |
|                                                           | # | # | * |
|                                                           |   |   | ? |
|                                                           | Y | N | * |
|                                                           | e | o | * |
|                                                           | s |   |   |
+-----------------------------------------------------------+---+---+---+
| 13\. Does your UCP in evaluating whether a firm's         |   |   |   |
| ownership is real and substantial, review that enjoys the |   |   |   |
| customary benefits of ownership, shares in the risks and  |   |   |   |
| profits, etc. (49 CFR 26.69(c))                           |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 14\. Does your UCP count assets held in a revocable       |   |   |   |
| living trust only when the same disadvantaged individual  |   |   |   |
| is the sole grantor, beneficiary, and trustee? (49 CFR    |   |   |   |
| 26.69(d)(1)(2))                                           |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 15\. When expertise is relied upon as a part of a         |   |   |   |
| disadvantaged owner's contribution, does your UCP require |   |   |   |
| the owner's expertise be: in specialized field, critical  |   |   |   |
| to firm's operation, documented in the record and the     |   |   |   |
| owner has made a significant financial investment in the  |   |   |   |
| firm? (49 CFR 26.69(f)(1)(2))                             |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 16\. If a socially and economically disadvantaged         |   |   |   |
| individual's interests or other assets in the applicant   |   |   |   |
| firm were obtained by divorce settlement, through         |   |   |   |
| inheritance, or the death of a former owner, does the UCP |   |   |   |
| always deem such interests acceptable? (49 CFR            |   |   |   |
| 26.69(g)(1)(2))                                           |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 17\. For determining ownership, does your UCP disallow    |   |   |   |
| assets obtained by individuals because of a gift transfer |   |   |   |
| without adequate consideration? (49 CFR 26.69(h)(1)(2))   |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 18\. Does your UCP require non-participating spouses in   |   |   |   |
| an applicant firm to irrevocably renounce and transfer    |   |   |   |
| their rights of ownership interest when interest is held  |   |   |   |
| jointly or as community property? (49 CFR 26.69(j))       |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 19\. In determining whether a potential DBE is an         |   |   |   |
| independent business, does your UCP: scrutinize           |   |   |   |
| relationships with non-DBEs, evaluate present and recent  |   |   |   |
| employer/employee relationships, consider consistency     |   |   |   |
| with industry practice, etc.? (49 CFR                     |   |   |   |
| 26.71(b)(1)(2)(3)(4))                                     |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 20\. Are corporate charters, by-laws, employment          |   |   |   |
| contracts, etc., reviewed in evaluating an applicant's    |   |   |   |
| ability to control? (49 CFR 26.71( c))                    |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 21\. Does your UCP require socially and economically      |   |   |   |
| disadvantaged individuals to possess the power to make    |   |   |   |
| day to day as well as long term management, policy, and   |   |   |   |
| operations decisions? (49 CFR 26.71(d))                   |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 22\. Is it acceptable in your UCP for DBE firms to have   |   |   |   |
| non-socially and economically disadvantaged individuals   |   |   |   |
| involved in the firm as long as such individuals are not  |   |   |   |
| disproportionately responsible and the DBE owner retains  |   |   |   |
| power to hire and fire the person to whom such authority  |   |   |   |
| is delegated? (49 CFR 26.71(e)(f))                        |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 23\. Does your UCP require the socially and economically  |   |   |   |
| disadvantaged owners to posses understanding of,          |   |   |   |
| **[and]{.underline}** managerial **[and]{.underline}**    |   |   |   |
| technical competence **[and]{.underline}** experience     |   |   |   |
| directly related to the type of work of the business?     |   |   |   |
|                                                           |   |   |   |
| (49 CFR 26.71(g))                                         |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 24\. In determining control, does your UCP require the    |   |   |   |
| socially and economically disadvantaged owner to possess  |   |   |   |
| the license or credential necessary for a particular line |   |   |   |
| of work according to your state or local law              |   |   |   |
| requirements? (49 CFR 26.71(h))                           |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 25\. When a socially and economically disadvantaged       |   |   |   |
| individual is engaged in employment outside the applicant |   |   |   |
| firm, does your UCP evaluate the circumstances based on   |   |   |   |
| such issues as: possible conflicts of interest, time and  |   |   |   |
| attention devoted to DBE firm, etc.? (49 CFR 26.71(j))    |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 26\. Does your UCP certify firms only for the specific    |   |   |   |
| types of work a potential DBE has the ability to control  |   |   |   |
| and possesses the equipment and key personnel to perform? |   |   |   |
| (49 CFR 26.71(m)(n) & 26.83(c)(4)(5))                     |   |   |   |
+-----------------------------------------------------------+---+---+---+
| 27\. Is your UCP's evaluation of a DBE firms' eligibility |   |   |   |
| based on present circumstances only? (49 CFR 26.73(b))    |   |   |   |
+-----------------------------------------------------------+---+---+---+

+-----------------------------------------------------------+----+---+---+
| **Subpart E: Certification Procedures**                   | ## | # | * |
|                                                           |  Y | # | * |
|                                                           | es |   | ? |
|                                                           |    | N | * |
|                                                           |    | o | * |
+-----------------------------------------------------------+----+---+---+
| 1\. Is your UCP fully in effect and being fully           |    |   |   |
| implemented in accordance with the approved UCP agreement |    |   |   |
| and provides for one stop shopping? (49 CFR 26.81 (a)(2), |    |   |   |
| (b)(2)                                                    |    |   |   |
+-----------------------------------------------------------+----+---+---+
| 2\. Do all certification decision makers have expertise   |    |   |   |
| on certification regulations, policies, and procedures?   |    |   |   |
| (Consideration: training within last 2-3 years, etc.) (49 |    |   |   |
| CFR 26.81(a)(2))                                          |    |   |   |
+-----------------------------------------------------------+----+---+---+
| 3\. Does your UCP require a firm to be certified in its   |    |   |   |
| home state before you will process that application? (49  |    |   |   |
| CFR 26.83) & (49 CFR 26.83(d)(e)(3))                      |    |   |   |
+-----------------------------------------------------------+----+---+---+
| 4\. Does your UCP maintain a unified certification        |    |   |   |
| directory that is electronic (on the internet) and in     |    |   |   |
| print? (49 CFR 26.81(g))                                  |    |   |   |
+-----------------------------------------------------------+----+---+---+
| 5\. If the firm is working, are job site visits being     |    |   |   |
| performed before certification decisions are rendered?    |    |   |   |
| (49 CFR 26.83 (c)(1))                                     |    |   |   |
+-----------------------------------------------------------+----+---+---+
| 6\. Do you verify the type of work the firm states it can |    |   |   |
| perform as part of your DBE certification procedures? (49 |    |   |   |
| CFR 26.83(c)(4)(5))                                       |    |   |   |
+-----------------------------------------------------------+----+---+---+
| 7\. Once a firm is certified, do they remain certified    |    |   |   |
| until their eligibility is removed? (49 CFR 26.83(h), 49  |    |   |   |
| CFR 26.87)                                                |    |   |   |
+-----------------------------------------------------------+----+---+---+
| 8\. Does your UCP require an annual affidavit with        |    |   |   |
| supporting documentation? (Consideration: tax returns)    |    |   |   |
| (49 CFR 26.83(j))                                         |    |   |   |
+-----------------------------------------------------------+----+---+---+
| 9\. Does your UCP process applications within 90 days of  |    |   |   |
| receiving a complete application, (i.e., all supporting   |    |   |   |
| documents from the applicant firm? (49 CFR 26.83(k))      |    |   |   |
+-----------------------------------------------------------+----+---+---+
| 10\. Does your UCP honor the provisions of the SBA/DOT    |    |   |   |
| Certification MOU in processing SBA applications? (49 CFR |    |   |   |
| 26.84, 26.85                                              |    |   |   |
+-----------------------------------------------------------+----+---+---+
| 11\. When your UPC denies a request for initial           |    |   |   |
| consideration does the denial letter include the reasons  |    |   |   |
| for denial, opportunity to appeal, and timeframe to       |    |   |   |
| reapply? (49 CFR 26.86 (a)(b)(c)(d))                      |    |   |   |
+-----------------------------------------------------------+----+---+---+
| 12\. In order to be processed, does your UCP require      |    |   |   |
| ineligibility complaints to be in writing and specifying  |    |   |   |
| the alleged reason(s) why the firm is ineligible? (49 CFR |    |   |   |
| 26.87(a))                                                 |    |   |   |
+-----------------------------------------------------------+----+---+---+
| 13\. Does your UCP follow the specific regulatory process |    |   |   |
| for removing a firm's eligibility, (i.e., opportunity for |    |   |   |
| informal hearing, separation of functions, grounds for    |    |   |   |
| decision, etc.)? (49 CFR 26.87(d)(e)(f)(g))               |    |   |   |
+-----------------------------------------------------------+----+---+---+
| 14\. When the prime contractor executes a subcontract     |    |   |   |
| prior to your notification that the DBE firm is           |    |   |   |
| ineligible, do you count the subcontract amount toward    |    |   |   |
| the prime contractor's goal? (49 CFR 26.87(j)(2))         |    |   |   |
+-----------------------------------------------------------+----+---+---+
| 15\. Does your UCP provide that for denial appeals to     |    |   |   |
| only the US DOT within 90 days of the STA's final         |    |   |   |
| decision?                                                 |    |   |   |
|                                                           |    |   |   |
| (49 CFR 26.89(a)(1)& (c) )                                |    |   |   |
+-----------------------------------------------------------+----+---+---+
| 16\. If the US DOT determines that the STA erroneously    |    |   |   |
| certified a firm and directs that firm's eligibility      |    |   |   |
| removed, do you remove the firm's eligibility without any |    |   |   |
| further proceedings? (49 CFR 26.91(b)(1))                 |    |   |   |
+-----------------------------------------------------------+----+---+---+
| **Subpart F: Compliance and Enforcement**                 | ## | # | * |
|                                                           |  Y | # | * |
|                                                           | es |   | ? |
|                                                           |    | N | * |
|                                                           |    | o | * |
+-----------------------------------------------------------+----+---+---+
| 1\. Does the STA have a procedure that allows anyone to   |    |   |   |
| file a written complaint alleging the STA failed to       |    |   |   |
| comply with the DBE program requirements? (49 CFR         |    |   |   |
| 26.103(a))                                                |    |   |   |
+-----------------------------------------------------------+----+---+---+
| 2\. Does the STA have a process and procedure that        |    |   |   |
| includes appropriate enforcement actions (i.e.,           |    |   |   |
| suspension, debarment, etc.) against fraudulent           |    |   |   |
| activities by DBEs and non-DBEs? (49 CFR 26.107)          |    |   |   |
+-----------------------------------------------------------+----+---+---+
| 3\. Does the STA have a mechanism to receive and respond  |    |   |   |
| to requests for information and to safeguard from         |    |   |   |
| disclosure confidential personal and business information |    |   |   |
| of DBEs? (49 CFR 26.109)                                  |    |   |   |
+-----------------------------------------------------------+----+---+---+

**DBE-Certification Procedures**

**DBE-Certification Procedures & Compliance**