HUB Subcontracting Plan (HSP) Change Request Form

Step 1 of 3

Primary Information

Contractor Name:

Contract Number:

Step 2 of 3

Section I (to be completed by prime contractor)

Complete if requesting approval to make any changes in subcontracting opportunities and/or subcontractors.

If at any time during the term of the contract, the prime contractor wants to make any changes to the approved HSP, such proposed changes must be received in writing for prior review and approval by TxDOT before the changes will be effective under the contract. The prime contractor must comply with provisions of the contract relating to developing and submitting a HSP change request in order to substitute/add a subcontracting opportunity and/or a subcontractor prior to any alternative under the original HSP.

When initiating a change to an HSP, the prime contractor is required to meet the good faith effort provisions of the HSP by submitting a revised HSP.

In the space below, please provide a detailed explanation indicating the change that will be made to the HSP, and why the change is being made. (Attach a revised HSP that shows the prime contractor made a good faith effort to meet the requirements of the HSP when making a change.)

Explanation for any item marked "No".

Prime Contractor Representative Name

Signature

Date

Step 3 of 3

Section II (to be completed by TxDOT)

I have reviewed and approved the prime contractor's explanation of changes and revised HSP based on the HSP requirements.

Comments

District/Division Representative

Signature

Date

CIV Representative

Signature

Date