Civil Rights Forms

ADA

• ADA Complaint Form

• ADA Reasonable Accommodation Request Form

• ADA Reasonable Accommodation Employee Release Form

• ADOT&PF ADA Work Plan

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Contract Compliance

• Bidder's Registration Form (25D-6)

• Required Contract Provisions for Federal-Aid Construction Contracts (25D-55 )

• Contractor's Civil Rights Representatives (25A-302)

• Federal EEO Bid Conditions (25A-301)

• EEO-1 Certification (25A-304)

• Federal-aid Highway Construction Contractors Annual EEO Report (FHWA-1391, Rev. 06-10)

• Contract Compliance Review Checklist

• Monthly Employment Utilization Report (25A-303)

• Women & Minority Organizations List   This is a 'working' document. Please help us keep it up-to-date and let us know if any information included is inaccurate.

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DBE Certification

• Alaska Unified Certification Program Agreement

• Appendix A and B [Required for On-site Representative(s)

• Brochure: Your Guide to DBE Certification

• DBE Application Form

• Personal Net Worth Form

• Work Category List

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DBE Compliance - Goals & Good Faith Effort (GFE)

• Specification 120

• Brochure: Demystifying DBE Project Goal Setting

• Brochure: DBE Good Faith Efforts

• GFE Submittal Checklist

• Contact Report (25A-321A)

• DBE Subcontractable Items (25A-324)

• DBE Utilization Report (25A-325C)

• Prime Contractor's Written DBE Commitment Form (25A-326)

• Subcontractor List (25D-5)

• Summary of DBE Participation (25A-336)

• Summary of DBE Participation (25A-336) Instructions

• Summary of GFE Documentation (25A-332A)

• CUF Monitoring Report (25A-298)

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DBE Support Services

• Brochure: DBE Support Services

• Brochure: Welcome to the DBE Program - Federal Hwy Administration Programs

• Flyer: Is the DBE Program for You?

• Brochure: Welcome to the DBE Program - Federal Hwy Administration Programs

• "Map to Success" Specialized Assistance Application

• DBE Survey

• 50% Reimbursement Program Application

• In House Financial Assistance Application

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OJT Training

• Brochure: OJT Support Services

• Brochure: OJT Apprentice Reimbursement Assistance

• Reimbursement Assistance for Apprentices Application

• Section 645

• ADOT&PF Training Program Request (25A310)

• Training Utilization Report (25A311)

• Apprentice Trainee Employment Report (25A312)

• Training Report (25A313)

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On-Site Representative

Section 120, Part 3.03(f)(3), which is a Special Provision of Alaska Department of Transportation and Public Facilities Construction Contracts for the Disadvantaged Business Enterprise (DBE) program, requires that DBE owners or one of their key employees be at the work site and responsible for the work performed on the contract. Key employees are individuals that have been approved as "onsite representatives" by the Civil Rights Office. To have an employee designated as an onsite representative, a completed Appendix A (Management Responsibilities form) and Appendix B (Employment History form) must be submitted to the Civil Rights Office for approval. DBE credit will not be given for work performed on departmental contracts prior to approval of the DBE firm's designated onsite representative.

Appendix A and B

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Title VI The below documents are offered in PDF format.

• Title VI Brochure

• Title VI Work Plan

• Discrimination Complaint Questionnaire

• Title VI Complaint Process and Procedure

• Title VI Public Meeting Report

• Title VI Public Sign-In Sheet

• Civil Rights Brochures

  • Spanish

  • Tagalog

  • Hmong

  • Korean

  • Yup'ik

  • Inupiat

  • Russian

  • English

• Title VI Documents

  • Title VI Brochure

  • Title VI Annual Update

  • Title VI Public Meeting Report

  • Title VI Public Sign-In Sheet

  • Title VI Annual Update Approval

  • Title VI Demographics and Statistics

• ADA & Title VI policies in English & Translated

  • Spanish

  • Tagalog

  • Korean

  • Russian

  • Vietnamese

  • English

• How to file a Complaint

  • Title VI Complaint Process and Procedure

  • Discrimination Complaint Questionnaire

  • Brochure

    • Spanish
    • Tagalog
    • Korean
    • English

  • Instructions

    • Spanish
    • Tagalog
    • Korean
    • English

  • Discrimination Complaint Questionnaire

    • Spanish
    • Tagalog
    • Korean
    • English
    • Hmong
    • Russian

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Other

• DBE Exchange

• Tanana Chiefs Conference, Inc.

• Alaska DOT&PF Procurement Page

Forms

	ADA
	Contract Compliance
	DBE Certification
	DBE Compliance Goals and Good Faith Effort
	DBE Support Services
	On the Job Training
	On-Site Representative
	Title VI
	Other