83_FR_40273 83 FR 40117 - Request for Comments of a Previously Approved Information Collection(s)

83 FR 40117 - Request for Comments of a Previously Approved Information Collection(s)

DEPARTMENT OF TRANSPORTATION

Federal Register Volume 83, Issue 156 (August 13, 2018)

Page Range40117-40140
FR Document2018-17301

In accordance with the Paperwork Reduction Act of 1995, this notice announces that the Information Collection Request (ICR) abstracted below is being forwarded to the Office of Management and Budget (OMB) for review and comment. A Federal Register Notice with a 60-day comment period soliciting comments on the information collection was published on June 4, 2018. One comment was received that does not warrant any adjustments to the forms.

Federal Register, Volume 83 Issue 156 (Monday, August 13, 2018) 
[Federal Register Volume 83, Number 156 (Monday, August 13, 2018)]
[Notices]
[Pages 40117-40140]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2018-17301]


-----------------------------------------------------------------------

DEPARTMENT OF TRANSPORTATION

[Docket No. DOT-OST-2018-0075]


Request for Comments of a Previously Approved Information 
Collection(s)

AGENCY: Office of the Secretary, DOT.

ACTION: Notice and request for comments.

-----------------------------------------------------------------------

SUMMARY: In accordance with the Paperwork Reduction Act of 1995, this 
notice announces that the Information Collection Request (ICR) 
abstracted below is being forwarded to the Office of Management and 
Budget (OMB) for review and comment. A Federal Register Notice with a 
60-day comment period soliciting comments on the information collection 
was published on June 4, 2018. One comment was received that does not 
warrant any adjustments to the forms.

DATES: Comments must be submitted on or before September 12, 2018.

ADDRESSES: Send comments regarding the burden estimate, including 
suggestions for reducing the burden, to the Office of Management and 
Budget, Attention: Desk Officer for the Office of the Secretary of 
Transportation, 725 17th Street NW, Washington, DC 20503.
    Comments are invited on: Whether the proposed collection of 
information is necessary for the proper performance of the functions of 
the Department, including whether the information will have practical 
utility; the accuracy of the Department's estimate of the burden of the 
proposed information collection; ways to enhance the quality, utility 
and clarity of the information to be collected; and ways to minimize 
the burden of the collection of information on respondents, including 
the use of automated collection techniques or other forms of 
information technology.

FOR FURTHER INFORMATION CONTACT: Mr. Marc Pentino, Departmental Office 
of Civil Rights, Office of the Secretary, U.S. Department of 
Transportation, 1200 New Jersey Avenue SE, Washington, DC 20590, (202) 
366-6968, or at [email protected].

SUPPLEMENTARY INFORMATION:
    Title: Disadvantaged Business Enterprise Program Collections.
    OMB Control Number: 2105-0510.
    Type of Request: Renewal of a Previously Approved Information 
Collection.
    Abstract: The following information collections are associated with 
the U.S. Department of Transportation's (DOT) Disadvantaged Business 
Enterprise (DBE) program: Uniform Report of DBE Awards or Commitments 
and Payments, Uniform Certification Application Form, Annual Affidavit 
of No Change, DOT Personal Net Worth Form, and Reporting Requirements 
for Percentages of DBEs in Various Categories. All five collections 
were previously approved under one OMB Control Number (2105-0510) to 
allow DOT to more efficiently administer the DBE program. The DBE 
program is mandated by statute, including Section 1101(b) of the Fixing 
America's Surface Transportation Act (FAST Act) (Pub. L. 114-94) and 49 
U.S.C. 47113. DOT's final regulations implementing these statutes are 
49 CFR parts 23 and 26. The information to be collected is necessary 
because it helps to ensure that State and local recipients that let 
federally-funded contracts carry out their mandated responsibility to 
provide a level playing field for small businesses owned and controlled 
by socially and economically disadvantaged individuals.

Uniform Report of DBE Awards/Commitments and Payments

    Affected Public: DOT financially-assisted State and local 
transportation agencies.

[[Page 40118]]

    Number of Respondents: 1,250.
    Frequency: Once/twice per year.
    Number of Responses: One/two.
    Total Annual Burden: 9,000 hours.

Uniform Certification Application Form

    Affected Public: Firms applying to be certified as DBEs.
    Number of Respondents: 9,500.
    Frequency: Once during initial certification.
    Number of Responses: One.
    Total Annual Burden: 76,000 hours.

Annual Affidavit of No Change

    Affected Public: Certified DBEs.
    Number of Respondents: Approximately 38,465 certified DBE firms.
    Frequency: Once per year.
    Number of Responses: One.
    Total Annual Burden: 57,698 hours.

Personal Net Worth Form

    Affected Public: Firms applying to be DBEs.
    Number of Respondents: 9,500.
    Frequency: Once.
    Number of Responses: One.
    Total Annual Burden: 19,000 hours.

Percentage of DBEs in Various Categories

    Affected Public: States (through their Unified Certification 
Programs).
    Number of Respondents: 53 (50 states, plus the District of 
Columbia, Puerto Rico, and the Virgin Islands).
    Frequency: Once per year.
    Number of Responses: One.
    Total Annual Burden: 161.6 hours.

    Authority: The Paperwork Reduction Act of 1995; 44 U.S.C. 
Chapter 35, as amended; and 49 CFR 1:48.

    Issued in Washington, DC.
Charles E. James, Sr.,
Director, Departmental Office of Civil Rights, U.S. Department of 
Transportation.
BILLING CODE 4910-9X-P

[[Page 40119]]

[GRAPHIC] [TIFF OMITTED] TN13AU18.042


[[Page 40120]]


[GRAPHIC] [TIFF OMITTED] TN13AU18.043


[[Page 40121]]


[GRAPHIC] [TIFF OMITTED] TN13AU18.044


[[Page 40122]]


[GRAPHIC] [TIFF OMITTED] TN13AU18.045


[[Page 40123]]


[GRAPHIC] [TIFF OMITTED] TN13AU18.046


[[Page 40124]]


[GRAPHIC] [TIFF OMITTED] TN13AU18.047


[[Page 40125]]


[GRAPHIC] [TIFF OMITTED] TN13AU18.048


[[Page 40126]]


[GRAPHIC] [TIFF OMITTED] TN13AU18.049


[[Page 40127]]


[GRAPHIC] [TIFF OMITTED] TN13AU18.050


[[Page 40128]]


[GRAPHIC] [TIFF OMITTED] TN13AU18.051


[[Page 40129]]


[GRAPHIC] [TIFF OMITTED] TN13AU18.052


[[Page 40130]]


[GRAPHIC] [TIFF OMITTED] TN13AU18.053


[[Page 40131]]


[GRAPHIC] [TIFF OMITTED] TN13AU18.054


[[Page 40132]]


[GRAPHIC] [TIFF OMITTED] TN13AU18.055


[[Page 40133]]


[GRAPHIC] [TIFF OMITTED] TN13AU18.056


[[Page 40134]]


[GRAPHIC] [TIFF OMITTED] TN13AU18.057


[[Page 40135]]


[GRAPHIC] [TIFF OMITTED] TN13AU18.058


[[Page 40136]]


[GRAPHIC] [TIFF OMITTED] TN13AU18.059


[[Page 40137]]


[GRAPHIC] [TIFF OMITTED] TN13AU18.060


[[Page 40138]]


[GRAPHIC] [TIFF OMITTED] TN13AU18.061

BILLING CODE 4910-9X-C

[[Page 40139]]

Appendix B to Part 26--Uniform Report of DBE Awards or Commitments and 
Payments Form

Instructions for Completing the Uniform Report of DBE Awards/
Commitments and Payments

    Recipients of Department of Transportation (DOT) funds are 
expected to keep accurate data regarding the contracting 
opportunities available to firms paid for with DOT dollars. Failure 
to submit contracting data relative to the DBE program will result 
in noncompliance with Part 26. All dollar values listed on this form 
should represent the DOT share attributable to the Operating 
Administration (OA): Federal Highway Administration (FHWA), Federal 
Aviation Administration (FAA) or Federal Transit Administration 
(FTA) to which this report will be submitted.
    1. Indicate the DOT (OA) that provides your Federal financial 
assistance. If assistance comes from more than one OA, use separate 
reporting forms for each OA. If you are an FTA recipient, indicate 
your Vendor Number in the space provided.
    2. If you are an FAA recipient, indicate the relevant AIP 
Numbers covered by this report. If you are an FTA recipient, 
indicate the Grant/Project numbers covered by this report. If more 
than ten attach a separate sheet.
    3. Specify the Federal fiscal year (i.e., October 1-September 
30) in which the covered reporting period falls.
    4. State the date of submission of this report.
    5. Check the appropriate box that indicates the reporting period 
that the data provided in this report covers. For FHWA and FTA 
recipients, if this report is due June 1, data should cover October 
1-March 31. If this report is due December 1, data should cover 
April 1-September 30. If the report is due to the FAA, data should 
cover the entire fiscal year.
    6. Provide the name and address of the recipient.
    7. State your overall DBE goal(s) established for the Federal 
fiscal year of the report being submitted to and approved by the 
relevant OA. Your overall goal is to be reported as well as the 
breakdown for specific Race Conscious and Race Neutral projections 
(both of which include gender-conscious/neutral projections). The 
Race Conscious projection should be based on measures that focus on 
and provide benefits only for DBEs. The use of contract goals is a 
primary example of a race conscious measure. The Race Neutral 
projection should include measures that, while benefiting DBEs, are 
not solely focused on DBE firms. For example, a small business 
outreach program, technical assistance, and prompt payment clauses 
can assist a wide variety of businesses in addition to helping DBE 
firms.

Section A: Awards and Commitments Made During This Period

    The amounts in items 8(A)-10(I) should include all types of 
prime contracts awarded and all types of subcontracts awarded or 
committed, including: professional or consultant services, 
construction, purchase of materials or supplies, lease or purchase 
of equipment and any other types of services. All dollar amounts are 
to reflect only the Federal share of such contracts and should be 
rounded to the nearest dollar.
    Line 8: Prime contracts awarded this period: The items on this 
line should correspond to the contracts directly between the 
recipient and a supply or service contractor, with no intermediaries 
between the two.
    8(A). Provide the total dollar amount for all prime contracts 
assisted with DOT funds and awarded during this reporting period. 
This value should include the entire Federal share of the contracts 
without removing any amounts associated with resulting subcontracts.
    8(B). Provide the total number of all prime contracts assisted 
with DOT funds and awarded during this reporting period.
    8(C). From the total dollar amount awarded in item 8(A), provide 
the dollar amount awarded in prime contracts to certified DBE firms 
during this reporting period. This amount should not include the 
amounts sub contracted to other firms.
    8(D). From the total number of prime contracts awarded in item 
8(B), specify the number of prime contracts awarded to certified DBE 
firms during this reporting period.
    8(E&F). This field is closed for data entry. Except for the very 
rare case of DBE-set asides permitted under 49 CFR part 26, all 
prime contracts awarded to DBES are regarded as race-neutral.
    8(G). From the total dollar amount awarded in item 8(C), provide 
the dollar amount awarded to certified DBEs through the use of Race 
Neutral methods. See the definition of Race Neutral in item 7 and 
the explanation in item 8 of project types to include.
    8(H). From the total number of prime contracts awarded in 8(D), 
specify the number awarded to DBEs through Race Neutral methods.
    8(I). Of all prime contracts awarded this reporting period, 
calculate the percentage going to DBEs. Divide the dollar amount in 
item 8(C) by the dollar amount in item 8(A) to derive this 
percentage. Round the percentage to the nearest tenth.
    Line 9: Subcontracts awarded/committed this period: Items 9(A)-
9(I) are derived in the same way as items 8(A)-8(I), except that 
these calculations should be based on subcontracts rather than prime 
contracts. Unlike prime contracts, which may only be awarded, 
subcontracts may be either awarded or committed.
    9(A). If filling out the form for general reporting, provide the 
total dollar amount of subcontracts assisted with DOT funds awarded 
or committed during this period. This value should be a subset of 
the total dollars awarded in prime contracts in 8(A), and therefore 
should never be greater than the amount awarded in prime contracts. 
If filling out the form for project reporting, provide the total 
dollar amount of subcontracts assisted with DOT funds awarded or 
committed during this period. This value should be a subset of the 
total dollars awarded or previously in prime contracts in 8(A). The 
sum of all subcontract amounts in consecutive periods should never 
exceed the sum of all prime contract amounts awarded in those 
periods.
    9(B). Provide the total number of all sub contracts assisted 
with DOT funds that were awarded or committed during this reporting 
period.
    9(C). From the total dollar amount of sub contracts awarded/
committed this period in item 9(A), provide the total dollar amount 
awarded in sub contracts to DBEs.
    9(D). From the total number of sub contracts awarded or 
committed in item 9(B), specify the number of sub contracts awarded 
or committed to DBEs.
    9(E). From the total dollar amount of sub contracts awarded or 
committed to DBEs this period, provide the amount in dollars to DBEs 
using Race Conscious measures.
    9(F). From the total number of sub contracts awarded or 
committed to DBEs this period, provide the number of sub contracts 
awarded or committed to DBEs using Race Conscious measures.
    9(G). From the total dollar amount of sub contracts awarded/
committed to DBEs this period, provide the amount in dollars to DBEs 
using Race Neutral measures.
    9(H). From the total number of sub contracts awarded/committed 
to DBEs this period, provide the number of sub contracts awarded to 
DBEs using Race Neutral measures.
    9(I). Of all subcontracts awarded this reporting period, 
calculate the percentage going to DBEs. Divide the dollar amount in 
item 9(C) by the dollar amount in item 9(A) to derive this 
percentage. Round the percentage to the nearest tenth.
    Line 10: Total contracts awarded or committed this period. These 
fields should be used to show the total dollar value and number of 
contracts awarded to DBEs and to calculate the overall percentage of 
dollars awarded to DBEs.
    10(A)-10(B). These fields are unavailable for data entry.
    10(C-H). Combine the total values listed on the prime contracts 
line (Line 8) with the corresponding values on the subcontracts line 
(Line 9).
    10(I). Of all contracts awarded this reporting period, calculate 
the percentage going to DBEs. Divide the total dollars awarded to 
DBEs in item 10(C) by the dollar amount in item 8(A) to derive this 
percentage. Round the percentage to the nearest tenth.

Section B: Breakdown by Ethnicity & Gender of Contracts Awarded to 
DBEs This Period

    11-17. Further breakdown the contracting activity with DBE 
involvement. The Total Dollar Amount to DBEs in 17(C) should equal 
the Total Dollar Amount to DBEs in 10(C). Likewise, the total number 
of contracts to DBEs in 17(F) should equal the Total Number of 
Contracts to DBEs in 10(D).
    Line 16: The ``Non-Minority'' category is reserved for any firms 
whose owners are not members of the presumptively disadvantaged 
groups already listed, but who are either ``women'' OR eligible for 
the DBE program on an individual basis. All DBE firms must be 
certified by the Unified Certification Program to be counted in this 
report.

[[Page 40140]]

Section C: Payments on Ongoing Contracts

    Line 18(A-E). Submit information on contracts that are currently 
in progress. All dollar amounts are to reflect only the Federal 
share of such contracts, and should be rounded to the nearest 
dollar.
    18(A). Provide the total number of prime and sub-contracts where 
work was performed during the reporting period.
    18(B). Provide the total dollar amount paid to all firms 
performing work on contracts.
    18(C). From the total number of contracts provided in 18(A) 
provide the total number of contracts that are currently being 
performed by DBE firms for which payments have been made.
    18(D). From the total dollar amount paid to all firms in 18(A), 
provide the total dollar value paid to DBE firms currently 
performing work during this period.
    18(E). Provide the total number of DBE firms that received 
payment during this reporting period. For example, while 3 contracts 
may be active during this period, one DBE firm may be providing 
supplies or services on all three contracts. This field should only 
list the number of DBE firms performing work.
    18(F). Of all payments made during this period, calculate the 
percentage going to DBEs. Divide the total dollar value to DBEs in 
item 18(D) by the total dollars of all payments in 18(B). Round the 
percentage to the nearest tenth.

Section D: Actual Payments on Contracts Completed This Reporting 
Period

    This section should provide information only on contracts that 
are closed during this period. All dollar amounts are to reflect the 
entire Federal share of such contracts, and should be rounded to the 
nearest dollar.
    19(A). Provide the total number of contracts completed during 
this reporting period that used Race Conscious measures. Race 
Conscious contracts are those with contract goals or another race 
conscious measure.
    19(B). Provide the total dollar value of prime contracts 
completed this reporting period that had race conscious measures.
    19(C). From the total dollar value of prime contracts completed 
this period in 19(B), provide the total dollar amount of dollars 
awarded or committed to DBE firms in order to meet the contract 
goals. This applies only to Race Conscious contracts.
    19(D). Provide the actual total DBE participation in dollars on 
the race conscious contracts completed this reporting period.
    19(E). Of all the contracts completed this reporting period 
using Race Conscious measures, calculate the percentage of DBE 
participation. Divide the total dollar amount to DBEs in item 19(D) 
by the total dollar value provided in 19(B) to derive this 
percentage. Round to the nearest tenth.
    20(A)-20(E). Items 21(A)-21(E) are derived in the same manner as 
items 19(A)-19(E), except these figures should be based on contracts 
completed using Race Neutral measures.
    20(C). This field is closed.
    21(A)-21(D). Calculate the totals for each column by adding the 
race conscious and neutral figures provided in each row above.
    21(C). This field is closed.
    21(E). Calculate the overall percentage of dollars to DBEs on 
completed contracts. Divide the Total DBE participation dollar value 
in 21(D) by the Total Dollar Value of Contracts Completed in 21(B) 
to derive this percentage. Round to the nearest tenth.
    22. Name of the Authorized Representative preparing this form.
    23. Left blank for future use.
    24. Signature of the Authorized Representative.
    25. Phone number of the Authorized Representative.
    **Submit your completed report to your Regional or Division 
Office.

[FR Doc. 2018-17301 Filed 8-10-18; 8:45 am]
 BILLING CODE 4910-9X-P

Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices 40117 Federal Register by the Paperwork fixed residential moving costs are the Office of Management and Budget, Reduction Act of 1995. submitted to the FHWA electronically. Attention: Desk Officer for the Office of DATES: Please submit comments by Respondents: State Departments of the Secretary of Transportation, 725 October 12, 2018. Transportation (52, including the 17th Street NW, Washington, DC 20503. ADDRESSES: You may submit comments District of Columbia and Puerto Rico). Comments are invited on: Whether identified by DOT Docket ID 2018–0041 Frequency: Once every 3 years. the proposed collection of information Estimated Average Burden per is necessary for the proper performance by any of the following methods: Website: For access to the docket to Response: 24 hours per respondent. of the functions of the Department, Estimated Total Annual Burden including whether the information will read background documents or Hours: 24 hours for each of the 52 State have practical utility; the accuracy of comments received go to the Federal Departments of Transportation. The the Department’s estimate of the burden eRulemaking Portal: Go to http:// total is 1,248 burden hours, once every of the proposed information collection; www.regulations.gov. Follow the online 3 years, or 416 hours annually. ways to enhance the quality, utility and instructions for submitting comments. Public Comments Invited: You are clarity of the information to be Fax: 1–202–493–2251. Mail: Docket Management Facility, asked to comment on any aspect of this collected; and ways to minimize the U.S. Department of Transportation, information collection, including: (1) burden of the collection of information West Building Ground Floor, Room Whether the proposed collection is on respondents, including the use of W12–140, 1200 New Jersey Avenue SE, necessary for the FHWA’s performance; automated collection techniques or Washington, DC 20590–0001. (2) the accuracy of the estimated other forms of information technology. Hand Delivery or Courier: U.S. burdens; (3) ways for the FHWA to FOR FURTHER INFORMATION CONTACT: Mr. Department of Transportation, West enhance the quality, usefulness, and Marc Pentino, Departmental Office of Building Ground Floor, Room W12–140, clarity of the collected information; and Civil Rights, Office of the Secretary, U.S. 1200 New Jersey Avenue SE, (4) ways that the burden could be Department of Transportation, 1200 Washington, DC 20590, between 9 a.m. minimized, including the use of New Jersey Avenue SE, Washington, DC and 5 p.m. ET, Monday through Friday, electronic technology, without reducing 20590, (202) 366–6968, or at except Federal holidays. the quality of the collected information. marc.pentino@dot.gov. The agency will summarize and/or SUPPLEMENTARY INFORMATION: FOR FURTHER INFORMATION CONTACT: include your comments in the request Title: Disadvantaged Business Melissa Corder, 202–366–5853, for OMB’s clearance of this information Enterprise Program Collections. melissa.corder@dot.gov; Office of Real collection. OMB Control Number: 2105–0510. Estate Services, Federal Highway Authority: The Paperwork Reduction Act Type of Request: Renewal of a Administration, Department of of 1995; 44 U.S.C. Chapter 35, as amended; Previously Approved Information Transportation, New Jersey Avenue SE., and 49 CFR 1.48. Collection. Washington, DC 20590–0001. Office Abstract: The following information hours are from 6:15 a.m. to 3:45 p.m., Issued On: August 7, 2018. collections are associated with the U.S. Monday through Friday, except Federal Michael Howell, Department of Transportation’s (DOT) holidays. Information Collection Officer. Disadvantaged Business Enterprise SUPPLEMENTARY INFORMATION: [FR Doc. 2018–17314 Filed 8–10–18; 8:45 am] (DBE) program: Uniform Report of DBE Title: Fixed Residential Moving Cost BILLING CODE 4910–22–P Awards or Commitments and Payments, Schedule. Uniform Certification Application Form, Background: Relocation assistance Annual Affidavit of No Change, DOT payments to owners and tenants who DEPARTMENT OF TRANSPORTATION Personal Net Worth Form, and move personal property for a Federal or Reporting Requirements for Percentages [Docket No. DOT–OST–2018–0075] federally-assisted program or project are of DBEs in Various Categories. All five governed by the Uniform Relocation Request for Comments of a Previously collections were previously approved Assistance and Real Property Approved Information Collection(s) under one OMB Control Number (2105– Acquisition Policies Act of 1970, as 0510) to allow DOT to more efficiently amended (Uniform Act). 49 Code of Office of the Secretary, DOT. AGENCY: administer the DBE program. The DBE Federal Regulations (CFR), part 24, is Notice and request for ACTION: program is mandated by statute, the implementing regulation for the comments. including Section 1101(b) of the Fixing Uniform Act. 49 CFR 24.301 addresses America’s Surface Transportation Act payments for actual and reasonable SUMMARY: In accordance with the (FAST Act) (Pub. L. 114–94) and 49 moving and related expenses. The fixed Paperwork Reduction Act of 1995, this U.S.C. 47113. DOT’s final regulations residential moving cost schedule is an notice announces that the Information implementing these statutes are 49 CFR administrative alternative to Collection Request (ICR) abstracted parts 23 and 26. The information to be reimbursement of actual moving costs. below is being forwarded to the Office collected is necessary because it helps This option provides flexibility for the of Management and Budget (OMB) for to ensure that State and local recipients agency and affected property owners review and comment. A Federal that let federally-funded contracts carry and tenants. The FHWA requests the Register Notice with a 60-day comment out their mandated responsibility to State Departments of Transportation period soliciting comments on the provide a level playing field for small (State DOTs) to analyze moving cost information collection was published on businesses owned and controlled by data periodically to assure that the fixed June 4, 2018. One comment was sradovich on DSK3GMQ082PROD with NOTICES socially and economically residential moving cost schedules received that does not warrant any disadvantaged individuals. accurately reflect reasonable moving adjustments to the forms. and related expenses. The regulation DATES: Comments must be submitted on Uniform Report of DBE Awards/ allows State DOTs flexibility in or before September 12, 2018. Commitments and Payments determining how to collect the cost data ADDRESSES: Send comments regarding Affected Public: DOT financially- in order to reduce the burden of the burden estimate, including assisted State and local transportation government regulation. Updated State suggestions for reducing the burden, to agencies. VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00137 Fmt 4703 Sfmt 4703 E:\FR\FM\13AUN1.SGM 13AUN1

40118 Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices Number of Respondents: 1,250. Frequency: Once per year. Number of Respondents: 53 (50 states, Frequency: Once/twice per year. Number of Responses: One. plus the District of Columbia, Puerto Number of Responses: One/two. Rico, and the Virgin Islands). Total Annual Burden: 9,000 hours. Total Annual Burden: 57,698 hours. Frequency: Once per year. Uniform Certification Application Form Personal Net Worth Form Number of Responses: One. Affected Public: Firms applying to be Affected Public: Firms applying to be Total Annual Burden: 161.6 hours. certified as DBEs. DBEs. Number of Respondents: 9,500. Authority: The Paperwork Reduction Act Frequency: Once during initial Number of Respondents: 9,500. of 1995; 44 U.S.C. Chapter 35, as amended; certification. Frequency: Once. and 49 CFR 1:48. Number of Responses: One. Number of Responses: One. Issued in Washington, DC. Total Annual Burden: 76,000 hours. Total Annual Burden: 19,000 hours. Charles E. James, Sr., Annual Affidavit of No Change Director, Departmental Office of Civil Rights, Percentage of DBEs in Various Affected Public: Certified DBEs. Categories U.S. Department of Transportation. Number of Respondents: BILLING CODE 4910–9X–P Approximately 38,465 certified DBE Affected Public: States (through their firms. Unified Certification Programs). sradovich on DSK3GMQ082PROD with NOTICES VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00138 Fmt 4703 Sfmt 4703 E:\FR\FM\13AUN1.SGM 13AUN1

Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices 40119 0 Personal Net Worth Statement OMB APPROVAL NO: £105-0510 U.S. Department of For DBE/ACDBE Program Eligibility EXPIRATION DATE: 8/31/2018 Transportation As of This form is used by all participants in the U.S. Department of Transportation's Disadvantaged Business Enterprise (DBE) and Airport Concession DBE (ACDBE) Programs. Each individual owner of a firm applying to participate as a DBE or ACDBE, whose ownership and control are relied upon for DBE certification must complete this form. Each person signing this form authorizes the certifying agency to make inquiries as necessary to verify the accuracy of the statements made. The agency you apply to will use the information provided to determine whether an owner is economically disadvantaged as defined in the DBE program regulations 49 C.F.R. Parts 23 and 26. Return form to appropriate certifying agency, not U.S. DOT. Applicant Name: Residence: (As reported to the IRS) Residence Phone Address, City, State and Zip Code Business Name of Applicant Firm Business Phone Marital Status: D Single, D Married, D Divorced, D Union Spouse's Full Name: ASSETS (Omit Cents) LIABILITIES (Omit Cents) Cash and Cash Equivalents $ Loan on Life Insurance $ (Complete Section 5) Retirement Accounts (IRAs, 401 Ks, 403Bs. Pensions. $ Mortgages on Real Estate $ etc.) (Report full value minus Federal taxes and Excluding Primary Residence Debt penalties if applicable if assets were distributed today) (Complete Section 4) (Complete Section 3) Brokerage, Investment Accounts $ Notes, Obligations on Personal $ Property (Complete Section 6) Assets Held in Trust $ Noles & Accounts Payable to $ Banks and others (Complete Section 2) Loans from You to the Firm, Other Entities, Individuals, $ Other Liabilities $ & Other Receivables (Complete Section 6) (Complete Section 8) Real Estate Excluding Primary Residence $ Unpaid Taxes $ (Complete Section 4) (Complete Section 8) Life Insurance (Cash Surrender Value Only) $ (Complete Section 5) Other Personal Property and Assets $ (Complete Section 6) Business Interests Other Than the Applicant Firm $ (Complete Section 7) Total Assets $ Total Liabilities $ NET WORTH Section 2. Notes Payable to Banks and Others Original Current Payment Frequency How Secured or Endorsed Type of Collateral Name of Noteholder(s) Balance Balance Amount (monthly, etc.) sradovich on DSK3GMQ082PROD with NOTICES U.S. DOT Personal Net Worth Statement for DBE/ACDBE Program Eligibility • Page 1003 of 5 EN13AU18.042</GPH> VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00139 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1

40120 Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices Section 3. Brokerage and custodial accounts, stocks, bonds, retirement accounts. (Full Value) (Use attachments if necessary). Name of Security I Brokerage Account I Retirement Markel Value Dale of Cost Total Value Account Quotation/Exchange Quotation/Exchange Section 4. Real Estate Owned (Including Primary Residence, Investment Properties, Personal Property Leased or Rented for Business Purposes, Farm Properties, or any Other Income Producing property), (List each parcel separately. Add additional sheets if necessary). Primary Residence Property B Property C Type of Property Address Date Acquired and Method of Acquisition (purchase, inherit, divorce, gift, etc.) Names on Deed Purchase Price Present Market Value Source of Markel Valuation Name of all Mortgage Holders Mortgage Ace. # and balance (as of date of form) Equity line of credit balance Amount of Payment Per Month/Year (Specify) Section 5. Life Insurance Held (Give face amount and cash surrender value of policies, name of insurance company and beneficiaries). Insurance Company Face Value Cash Surrender Amount Beneficiaries Loan on Policy Information sradovich on DSK3GMQ082PROD with NOTICES U.S. DOT Personal Net Worth Statement for DBE/ACDBE Program Eligibility • Page 1004 of 5 EN13AU18.043</GPH> VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00140 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1

Federal Register/Vol. 83, No. 156 /Monday, August 13, 2018 /Notices 40121 :‘Sectlon 6Other PersonalProperty and Assets(Useattachmentsas necessary) Total Present Ameuntof . s this _ Lien orNote amount : Value _ Liability _| asset | _ and Termsof TypeofPropertyorAsset (Balance) | insured? |_ Payment ;Automoblles and Vehlcles (mcludlng recreataon vehlclesmolorcycres boats, etc.)Include personally owned veh|cles thatare Ieasedof rented to busmessesOr othermdlwduals . | HouseholdGoods / Jewelry _ Ltééns’fram Owner to Firm,Other Entities,Individuals: Other(List) _ Accountsand Notes Recewabless | Sectlon 7.Valueof Dther Busmess lnvestments, Other Busmesses Owned (excluding applicant firm) ‘Sole Proprietorships, General Parthers, Joint Ventures, Limited Liability Companies, Closely—held and Public TradedCorgoratmns . _Section 8. Other Liabilities and Unpaid Taxes (Describe)_____ Section 9. Transfer of Assets: Have you within 2 years ofthis personal net worth statement, transferred assetsto a spouse,domestlc : artner,relative,or entity in which you have an ownership or benéeficial interestincludinga trust? Yes C No D If yes, describe. o | declare under penalty of perjury that the information provided in this personal net worth statement and supporting documents is complete, true and correct. | certify that no assets have been transferred to any beneficiary for less than fair market value in the last two years. I recognize that the information submitted in this application is for the purpose of inducing certification approval by a government agency. | understand that a government agency may, by means it deems appropriate, determine the accuracy and truth of the statements in the application and this personal net worth statement, and | authorize such agency to contact any entity named in the application or this personal financial statement, including the names banking institutions, credit agencies, contractors, clients, and other certifying agencies for the purpose of verifying the information supplied and determining the named firm‘s eligibility. | acknowledge and agree that any misrepresentations in this application or in records pertaining to a contract or subcontract will be grounds for terminating any contract or subcontract which may be awarded; denial or revocation of certification; suspension and debarment; and for initiating action under federal and/or state law concerning false statement, fraud or other applicable offenses. NOTARY CERTIFICATE: (Insert applicable state acknowledgment, affirmation, or cath) Signature (DBE/ACDEE Owner) Date In collecting the information requested by this form, the Department of Transportation complies with Federal Freedom of Information and Privacy Act (§ U.S.C. 552 and 552a) provisions. The Privacy Act provides comprehensive protections for your personal information. This includes howinformation is collected, used, disclosed, stored, and discarded. Your information will not be disclosed to third parties without your consent. The information collected will be used solely to determine your firm‘s eligibility to participate in the Disadvantaged Business Enterprise (DBE) Program or Airport Concessionaire DBE Programs as defined in 49 C.F.R. Parts 23 and 26. You may review DOT‘s complete Privacy Act Statement in the Federal Register published on April 11, 2000 (65 FR 19477). U.S. DOT Personal Net Worth Statement for DBE/ACDBE Program Eligibility e Page 1005 of 5

Federal Register/Vol. 83, No. 156 /Monday, August 13, 2018 /Notices General Instructions for Completing the Personal Net Worth Statement for DBE/ACDBE Program Eligibility Please do not make adjustments to your figures pursuant to U.S. DOT regulations 49 C.E.R. Parts 23 and 26. The Brokerage and Custodial Accounts, Stocks, Bonds, agency that you apply to will use the information provided Retirement Accounts: Report total value on page 1, and on on your completed Personal Net Worth (PNW) Statement to page 2, section 3, enter the name of the security, brokerage determine whether you meet the economic disadvantage account, retirement account, etc.; the cost; market value of requirements of 49 C.F.R. Parts 23 and 26. If there are the asset; the date of quotation; and total value as of the date discrepancies or questions regarding your form, it may be of the PNW statement. returned to you to correct and complete again. Assets Held in Trust: Enter the total value of the assets held An individual‘s personal net worth according to 49 C.F.R. in trust on page 1, and provide the names of beneficiaries Parts 23 and 26 includes only his or her own share of assets and trustees, and other information in Section 6 on page 3. held separately, jointly, or as community property with the individual‘s spouse and excludes the following: Loans from you to the firm, other Entities, Individuals, and Other Receivables not listed: Enter current balances of * Individual‘s ownership interest in the applicant firm:; loans you have extended to this firm and to other entities or * Individual‘s equity in his or her primaryresidence; individuals, plus interest payable on those loans; and other * Federal Tax and penalties, if applicable, that would receivables not listed above. Complete Section 6 on page 3. accrue if retirement savings or investments (e.g., pension plans, Individual Retirement Accounts, 401(k) accounts, Real Estate: The total value of real estate excluding your etc.) were distributed at the present time. primary residence should be listed on page 1. In section 4 on page 2, please list your primary residence in column 1, Indicate on the form if any items are jointly owned. If the including the address, method of acquisition, date of personal net worth of the majority owner(s) of the firm acquired, names of deed, purchase price, present fair market exceeds $1.32 million, as defined by 49 C.F.R. Parts 23 and value, source of market valuation, names of all mortgage 26, the firm is not eligible for DBE or ACDBE certification. holders, mortgage account number and balance, equity line If the personal net worth of the majority owner(s) exceeds of credit balance, and amount of payment. List this the $1.32 million cap specified in §26.67(a)(2)(1) at any time informationfor all real estate held. Please ensure that this after your firm is certified. the firm is no longer cligible for section contains all real estate owned, including rental certification. Should that occur, it is your responsibility to properties, vacation properties, commercial properties. contact your certifying agency in writing to advise that your personal property leased or rented for business purposes, firm no longer qualifies as a DBE or ACDBE. You must fill farm properties and any other income producing properties, out all linc items on the Personal Net Worth Statement. etc. Attach additional sheets if needed. If necessary, use additional sheets of paper to report all Life Insurance: On page 1, enter the cash surrender value of information and details. If you have any questions about this asset. In section 5 on page 2. enter the name of the completing this form, please contact the certifyving agency. insurance company, the face value of the policy, cash surrender value, names of beneficiarics. and loans on the Assets policy. All assets must be reported at their current fair market values Other Personal Property and Assets: Enter the total value as of the date of your statement. Assessor‘s assessed value of personal property and assets you own on page 1. Personal for real estate. for example, is not acceptable. Assets held in property includes motor vehicles, boats, trailers, jewelry, a trust should be included. furniture, houschold goods, collectibles, clothing, and personally owned vehicles that are leased or rented to Cash and Cash Equivalents: On page 1, enter the total businesses or other individuals. In section 6 on page 3. list amount of cash or cash equivalents in bank accounts, these assets and enter the present value, the balance of any including checking, savings, money market, certificates of liabilities, whether the asset is insured, and lien or note deposit held domestic or foreign. Provide copies of the bank information and terms of payments. For accounts and notes statement. receivable, enter the total value of all monies owed to you personally, if any. You may also be asked to provide a copy Retirement Accounts, IRA, 401Ks, 403Bs, Pensions: On of anyliens or notes on the property. page 1, enter the full value minus Federal tax and penalties that would apply if assets were distributed as of the date of Other Business Interests Other than Applicant Firm: On the form. Describe the number of shares, name of securities, page 1, enter the total value of your other business cost market value, date of quotation, and total value in investments (excluding the applicant firm). In section 7 on section 3 on page 2. page 3, enter information concerning the businesses you U.S. DOT Personal Net Worth Statement for DBE/ACDBE Program Eligibility e Page 1006 of 5

Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices 40123 hold an ownership interest in, such as sole proprietorships, have co-signed on a relative's loan, but you are not partnerships, joint ventures, corporations, or limited liability responsible for the debt until your relative defaults, that is a corporations (other than the applicant finn). Do not reduce contingent liability. Contingent liabilities do not count the value of these entries by any loans from the outside firm toward your net worth until they become actual liabilities. to the DBE/ACDBE applicant business. Unpaid Taxes: Enter the total amount of all taxes that are Liabilities currently due, but are unpaid on page 1, and complete section 8 on page 3. Contingent tax liabilities or anticipated Mortgages on Real Estate: Enter the total balance on all taxes for current year should not be included. Describe in mortgages payable on real estate on page 1. detail the name of the individual obligated, names of co- signers, tlte type of unpaid tax, to whom the tax is payable, Loans on Life Insurance: Enter the total value of all loans due date, amount, and to what property, if any, the tax lien due on life insurance policies on page 1, and complete attaches. If none, state "NONE." You must include section 5 on page 2. documentation, such as tax liens, to support the amounts. Notes & Accounts Payable to Bank and Others: On page Transfers of Assets: 1, section 2, enter details concerning any liability, including name of notcholdcrs, original and current balances, payment Transfers of Assets: If you checked the box indicating yes terms, and security/collateral information. The entries should on page 3 in this category, provide details on all asset include automobile installment accounts. This should not, transfers (within 2 years of the date of tlris personal net however, include any mortgage balances as this information worth statement) to a spouse, domestic partner, relative, or is captured in section 4. Do not include loans for your entity in which you have an ownership or beneficial interest business or mortgages for your properties in this section. including a trust. Include a description of the asset; names of You may be asked to submit copy of note/security individuals on the deed, title, note or otl1er instrument agreement, and the most recent account statement. indicating ownership rights; the names of individuals receiving the assets and their relation to the transferor; the Other Liabilities: On page I, enter the total value due on all date of the transfer; and the value or consideration received. other liabilities not listed in the previous entries. In section Subnrit documentation requested on tl1e fom1 related to the 8, page 3, report the name of the individual obligated, names transfer. of co-signers, description of the liability, the name of the Affidavit entity owed, the date of the obligation, payment amounts and tenus. Note: Do not include contingent liabilities in Uris Be sure to sign and date the statement. The Personal Net section. Contingent liabilities are liabilities that belong to Worth Statement must be notarized. you only if an event(s) should occur. For example, if you sradovich on DSK3GMQ082PROD with NOTICES U.S. DOT Personal Net Worth Statement for DBE/ ACDBE Program Eligibility • Page 1007 of 5 EN13AU18.046</GPH> VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00143 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1

40124 Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices Appendix F UNIFORM CERTIFICATION APPLICATION DISADVANTAGED BUSINESS ENTERPRISE (DBE) I AIRPORT CONCESSION DISADVANTAGED BUSINESS ENTERPRISE (ACDBE) 49 C.F.R. Parts 23 and 26 Roadmap for Applicants 1. Should I apply? You may be eligible to participate in the DEE/ACD BE program if: • The firm is a for-profit business that performs or seeks to perform transportation related work (or a concession activity) for a recipient of Federal Transit Administration, Federal Highway Administration, or Federal Aviation Administration funds. • The finn is at least 51% owned by a socially and economically disadvantaged individual(s) who also controls it. • The firm's disadvantaged owners are U.S. citizens or lawfully admitted permanent residents of the U.S. • The firm meets the Small Business Administration's size standard and docs not exceed $23.9R million in gross annual receipts for DBE ($56.42 million for ACDBEs). (Other size standards apply for ACD BE that arc banks/financial institutions, car rental companies, pay telephone finns, and automobile dealers.) 2. How do I apply? First time applicants for DBE certification must complete and submit this certification application and related material to the certifying agency in your home state and participate in an on-site interview conducted by that agency. The attached document checklist can help you locate the items you need to submit to the agency with your completed application. lfyou fail to submit the required documents, your application may be delayed and/or denied. Firms already certified as a DEE do not have to complete this form, but may be asked by certifying agencies outside of your home state to provide a copy of your initial application form, supporting documents, and any other information you submitted to your home state to obtain certification or to any other state related to your certification. 3. Where can I send my application? [INSERT UCP PARTICIPATING MEJ\1BER CONTACT INFORMATION] 4. Who will contact me about my a1>plication and what are the eligibility standards? A transportation agency in your state that performs certification functions will contact you. The agency is a member of a statewide Unified Certification Program (UCP), which is required by the U.S. Department of Transportation. The UCP is a one-stop certification program that eliminates the need for your finn to obtain certification from multiple certifying agencies within your state. The UCP is responsible for certifying firms and maintaining a database of certified DBEs and ACDBEs, pursuant to the eligibility standards found in 49 C.F.R. Parts 23 and 26. 5. Where can I find more information? U.S. DOT-https://www.transportation.gov/civil-rights (This site provides useful links to the rules and regulations governing the DEE/ACDBE program, questions and answers, and other pertinent information) SEA-Small Business Size Standards matched to the North American Industry Classification System (NAICS): http :1/www. census. gov/eos/www/naics/ and http://www. sba. gov/content/table-small-business-size-standards. In collecting the information requested by this form, the Department of Transportation (Department) complies with the provisions of the Federal Freedom oflnformation and Privacy Acts (5 U.S.C. 552 and 552a). The Privacy Act provides comprehensive protections for your personal information. This includes how information is collected. used, disclosed, stored, and discarded. Your information will not be disclosed to third parties without your consent. 1l1e information collected will be used solely to determine your tim1's eligibility to participate in the Department's Disadvantaged Business Enterprise Program as defined in 49 C.F.R. §26.5 and the Airport Concession Disadvantaged Business Enterprise Program as defined in 49 C.F.R. §23.3. You may review DOT's complete Privacy Act Statement in the Federal Register published on Aprilll, 2000 (65 FR 19477). Under 49 C.F.R. §26.107, dated Febmary 2, 1999 and January 28, 2011, if at any time, the Department or a recipient has reason to believe that any person or firm has willfully and knowingly provided incorrect information or made false statements, the Department may initiate suspension or debarment proceedings against the person or fim1under 2 C.F.R. Parts 180 and 1200, Konprocurement Suspension and Department, take sradovich on DSK3GMQ082PROD with NOTICES enforcement action under 49 C.F.R. Part 31, Program Fraud and Civil Remedies, and/or refer the matter to the Department of Justice for criminal prosecution under 18 U.S.C. 1001, which prohibits false statements in Federal programs. U.S. DOT Uniform DBE/ACDBE Certification Application • Page 1008 of 15 EN13AU18.047</GPH> VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00144 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1

Federal Register/Vol. 83, No. 156 /Monday, August 13, 2018 /Notices 40125 INSTRUCTIONS FOR COMPLETING THE DISADVANTAGED BUSINESS ENTERPRISE (DBE) AIRPORT CONCESSIONS DISADVANTAGED BUSINESS ENTERPRISE (ACDBE) UNIFORM CERTIFICATION APPLICATION NOTE: All participating firms must be for—profit enterprises. If your firm is not for profit, then you do NOT qualify for the DBE/ACDBE program and should not complete this application. If you require additional space for any question in this application, please attach additional sheets or copies as needed, taking care to indicate on each attached sheet/copy the section and number of this application to which it refers. Section 1: CERTIFICATION INFORMATION (2) If you know the appropriate NAICS Code for the line(s) of work you identified in your business profile, A. Basic Contact Information enter the codes in the space provided. (1) Enter the contact name and title of the person State the date on which your firm was established as completing this application and the person who will stated in your firm‘s Articles of Incorporation or serve as yourfirm‘s contact for this application. charter. (2) Enter the legal name of your firm, as indicated in your State the date each person became a Firm owner. firm‘s Articles of Incorporation or charter. Check the appropriate box describing the manner in (3) Enter the primary phone number of your firm. which you and cach other owner acquired ownership (4) Enter a secondary phone number. if any. of your firm. If you checked "Other," explain in the (5) Enter your finm‘s fax number, if any. space provided. (6) Enter the contact person‘s email address. (6) Check the appropriate box that indicates whether your (7) Enter your finm‘s website addresses, if any. im is "Lor profit." If you checked "No," then you (8) Enter the street address of the firm where its offices do NOT qualify for the DBE/ACDBE program and are physically located (not a P.O. Box). should not complete this application. All participating (9) Enter the mailing address of your firm, if it is different firmns must be for—profit enterprises. Provide the from your firm‘s street address. Federal Tax ID number as stated on your firm‘s Federal tax return. B. Prior/Other Certifications and Applications (7) Check the appropriate box that describes the type of (10) Check the appropriate box indicating whether your legal business structure of your firm, as indicated in firim is currently certified in the DBE/ACDBE your firm‘s Articles of Incorporation or similar programs, and provide the name of the certifving document. If you checked "Other," briefly explain in agency that certified your firm. List the dates of any the space provided. site visits conducted by your home state and any other (8) Indicate in the spaces provided how many employees slates or UCP members. Also provide the names of your lirm has, specifying the number of employees state/LICP members that conducted the review. who work on a full—time, part—time, and seasonal basis. (11) Indicate whether your firm or any firms owned by the Attach a list of employees, their jobtitles, and dates of persons listed has ever been denied certification as a employment, to your application. DBE/ACDBE, 8(a), or Small Disadvantaged Business (9) Specify the firm‘s gross receipts for each of the past (SDB) firm, or state and local MBE/WBE firm. three years, as stated in your firm‘s filed Federal tax Indicate if the litm has ever been decertiied from one relurns. You must submit complele copies ol the of these programs. Indicate if the application was finm‘s Federal tax returns for each year. If there are withdrawn or whether the firm was debarred, any affiliates or subsidiarics of the applicant firm or suspended, or otherwise had its bidding privileges owners, you must provide these firms‘ gross receipts denied or restricted by any state or local agency, or and submit complete copies of these firm(s) Federal Federal entity. If your answer is ves, identify the name tax returns. Affiliation is defined in 49 C.F.R. §26.5 of the agency, and explain fully the nature of the and 13 C.F.R. Part 121. action in the space provided. Indicate if you have ever appealed this decision to the Department and if so, B. Relationships and Dealings with Other Businesses attach a copy of USDOT‘s final agency decision(s). (1) Check the appropriate box that indicates whether your firm is co—located at any of its business locations, or Section 2: GENERAL INFORMATION whether your firm shares a telephone number(s), a post office box, any office space, a yard, warehouse, A. Business profile: other facilities, any equipment, financing, or any (1) Give a concise description of the firm‘s primary office staff and/or employees with any other business, activities. the product(s) or services the company organization or entity of any kind. If you answered provides, or type of construction. If your company "Yes," then specify the name of the other firm(s) and offers more than one product/service, list primary fully explain the nature of yourrelationship with these product or service first (altach additional sheels if other businesses by identifying the business or person necessary). This description may be used in our UCP with whom you have any formal, informal, written, or online directory if you are certified as a DBE. U.S. DOT Uniform DBE/ACDBE Certification Application e Page 1009 of 15

40126 Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices oral agreement. Provide an explanation of any items (3) (a) Check the appropriate box tlrat indicates whether shared with other finns in the space provided. this owner owns or works for any other firm( s) that (2) Check the appropriate box indicating whether any has l!!.!Y relationship witlr your finn. lf you checked other finn currently has or had an ownership interest "Yes," identify the name of the other business, the in your firm at present or at any time in the past. lf you nature of tire business relationslrip, and tire owner's checked yes, please explain. function at the finn. (3) Check the appropriate box tlmt indicates whether at (b) lf the owner works for any other finn, non-profit present or at any time in the past your finn: organization, or is engaged in any other activity more (a) ever existed under ditTerent mvnership, a ditlerent tlran l 0 hours per week, please identity tlris activity. type of ow1rership, or a different name; (4) (a) Provide the personal net worth of the owner (b) existed as a subsidiary of any other firm; applying for certification in tire space provided. (c) existed as a partnership in which one or more of the Complete and attach the accompanying "Personal Net partners are/were other finns; Worth Statement for DEE/ACDEE Program (d) ow11ed any percentage of any other tinn; and Eligibility" with your application. Note, complete this (e) had any subsidiaries of its own. section and accompanying statement only for each (f) served as a subcontractor with another firm owner applying for DEE qualification (i.e., for each constituting more tlmn 25% of your tum's receipts. owner clainring to be socially and economically disadvantaged). If you answered "Yes" to any of the questions in (3)(a-f), (b) Check tire appropriate box that indicates whetlrer any you may he asked to explain the arrangement in detail. trust has heen created for the benefit of the disadvantaged owner(s). If you answered "Yes," you Section 3: MAJORITY OWNER INFORMATTON may be asked to provide a copy of the trust instrument. Tdentity all individuals or holding companies with any (5) Check the appropriate to indicate whether any of your ov.nership interest in your finn, providing tlre infonnation immediate family members, managers, or employees, requested below (if your finn has more than one owner, own, manage, or are associated with another company. provide completed copies of this section for each ow1rer ): Immediate family member is defined in 49 C.F.R. §26.5. If you answered "Yes," provide the name of A. Identify the majority owner of the firm holding 51% each person, your relationship to tlrem, the name of or more ownership interest the company, the type of business, and whether they ( l) Enter the full name of the owner. own or manage tire company. (2) Enter his/her title or position within your finn. (3) Give his/her home phone number. Section 4: CONTROL (4) Enter his/her home (street) address. (5) Indicate this owner's gender. A Identity the firm's Officers and Board of (6) Iclenlify the owner's elhnic group membership. If you Directors checked "Other," specify this owner's ethnic (1) In the space provided, state the name, title, date of group/identity not otherwise listed. appoinlmenl, elhuicily, ancl gencler of each officer. (7) Check the appropriate box to indicate whether this (2) In the space provided, state the name, title, date of ow1rer is a U.S. citizen or a lawfully admitted appointment, etlmicity, and gender of each individual permanent resident. If this owner is neither a U.S. serving on your finn's Doard of Directors. cilizen nor a lawfully aclmillecl pennanenl resiclenl of (3) Check the appropriate box lo inclicale whether any of the U.S., then this owner is NOT eligible for your firm's ofticers and/or directors listed above cerli1icalion as a DEE owner. per1onns a managemenl or supervisory runclion ror (8) Enter the number of years during which this owner has any other business. If you answered "Yes," identifv been an owner of your fmn. each person by name, Iris/her title, tire name of tire (9) Indicate the percentage of the total ownership this other business in which s/he is involved, and his/her person holcls ancl the clale acquirecl, inclucling (if funclion perfonnecl in thal other business. appropriate), the class of stock owned. (4) Check the appropriate box that indicates whether any (10) Indicate the dollar value of tlris owner's initial of your finn's otlicers and/or directors listed above investment to acquire an ownership interest in your own or work for any other finn(s) that has a finn, broken down by cash, real estate, equipment, relationship witlr your finn. (e.g., ownership interest, and/or other investment. Describe how you acquired shared office space, financial investments, equipment your business ancl allach clocumenlalion subslanlialing leases, personnel sharing, elc.) If you answerecl "Yes," this investment. identify the name of the firm, tire individual's name, and the nature of his/her business relationslrip with B. Additional Owner Information that other firm. ( l) Describe tire familial relationship of tlris mv1rer to each other ow1rer of your firm and employees. (2) Indicate whether tlris owner perfonns a management B. Duties of Owners, Officers, Directors, Managers and or supervisory function for any other business. If you Key Personnel checked "Yes," state the name of tire other business sradovich on DSK3GMQ082PROD with NOTICES and this owner's fi.mctionltitlc held in that business. (1 ), (2) Specify the roles of the majority and minority owners, directors, otlicers, and managers, and key U.S. DOT Uniform DEE/ACDEE Certification Application • Page 1010 of 15 EN13AU18.049</GPH> VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00146 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1

Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices 40127 persmmel who are responsible for the functions listed for each loau was made to your finn. Provide copies of signed the finn. Submit resumes for each owner aud non-owner loan agreements and security agreements identified belov.. Slate lhe mune of lhe individmtl, lille, race and gender and pencentage ov.11ership if any. Circle the G. Contributions or transfers of assets to/from your frequency of each person's involvement as follows: firm and to/from any of its owners or another "always, frequently, seldom, or never" in each area. individual over the past two years: Indicate whether any of the persons listed in this section Indicate in the spaces provided, the type of contribution or perfonn a management or supervisory function for any asset that was transferred, its current dollar value, the other business. Identify the person, business, aud their person or firm from whom it was transferred, the person or title/function Identify if any of the persons listed above finn to whom it was tmnsfenec"'" the relationship between own or work for any otlrer finn(s) tlmt has a relationship tire two persons and/or finns, and tire date of tire transfer. with this finn (e.g. ownership interest, shared office space, financial investment, equipment, leases, personnel sharing. H Current licenses/permits held by any owner or etc.) If you answered ·'Yes," describe the natme of his/her employee of your firm. business relationship with that otlrer finn. List the name of each person in your firm who holds a C. Inventory: Indicate finn inventory in these categories: professional license or penni!, the type of permit or license, the expiration date of the permit or license, and issuing (1) Equipment and Vehicles State of the license or pennit. Attach copies of licenses, State the make and model, and current dollar value of license renewal forms, pennits, and haul authority forms. each piece of equipment and motor vehicle held and/or used hy your tlnn. Indicate whether each piece is l Largest contracts completed by your firm in the past either ov.ned or leased by your tlnn or ov.ner, whetlrer three years, if any. it is used as collateral, and where this item is stored. List llie name of each owner or contractor for each contract, (2) Office Space tire name and location of tire projects wrder each contract, State tire street address of each office space held the type of work perfonned on each contract, and the dollar and/or used by your firm. Indicate whether your firm value of each contract. or mvner owns or leases the office space and the current dollar value of that property or its lease. J. Largest active _jobs on which your firm is currently working. (3) Storage Space For each active job listed, state the name of the prime State the str·eet adch·ess of each storage space held contractor and tire project nurnber, tire location, the type of and/or used by your finn. Indicate whether your fmn work perfonned, the project start date, the anticipated or ov.ner owns or leases the storage space and the completion date, mrd the dollar value ofthe contract. current dollar value of llial properly or ils lease. Provide a signed lease agreement for each property. Section 5: AIRPORT CONCESSION (A CD BE) APPLICANTS D. Does your firm rely on any other firm for management functions or employee payroll'! Cornplele llie entries in lliis sec lion if you are applying for ACDRR certification. Indicate in Section A if you operate a Check the appropriate box that indicates whether your fum concession at the airport, aud/or supply a good or service to relics on auy other tirm for management fimctions or for an airport concessionaire. Indicate in Section B whether the employee payroll. If you answered "Yes," you may be applicant finn owns or operates any off.ai:tpori locations, asked to explain the narure of that reliance and the extent to providi:trg tire type of busi:tress, lease i:trfonnation, which the other tlnn carries out such functions. address/location, mrd mrnual gross receipts generated. Provide similar information in section C for any airport E. Financial/ Banking Information concession locations the finn cunently owns or operates. If tire applicmrt tlnn has mry affiliates, provide the requested State the name, City and State of your firm's bank. Identify infonnation in Section D. Indicate whetlrer the ACDBE llie persons able lo sign checks on lliis account. Provide linn is participating i:tr tmy joint venlttres, tmd if so, include hank authorization and signature cards. the original and any amended joint venture agreements. Bonding Information. State your finn's bonding linlits both AFFIDAVIT & SIGNATURE aggregate and projecllimils. The Affidavit of Certification must accompany your F. Sources, amounts, and purposes of money loaned to application. Carefully read the attached affidavit in its your firm, including the names of persons or firms entirety. Fill in the required infomration tor each blmlk guaranteeing the loan. space, and sign and date the affidavit i:tt tire presence of a Notary Public, who must tlren notarize tire fonn. State the name aud address of each source, the name of sradovich on DSK3GMQ082PROD with NOTICES person securing the loan, original dollar amount aud the cunent balance of each loan, and tire pwpose for which U.S. DOT Unifonn DBE/A CDBE Certification Application • Page 1011 of 15 EN13AU18.050</GPH> VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00147 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1

40128 Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices Section 1: CERTIFICATION INFORMATION A. Basic Contact Information I am applying for certification as 0 DBE DACDBE (1) Contact person and Title: _ _ _ _ _ _ _ __ (2) Legal name offirm: _ _ _ _ _ _ _ _ _ __ (3) Phone#: (_) _ _ - _ _ _ (4) Other Phone#: ( _ ) _ _ - _ _ (5) Fax#: ( _ ) _ _ - _ _ (6) E-mail: _ _ _ _ _ _ _ _ _ _ _ _ _ _ (7) Firm Websites: _ _ _ _ _ _ _ _ _ _ _ _ __ (8) Street address of firm (No P.O. Box): City: County/Parish: State: Zip: (9) Mailing address of firm (ifdifferenl) City: County/Parish: State: Zip: B. Prior/Other Certifications and Applications (10) Is your firm currently certified for any ofthe following U.S. DOT programs? D DBE D A CD BE Names of certifying agencies: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ List the dates of any site visits conducted by your home state and any other states or UCP members: Date _ _ _ Statc/UCP Member: _ _ _ _ _ Date _ _ _ Statc/UCP Member: _ _ _ _ _ __ (11) Indicate whether the firm or any persons listed in this application have ever been: (a) Denied certification or decertified as a DBE, A CD BE, 8(a), SDB, MBE/WBE firm? D Y cs DNo (b) Withdrawn an application for these programs, or debarred or suspended or otherwise had bidding privileges denied or restricted by any state or local agency, or Federal entity? D Yes D No If yes, explain the nature of the action. (l{}'OU appealed the decision to DOT or another agency, attach a copy of the decision) Section 2: GENERAL INFORMATION A. Business Profile: (1) Give a concise description of the tlm1' s primary activities and the product(s) or service(s) it provides. If your company offers more than one product/service, list the primary product or service first. Please use additional paper if necessary. This description may be used in our database and the UCP online directory if you are certified as a DBE or ACDBE. (2) Applicable NAICS Codes for this line of work include:______ _ __ (3) This firm was established on I I I (4) J/We have owned this firm since: __/__/__ sradovich on DSK3GMQ082PROD with NOTICES U.S. DOT UniformDBE/ACDBE Certification Application• Page 1012 of 15 EN13AU18.051</GPH> VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00148 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1

Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices 40129 (5) Method of acquisition (Check all that appZv): D Started new business D Bought existing business D Inherited business D Gifted D Merger or consolidation D Other (explain! _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ (6) Is your firm "for profit"? DYes DNo----> ®STOP! If your finn is NOT for-profit, then you do NOT Federal Ta" ID# _ _ _ _ _ _ _ _ _ __ qualify for tlris program and should not fill out tlris application. (7) Type of Legal Business Structure: (check all that apply): D Sole Proprietorship D Limited Liability Partnership D Partnership DCorporation D Limited Liability Company D Other, Describe _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ (8) Number of employees: Full-time Part-time Seasonal Tot..1.l _ _ __ (Provide a list of employees, their job titles, and dates of employment, to your application). (9) Specify the firm's gross receipts for the last 3 years. (Sub mil complete copies ofthejirm 's Federal fax returnsfor each year. If /here are affiliates or subsidiaries of the applicanl firm or owners, you must submit complete copies of these firms' Federal tax returns). Year _ _ _ Gross Receipts of Applicant Firm $ _ _ _ _ _ _ Gross Receipts of Affiliate Firms $_ _ _ __ Year Gross Receipts of Applicant Firm $ Gross Receipts of Affiliate Firms $_ _ __ Y car Gross Receipts of Applicant Firm $ Gross Receipts of Affiliate Firms $_ _ _ __ B. Relationships and Dealings with Other Businesses (1) Is your firm co-located at any of its business locations, or does it share a telephone number, P.O. Box, office or storage space, yard, warehouse, facilities, equipment, inventory, financing, office staff, and/or employees with any other business, organization, or entity? 0 Y cs 0 No If Yes, explain the nature ofyour relationship with these other businesses by identifYing the business or person with whom you have any formal, informal, written, or oral agreement. Also detail the items shared (2) Has any other firm had an ownership interest in your firm at present or at any time in the past? DYes D No lfYes, explain_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ (3) At present, or at any time in the past, has your firm: (a) Ever existed under different ownership, a different type of ownership, or a different name? 0 Yes 0 No (b) Existed as a subsidiary of any other firm? 0 Yes 0 No (c) Existed as a partnership in \vhich one or more of the partners are/were other finns? 0 Yes 0 No (d) Owned any percentage of any other finn? 0 Yes 0 No (e) Had any subsidiaries? DYes D No (t) Served as a subcontractor with another finn constituting more than 25% of your finn's receipts? DYes D No ({(you answered "Yes" to any of the questions in (2) and/or (3)(a)-(f}, you may be asked to provide further details and explain whether the arrangement continues). sradovich on DSK3GMQ082PROD with NOTICES U.S. DOT U1riform DBE/ACD BE Certification Application • Page 1013 of 15 EN13AU18.052</GPH> VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00149 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1

40130 Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices Section 3: MAJORITY OWNER INFORMATION A. Identify the majority owner of the firm holding 51% or more ownership interest. (1) Full Name: I (2) Title: (3) Home Phone #: ( )---------- I (4) Home Address (Street and Number): City: State: Zip: (8) Number of years as owner: _ __ (5) Gender: 0 Male 0 Female (9) Percentage owned: _____ % Class of stock owned: _ _ __ (6) Ethnic group membership (Check all that appZr): Date acquired _ _ _ _ _ _ __ 0 Black 0 Hispanic (10) Initial investment to Type Dollar Value 0 Asian Pacific 0 Native American acquire ownership Cash $ 0 Subcontinent Asian interest in firm: Real Estate $ 0 Other (specifY) - - - - - - - - - Equipment $ Other $ (7) U.S. Citizenship: Describe how you acquired your business: 0 Started business myself 0 U.S. Citizen 0 It was a gift from: _ _ _ _ _ _ _ _ _ _ _ __ 0 Lawfully Admitted Permanent Resident 0 1 bought it from: _ _ _ _ _ _ _ _ _ _ _ __ 0 1 inherited it from: - - - - - - - - - - - - - 0 Other - - - - - - - - - - - - - - - - - - (Attach documentation substantiating your investment) B. Additional Owner Information (1) Describe familial relationship to other owners and employees: (2) Does this owner perform a management or supervisory function for any other business? 0 Yes 0 No If Yes, identifY: Name of Business _ _ _ _ _ _ _ _ _ _ _ _ _ Function!Iitle: _ _ _ _ _ _ _ _ _ _ __ (3)(a) Does this owner own or work for any other firm(s) that has a relationship with this firm? (e.g., ownership 0 Yes 0 No inleresl, shared office space, financial inves/menls, equipmenl, leases, personnel shan·ng, e/c.) IdentifY the name of the business, and the nature of the relationship, and the owner's function at the firm: (b) Does this owner work for any other firm, non-profit organization, or engage in any other activity more than 10 hours per week? 1fyes, identifY this activity: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ (4)(a) What is the personal net worth of this disadvantaged owner applying for certification?$._ _ _ __ (b )Has any trust been created for the benefit of this disadvantaged owner(s)? 0 Yes 0 No (I,[ Yes, you may be asked fo provide a copy of the trust instrument). (5) Do any of your immediate family members, managers, or employees own, manage, or are associated with another company? 0 Y cs 0 No IfY cs, provide their name, relationship, company, type of business, and indicate whether they own or manage the company: (Please attach exira sheets, if needed): _ _ _ _ _ _ _ _ __ sradovich on DSK3GMQ082PROD with NOTICES U.S. DOT UniformDBE/ACDBE Certification Application • Page 1014 of 15 EN13AU18.053</GPH> VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00150 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1

Federal Register/Vol. 83, No. 156 /Monday, August 13, 2018 /Notices 40131 Section 3: OWNER INFORMATION, Cont‘d. A. Identify all individuals, firms, or holding companies that hold LESS THAN 51% ownership interest in the _ _ I firm (Aftach separate sheetsfor each additional owner) (1) Full Name: (2) Title: (3) Home Phone #: ( ) — (4) Home Address (Street and Number): City: State: Zip: (5) Gender: U Male U Female (8) Number of years as owner: (9) Percentage owned: % (6) Ethnic group membership (Check all that apply) Class of stock owned: Date acquired LQ Black L Hispanic Q Asian Pacific Q Native American (10) Initial investment to Typo Dollar L Subcontinent Asian acquire ownership Cash $ C Other (specify) interest in firm: Real Estate $ ~ Equipment $ (7) U.S. Citizenship: Other $ Q U.S. Citizen Describe howyou acquired your business: Q Lawfully Admitted Permanent Resident C1 Started bu'smess myself. Q It was a gift from: L I bought it from: C I inherited it from: U Other (Attach documentation substantiating your investment) B. Additional Owner Information (1) Describe familial relationship to other owners and employees: (2) Does this owner perform a management or supervisory function for any other business? U Yes U No If Yes, identify: Name of Business: Function/Tille: (3)(a) Does this owner own or work for any other firm(s) that has a relationship with this firm? (e.g., ownership interest, shared office space, financial investments, equipment, leases, personnel sharing, etc.) LQ Yes U No Identify the name of the business, and the nature of the relationship, and the owner‘s function at the firm: (b) Does this owner work for any other firm, non—profit organization, or is engaged in any other activity more than 10 hours per week? If yes, identify this activity: (4)(a) What is the personal net worth of this disadvantaged owner applying for certification? $ (b) Has any trust been created for the benefit of this disadvantaged owner(s)? U Yes U No (If Yes, you may be asked to provide a copyofthe trust instrument). (5) Do any of your immediate family members, managers, or employees own, manage, or are associated with another company? U Yes U No IfYes, provide their name, relationship, company, type of business, and indicate whether they own or manage: (Please attach extra sheets, ifneeded): U.S. DOT Uniform DBE/ACDBE Certification Application e Page 1015 of 15

40132 Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices Section 4: CONTROL A. Identify your firm's Officers and Board of Directors (If additional space is required, attach a separate sheet): Name Title Date Appointed Ethnicitv Gender (1) Officers of the Company (a) (b) (c) (d) (2) Board of Directors (a) (b) (c) (d) (3) Do any of the persons listed above perform a management or supervisory function for any other business? D Yes D No lfYes, identity for each: Person: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Title: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Business: Function: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Person: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ T i t l e : , - - - - - - - - - - - - - - - - - - - - - - - Business: Function: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ (4) Do any ofthe persons listed in section A above own or work for any other firm(s) that has a relationship with this firm? (e.g., ownership interest, shared office space, .financial investments, equipment, leases, personnel sharing, etc.) D Yes D No lf Yes, identity for each: FirmName: _ _ _ _ _ _ _ _ _ _ _ _ _ _ Person: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Nature of Business R e l a t i o n s h i p : - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - B. Duties of Owners, Officers, Directors, Managers, and Key Personnel 1. Complete for all Owners who are responsible for the following functions of the firm (Atrach separate sheets as needed) Majority Owner (51% or more) Minority Owner (49% or less) A= Always S =Seldom Name: Name: F = Frequently N =Never Title: Title: Percent Owned: Percent Owned: Sets policy for company direction/scope A F s N A F s N of operations Bidding and estimating A F s N A F s N Major purchasing decisions A F s N A F s N Marketing and sales A F s N A F s N Supervises field operations A F s N A F s N Attend bid opening and lettings A F s N A F s N Perform office management (billing, A F s N A F s N accounts receivable/payable, etc ) Hires and fires management staff A F s N A F s N Hire and fire field staff or crew A F s N A F s N Designates profits spending or investment A F s N A F s N Obligates business by contract/credit A F s N A F s N Purchase equipment A F s N A F s N Signs business checks A F s N A F s N sradovich on DSK3GMQ082PROD with NOTICES U.S. DOT Uniform DEE/ACD BE Certification Application • Page 1016 of 15 EN13AU18.055</GPH> VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00152 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1

Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices 40133 2. Complete for all Officers, Directors, Managers, and Key Personnel who are responsible for the following functions of the firm (Artach separate sheets as needed) Officer/Director/Manager/Key Pers01mel Officer/Director/Manager/ Key Pers01mel A= Always S =Seldom Name: Name: F = Frequently N =Never Title: Title: Race and Gender: Race and Gender: Percent Owned: Percent Owned: Sets policy for company direction/scope A F s N A F s N of operations Bidding and cstimating A F s N A F s N Maior purchasing decisions A F s N A F s N Marketing and sales A F s N A F s N Supervises field opemtions A F s N A F s N Attend bid opening and lcttings A F s N A F s N Perform office management (billing, A F s N A F s N accounts receivable/pavable, etc.) Hires and fires management staff A F s N A F s N Hire and fire field staff or crew A F s N A F s N Designates profits spending or investment A F s N A F s N Obligates business bv contmct/crcdit A F s N A F s N Purchase equipment A F s N A F s N Signs business checks A F s N A F s N Do any of the persons listed in B 1 or B2 perform a management or supervisory function for any other business? TfY cs, identifY the person, the business, and their title/function: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Do any of the persons listed above own or work for any other firm(s) that has a relationship with this firm? (e.g, ownership inleres/, shared office space, financial inves/menls, equipment, leases, personnel sharing, etc.) If Yes, describe tl1e nature of the business relationship: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ C. Inventory: Indicate your firm's inventory in the following categories (Please artach additional sheets if needed): 1. Equipment and Vehicles Make and Model Current Owned or Leased Used as collateral? Where is item stored? Value by Firm or Owner? l. 2. 3. 4. 5. 6. 7. 8. 9. 2. Office Space Street Address Owned or Leased by Firm or Owner? Current Value of Property or Lease sradovich on DSK3GMQ082PROD with NOTICES U.S. DOT Uniform DBE/ACDBE Certification Application • Page 1017 of 15 EN13AU18.056</GPH> VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00153 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1

40134 Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices 3. Storage Space !Provide signed lease agreements for the properties listed) Street Address Owned or Leased by Current Value of Property or Lease Firm or Owner? D. Does your firm rely on any other firm for management functions or employee payroll? D Yes D No E. Financial/Banking Information (Provide bank authorization and signature cards) Name of bank: City and State: _ _ _ _ _ _ _ _ _ _ _ _ __ The following individuals are able to sign checks on this account: ___________________ Name of bank: City and State: _ _ _ _ _ _ _ _ _ _ _ _ _ __ The following individuals are able to sign checks on this account: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Bonding Information: If you have bonding capacity, identify the firm's bonding aggregate and project limits: Aggregate limit $ Project limit $ _ _ _ _ _ _ _ __ F. Identify all sources, amounts, and purposes of money loaned to your firm including from financial institutions. Identify whether you the owner and any other person or firm loaned money to the applicant DBE/ACDBE. Include the names of any persons or firms guaranteeing the loan, if other than the listed owner. (l'rovide copies ofsigned loan agreements and security agreements). N arne of Source Address of Source N arne of Person Original Current Purpose of Loan Guaranteeing the Amount Balance Loan !. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ 2. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____ 3. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ G. List all contributions or transfers of assets to/from your firm and to/from any of its owners or another individual over the past two years (Ailach additional sheets if needed): Contribution/Asset Dollar Value From Whom To Whom Relationship Date of Transferred Transferred Transfer l. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____ 2. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____ 3. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____ H. List current licenses/permits held by any owner and/or employee of your firm (e.g. contractor, engineer, architect, etc.)(Attach additional sheets if needed): Name of License/Permit Holder Type of License/Permit Expiration Date State l. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ 2. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ 3. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ____ sradovich on DSK3GMQ082PROD with NOTICES U.S. DOT UniformDBE/ACDBE Certification Application • Page 1018 of 15 EN13AU18.057</GPH> VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00154 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1

Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices 40135 I. List the three largest contracts completed by your firm in the past three years, if any: Name of Name/Location of Type of Work Performed Dollar Value of Owner/Contractor Project Contract 1.-------------------------------------------------------------------------------- 2·------------------------------------------------------------------------------- 3·------------------------------------------------------------------------------- J. List the three largest active jobs on which your firm is currently working: Name of Prime Location of Type of Work Project Anticipated Dollar Value Contractor and Project Project Start Date Completion of Contract Number Date 1.-------------------------------------------------------------------------------- 2·-------------------------------------------------------------------------------- 3·-------------------------------------------------------------------------------- Additional Information: sradovich on DSK3GMQ082PROD with NOTICES U.S. DOT Uniform DBE/A CD BE Certification Application • Page 1019 of 15 EN13AU18.058</GPH> VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00155 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1

Federal Register/Vol. 83, No. 156 /Monday, August 13, 2018 /Notices SECTION 5 — AIRPORT CONCESSION (ACDBE APPLICANTS ONLY) A. I am applying for ACDBE certification to: (check all that apply) C Operate a concession at an airport U Supply a good or service to an airport concessionaire B. Does the applicant firm own/operate any off—airport locations? O Yes O No If Yes, identify the following Type of Business Lease Lease Address / Location Annual Gross (e.g., F&B, News & Gift, Retail, Duty Term Start Date Receipts Generated Free, Advertising. etc.) (years) C. Does the applicant firm currently own/operate any airport concession locations? D Yes O No If Yes, supply the following information: Airport Name Concession Type |Number of| Number of Annual Gross Lease Type (e.g., F&B, News & Leases Locations Receipts (e.g. Direct Lease, Subcontract Gift, Retail, Duty Free, Generated Management Agreement, etc. enter Advertising, etc.) all that applyto the leases listed) D. Does the applicant firm have any affiliates? O Yes O No If Yes, provide the following information concerning any locations ow ned/operated by affiliate firms. Airport Name Concession Type |Number of Number of| Annual Gross Lease Type (e.g., F&B, News & Leases Locations Receipts (e.g. Direct Lease, Subcontract Gift, Reta_il,. Duty Free, Generated Management Agreement, etc.. enter Adveruising, elc.) all that apply to the leases listed) E. Is the ACDBE applicant firm a participant in any joint ventures? O Yes O No If Yes, attach all original and any amended Joint Venture Agreements and any amendments to the agreements. U.S. DOT Uniform DBE/ACDBE Certification Application e Page 1020 of 15

Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices 40137 AFFIDAVIT OF CERTIFICATION 1his form must be signed and notarized for each owner upon which disadvantaged status is relied. A MATERIAL OR FALSE STATEMENT OR OMISSION MADE IN CONNECTION WITH THIS APPLICATION IS SUFFICIENT CAUSE FOR DENIAL OF CERTIFICATION, REVOCATION OF A PRIOR APPROVAL, INITIATION OF SUSPENSION OR DEBARMENT PROCEEDINGS, AND MAY SUBJECT THE PERSON AND/OR ENTITY MAKING THE FALSE STATEMENT TO ANY AND ALL CIVIL AND CRIMINAL PENALTIES AVAILABLE PURSUANT TO APPLICABLE FEDERAL AND STATE LAW. _ _ _ _ _ _ _ _ _ _ _ _ _ _ (full name printed), J acknowledge and agree that any misrepresentations in this swear or affinn under penalty of law that Jam application or in records pertaining to a contract or subcontract _ _ _ _ _ _ _ _ _ _ _ _ (title) of the applicant firm will be grounds for terminating any contract or subcontract _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ and that 1 which 111ay be awarded; denial or revocation of certification; have read and understood all of the questions in this suspension and debarment; and for initiating action under application and that all of the foregoing infonnation and federal and/or state law conccming false statement, fraud or statements submitted in this application and its attachments other applicable offenses. and supporting documents are true and correct to U1e best of my knowledge, and Uml all responses to U1e questions are full I certify that I am a socially and economically disadvantaged and complete, omitting no material information. The responses individual who is an owner of tl1e above-referenced firm seeking include all material information necessary to fully and certification as a Disadvantaged Business Enterprise or Airport accurately identify and explain the operations, capabilities and Concession Disadvantaged Business Enterprise. In support of my pertinent history of the named firm as well as the ownership, application, I certify tlmt I am a member of one or more of the control, and affiliations thereof following groups, and tlmt I lmve held myself out as a member of the group(s): (Check all tlmt apply): J recognize that the infonnation submitted in this application is for the purpose of inducing certification approval by a 0 Female 0 Black American 0 Hispanic American government agency. 1 understand tlmt a government agency 0 Native American 0 Asian-Pacific American may, by means it deems appropriate, determine the accuracy 0 Subcontinent Asian American 0 Other (specify) and truth of the statements in the application, and I authorize such agency to contact any entity named in the application, and the named firm's bonding companies, banking institutions, I certify that I am socially disadvantaged because I have been credit agencies, contractors, clients, and oU1er certifying subjected to racial or eUnric prejudice or cultural bias, or have agencies for the purpose of verifying tl1e information supplied suffered the effects of discrimination, because of my identity and detennining tl1e named finn's eligibility. as a member of one or more of tl1e groups identified above, without regard to my individual qualities. I agree to submit to govemment audit, examination and review of books, records, documents and files, in wlmtever form they I further certify tlmt my personal net worth does not exceed exist, of the named firm and its affiliates. inspection of its $1.32 million, and tlmt I am economically disadvantaged places(s) of business and equipment, and to permit interviews because my ability to compete in the free enterprise system lms of its principals, agents. and employees. J understand that been impaired due to diminished capital and credit refusal to permit such inquiries slmll be grounds for denial of opportunities as compared to others in the same or similar line certification. of business who are not socially and economically disadvantaged. If awarded a contract, subcontract, concession lease or sublease, I agree to prompUy and direcUy provide U1e prime I declare under penally of peij ury Uml U1e infonnation contractor, if any, and U1e Department, recipient agency, or provided in tlris application and supporting documents is true federal funding agency on an ongoing basis, current, complete and correct. and accurate information regarding (1) work performed on tl1e project; (2) payments; and (3) proposed changes, if any, to the Signature----.,---------- foregoing arrangements. (DBE/ACDBE Applicant) (Date) I agree to provide written notice to the recipient agency or NOTARY CERTIFICATE Unified Certification Program of any 111aterial clmnge in the infommtion contained in the original application within 30 calendar days of such change (e.g., ownership changes, address/telephone number, personal net worth exceeding $1.32 million, etc.). sradovich on DSK3GMQ082PROD with NOTICES U.S. DOT Uniform DEE/A CD BE Certification Application • Page 1021 of 15 EN13AU18.060</GPH> VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00157 Fmt 4703 Sfmt 4725 E:\FR\FM\13AUN1.SGM 13AUN1

40138 Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices UNIFORM CERTIFICATION APPLICATION SUPPORTING DOCUMENTS CHECKLIST In order to complete your application for DBE or A CD BE certification, you must attach copies of all of the following REQUIRED documents. A failure to supply any information requested by the UCP may result in your firm denied DBE/ACDBE certification. Required Documents (or All Applicants =Minutes of all stockholders and board of directors meetings - Corporate by-laws and any amendments l Resumes (that include places of employment with - Corporate bank resolution and bank signature cards corresponding dates), for all owners, officers, and key =Official Certificate of Formation and Operating Agreement personnel of the applicant firm with any amendments (for LLCs) J Personal Net Worth Statement for each socially and economically disadvantaged owners who the applicant firm Optional Documents to Be Provided on Request relics upon to satisfy the Regulation's 51% ownership requirement. The certi[ving agency fo which you are appZving may require J Personal Federal tax returns for the past3 years, if the submission of the following documents. If requested to applicable, for each disadvantaged owner provide these document, you must suppZv them with your J Federal tax returns (and requests for extensions) filed by application or at the on-site visit. the finn and its affiliates with related schedules, for the past 3 years. L Proof of citizenship J Documented proof of contributions used to acquire = Insurance agreements for each tmck owned or operated by ownership for each owner (e.g., both sides ofcancelled your firm checks) - Audited financial statements (if available) l Signed loan and security agreements, and bonding forms - Tmst agreements held by any owner claiming L List of equipment and/or vehicles owned and leased disadvantaged status including YIN numbers, copy of titles, proof of ownership, = Year-end balance sheets and income statements for the insurance cards for each vehicle. past 3 years (or life affirm, !{less than three years) J Titlc(s), registration certificatc(s), and U.S. DOT numbers for each truck owned or operated by your finn Suppliers J Licenses, license renewal fonns, pennils, and haul =List of product lines carried and list of distribution authority forms equipment owned and/or leased J Descriptions of all real estate (including office/storage space, etc.) owned/leased by your finn and documented proof of ownership/signed leases J Documented proof of any transfers of assets to/from your firm and/or to/from any of its owners over the past 2 years J DBE/ACDBE and SEA 8(a). SDB, MBE/WBE certifications, denials, and/or decertifications, if applicable; and any U.S. DOT appeal decisions on these actions. J Bank authorization and signatory cards J Schedule of salaries (or other remuneration) paid to all officers, managers, owners, and/or directors of the finn J List of all employees, job titles, and dales of employment. J Proof of warehouse/storage facility ownership or lease arrangements Partnership or Joint Venture J Original and any amended Partnership or Joint Venture Agreements Corporation or LLC J Official Articles of Incorporation (5igned by the srate ojjicial) J Both sides of all corporate stock certificates and your firm's stock tnmsfcr ledger J Shareholders· Agrecment(s) sradovich on DSK3GMQ082PROD with NOTICES U.S. DOT Uniform DEE/A CD BE Certification Application • Page 1022 of 15 BILLING CODE 4910–9X–C EN13AU18.061</GPH> VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00158 Fmt 4703 Sfmt 4703 E:\FR\FM\13AUN1.SGM 13AUN1

Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices 40139 Appendix B to Part 26—Uniform equipment and any other types of services. exceed the sum of all prime contract amounts Report of DBE Awards or Commitments All dollar amounts are to reflect only the awarded in those periods. and Payments Form Federal share of such contracts and should be 9(B). Provide the total number of all sub rounded to the nearest dollar. contracts assisted with DOT funds that were Instructions for Completing the Uniform Line 8: Prime contracts awarded this awarded or committed during this reporting Report of DBE Awards/Commitments and period: The items on this line should period. Payments correspond to the contracts directly between 9(C). From the total dollar amount of sub Recipients of Department of Transportation the recipient and a supply or service contracts awarded/committed this period in (DOT) funds are expected to keep accurate contractor, with no intermediaries between item 9(A), provide the total dollar amount data regarding the contracting opportunities the two. awarded in sub contracts to DBEs. available to firms paid for with DOT dollars. 8(A). Provide the total dollar amount for 9(D). From the total number of sub Failure to submit contracting data relative to all prime contracts assisted with DOT funds contracts awarded or committed in item 9(B), the DBE program will result in and awarded during this reporting period. specify the number of sub contracts awarded noncompliance with Part 26. All dollar This value should include the entire Federal or committed to DBEs. values listed on this form should represent share of the contracts without removing any 9(E). From the total dollar amount of sub the DOT share attributable to the Operating amounts associated with resulting contracts awarded or committed to DBEs this Administration (OA): Federal Highway subcontracts. period, provide the amount in dollars to Administration (FHWA), Federal Aviation 8(B). Provide the total number of all prime DBEs using Race Conscious measures. Administration (FAA) or Federal Transit contracts assisted with DOT funds and 9(F). From the total number of sub Administration (FTA) to which this report awarded during this reporting period. contracts awarded or committed to DBEs this will be submitted. 8(C). From the total dollar amount awarded period, provide the number of sub contracts 1. Indicate the DOT (OA) that provides in item 8(A), provide the dollar amount awarded or committed to DBEs using Race your Federal financial assistance. If awarded in prime contracts to certified DBE Conscious measures. assistance comes from more than one OA, firms during this reporting period. This amount should not include the amounts sub 9(G). From the total dollar amount of sub use separate reporting forms for each OA. If contracts awarded/committed to DBEs this you are an FTA recipient, indicate your contracted to other firms. 8(D). From the total number of prime period, provide the amount in dollars to Vendor Number in the space provided. DBEs using Race Neutral measures. 2. If you are an FAA recipient, indicate the contracts awarded in item 8(B), specify the number of prime contracts awarded to 9(H). From the total number of sub relevant AIP Numbers covered by this report. contracts awarded/committed to DBEs this If you are an FTA recipient, indicate the certified DBE firms during this reporting period. period, provide the number of sub contracts Grant/Project numbers covered by this report. 8(E&F). This field is closed for data entry. awarded to DBEs using Race Neutral If more than ten attach a separate sheet. Except for the very rare case of DBE-set measures. 3. Specify the Federal fiscal year (i.e., asides permitted under 49 CFR part 26, all 9(I). Of all subcontracts awarded this October 1–September 30) in which the prime contracts awarded to DBES are reporting period, calculate the percentage covered reporting period falls. 4. State the date of submission of this regarded as race-neutral. going to DBEs. Divide the dollar amount in report. 8(G). From the total dollar amount awarded item 9(C) by the dollar amount in item 9(A) 5. Check the appropriate box that indicates in item 8(C), provide the dollar amount to derive this percentage. Round the the reporting period that the data provided in awarded to certified DBEs through the use of percentage to the nearest tenth. this report covers. For FHWA and FTA Race Neutral methods. See the definition of Line 10: Total contracts awarded or recipients, if this report is due June 1, data Race Neutral in item 7 and the explanation committed this period. These fields should should cover October 1–March 31. If this in item 8 of project types to include. be used to show the total dollar value and report is due December 1, data should cover 8(H). From the total number of prime number of contracts awarded to DBEs and to April 1–September 30. If the report is due to contracts awarded in 8(D), specify the calculate the overall percentage of dollars the FAA, data should cover the entire fiscal number awarded to DBEs through Race awarded to DBEs. year. Neutral methods. 10(A)–10(B). These fields are unavailable 6. Provide the name and address of the 8(I). Of all prime contracts awarded this for data entry. recipient. reporting period, calculate the percentage 10(C–H). Combine the total values listed on 7. State your overall DBE goal(s) going to DBEs. Divide the dollar amount in the prime contracts line (Line 8) with the established for the Federal fiscal year of the item 8(C) by the dollar amount in item 8(A) corresponding values on the subcontracts report being submitted to and approved by to derive this percentage. Round the line (Line 9). the relevant OA. Your overall goal is to be percentage to the nearest tenth. 10(I). Of all contracts awarded this reported as well as the breakdown for Line 9: Subcontracts awarded/committed reporting period, calculate the percentage specific Race Conscious and Race Neutral this period: Items 9(A)-9(I) are derived in the going to DBEs. Divide the total dollars projections (both of which include gender- same way as items 8(A)-8(I), except that these awarded to DBEs in item 10(C) by the dollar conscious/neutral projections). The Race calculations should be based on subcontracts amount in item 8(A) to derive this Conscious projection should be based on rather than prime contracts. Unlike prime percentage. Round the percentage to the measures that focus on and provide benefits contracts, which may only be awarded, nearest tenth. only for DBEs. The use of contract goals is subcontracts may be either awarded or Section B: Breakdown by Ethnicity & Gender a primary example of a race conscious committed. of Contracts Awarded to DBEs This Period measure. The Race Neutral projection should 9(A). If filling out the form for general include measures that, while benefiting reporting, provide the total dollar amount of 11–17. Further breakdown the contracting DBEs, are not solely focused on DBE firms. subcontracts assisted with DOT funds activity with DBE involvement. The Total For example, a small business outreach awarded or committed during this period. Dollar Amount to DBEs in 17(C) should equal program, technical assistance, and prompt This value should be a subset of the total the Total Dollar Amount to DBEs in 10(C). payment clauses can assist a wide variety of dollars awarded in prime contracts in 8(A), Likewise, the total number of contracts to businesses in addition to helping DBE firms. and therefore should never be greater than DBEs in 17(F) should equal the Total Number the amount awarded in prime contracts. If of Contracts to DBEs in 10(D). sradovich on DSK3GMQ082PROD with NOTICES Section A: Awards and Commitments Made filling out the form for project reporting, Line 16: The ‘‘Non-Minority’’ category is During This Period provide the total dollar amount of reserved for any firms whose owners are not The amounts in items 8(A)–10(I) should subcontracts assisted with DOT funds members of the presumptively disadvantaged include all types of prime contracts awarded awarded or committed during this period. groups already listed, but who are either and all types of subcontracts awarded or This value should be a subset of the total ‘‘women’’ OR eligible for the DBE program on committed, including: professional or dollars awarded or previously in prime an individual basis. All DBE firms must be consultant services, construction, purchase of contracts in 8(A). The sum of all subcontract certified by the Unified Certification Program materials or supplies, lease or purchase of amounts in consecutive periods should never to be counted in this report. VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00159 Fmt 4703 Sfmt 4703 E:\FR\FM\13AUN1.SGM 13AUN1

40140 Federal Register / Vol. 83, No. 156 / Monday, August 13, 2018 / Notices Section C: Payments on Ongoing Contracts 21(C). This field is closed. subject to the Regulatory Flexibility Act Line 18(A–E). Submit information on 21(E). Calculate the overall percentage of (5 U.S.C. chapter 6). contracts that are currently in progress. All dollars to DBEs on completed contracts. dollar amounts are to reflect only the Federal Divide the Total DBE participation dollar Donna Hansberry, share of such contracts, and should be value in 21(D) by the Total Dollar Value of Chief, Appeals. rounded to the nearest dollar. Contracts Completed in 21(B) to derive this [FR Doc. 2018–17286 Filed 8–10–18; 8:45 am] 18(A). Provide the total number of prime percentage. Round to the nearest tenth. BILLING CODE 4830–01–P and sub-contracts where work was performed 22. Name of the Authorized Representative during the reporting period. preparing this form. 18(B). Provide the total dollar amount paid 23. Left blank for future use. to all firms performing work on contracts. 24. Signature of the Authorized DEPARTMENT OF VETERANS 18(C). From the total number of contracts Representative. AFFAIRS provided in 18(A) provide the total number 25. Phone number of the Authorized of contracts that are currently being Representative. Privacy Act of 1974; System of performed by DBE firms for which payments **Submit your completed report to your Records have been made. Regional or Division Office. 18(D). From the total dollar amount paid to [FR Doc. 2018–17301 Filed 8–10–18; 8:45 am] AGENCY: Department of Veterans Affairs all firms in 18(A), provide the total dollar (VA), Debt Management Center. BILLING CODE 4910–9X–P value paid to DBE firms currently performing ACTION: Notice of modified system of work during this period. records. 18(E). Provide the total number of DBE firms that received payment during this DEPARTMENT OF THE TREASURY SUMMARY: The Privacy Act of 1974 (5 reporting period. For example, while 3 U.S.C. 522a (e) (4)) requires that all contracts may be active during this period, Internal Revenue Service agencies publish in the Federal Register one DBE firm may be providing supplies or a notice of the existence and character services on all three contracts. This field Art Advisory Panel—Notice of of their systems of records. Notice is should only list the number of DBE firms Availability of Report of 2017 Closed hereby given that the Department of performing work. Meetings 18(F). Of all payments made during this Veterans Affairs (VA) is modifying a period, calculate the percentage going to AGENCY: Internal Revenue Service, system of records entitled ‘‘Centralized DBEs. Divide the total dollar value to DBEs Treasury. Accounts Receivable System/ in item 18(D) by the total dollars of all ACTION: Notice. Centralized Accounts Receivable On- payments in 18(B). Round the percentage to Line System (CARS/CAROLS) the nearest tenth. SUMMARY: Pursuant to the Federal (88VA244)’’. This system was Section D: Actual Payments on Contracts Advisory Committee Act, and the previously called ‘‘Accounts Receivable Completed This Reporting Period Government in the Sunshine Act, a Records VA’’ (88VA244). This system This section should provide information report summarizing the closed meeting had also been previously numbered only on contracts that are closed during this activities of the Art Advisory Panel ‘‘88VA20A6’’. period. All dollar amounts are to reflect the during Fiscal Year 2017 has been DATES: Comments on this modified entire Federal share of such contracts, and prepared. A copy of this report has been system of records must be received no should be rounded to the nearest dollar. filed with the Assistant Secretary for 19(A). Provide the total number of later than September 12, 2018. If no Management of the Department of the contracts completed during this reporting public comment is received during the Treasury. period that used Race Conscious measures. period allowed for comment, or unless Race Conscious contracts are those with DATES: Effective Date: This report is otherwise published in the Federal contract goals or another race conscious available August 2, 2018. Register by VA, the modified system measure. ADDRESSES: The report is available at will become effective a minimum of 30 19(B). Provide the total dollar value of https://www.irs.gov/compliance/ days after publication in the Federal prime contracts completed this reporting appeals/art-appraisal-services. Register. If VA receives public period that had race conscious measures. comments, VA shall review the FOR FURTHER INFORMATION CONTACT: 19(C). From the total dollar value of prime contracts completed this period in 19(B), Maricarmen R. Cuello, AP:SPR:AAS, comments to determine whether any provide the total dollar amount of dollars Internal Revenue Service/Appeals, 51 changes to the notice are necessary. awarded or committed to DBE firms in order SW 1st Avenue, Room 1014, Miami, FL ADDRESSES: Written comments may be to meet the contract goals. This applies only 33130, Telephone number (305) 982– submitted through to Race Conscious contracts. 5364 (not a toll free number). www.Regulations.gov; by mail or hand- 19(D). Provide the actual total DBE SUPPLEMENTARY INFORMATION: Pursuant delivery to Director, Regulation Policy participation in dollars on the race conscious to 5 U.S.C. App. 2, section 10(d), of the and Management (00REG), Department contracts completed this reporting period. Federal Advisory Committee Act, and 5 of Veterans Affairs, 810 Vermont Ave. 19(E). Of all the contracts completed this reporting period using Race Conscious U.S.C. 552b, of the Government in the NW, Room 1064, Washington, DC measures, calculate the percentage of DBE Sunshine Act, a report summarizing the 20420; or by fax to (202) 273–9026 (not participation. Divide the total dollar amount closed meeting activities of the Art a toll-free number). Comments should to DBEs in item 19(D) by the total dollar Advisory Panel during Fiscal Year 2017 indicate that they are submitted in value provided in 19(B) to derive this has been prepared. A copy of this report response to ‘‘Centralized Accounts percentage. Round to the nearest tenth. has been filed with the Assistant Receivable System/Centralized 20(A)–20(E). Items 21(A)-21(E) are derived Accounts Receivable On-Line System sradovich on DSK3GMQ082PROD with NOTICES Secretary for Management of the in the same manner as items 19(A)-19(E), Department of the Treasury. (CARS/CAROLS)’’. Copies of comments except these figures should be based on It has been determined that this received will be available for public contracts completed using Race Neutral measures. document is not a major rule as defined inspection in the Office of Regulation 20(C). This field is closed. in Executive Order 12291 and that a Policy and Management, Room 1063B, 21(A)–21(D). Calculate the totals for each regulatory impact analysis is, therefore, between the hours of 8:00 a.m. and 4:30 column by adding the race conscious and not required. Additionally, this p.m., Monday through Friday (except neutral figures provided in each row above. document does not constitute a rule holidays). Please call (202) 461–4902 for VerDate Sep<11>2014 20:42 Aug 10, 2018 Jkt 244001 PO 00000 Frm 00160 Fmt 4703 Sfmt 4703 E:\FR\FM\13AUN1.SGM 13AUN1


Document Created: 2018-08-11 00:26:56
Document Modified: 2018-08-11 00:26:56
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionNotices
ActionNotice and request for comments.
DatesComments must be submitted on or before September 12, 2018.
ContactMr. Marc Pentino, Departmental Office of Civil Rights, Office of the Secretary, U.S. Department of Transportation, 1200 New Jersey Avenue SE, Washington, DC 20590, (202) 366-6968, or at [email protected]
FR Citation83 FR 40117 
2025 Federal Register | Disclaimer | Privacy Policy
USC | CFR | eCFR