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Page 1 of 14 Local Agency Professional Services Negotiated Hourly Rate Consultant <br />Agreement Revised <br />Local Agency Professional Services <br />Negotiated Hourly Rate Consultant Agreement <br />Agreement Number: Yes No <br />Firm/Organization Legal Name (do not use dba’s): <br />Address Federal Aid Number <br />UBI Number Federal TIN <br />Execution Date Completion Date <br />1099 Form Required <br /> Yes No <br />Federal Participation <br /> Yes No <br />Project Title <br />Description of Work <br /> Yes % No DBE Participation <br /> Yes % No MBE Participation <br /> Yes % No WBE Participation <br /> Yes % No SBE Participation <br />Maximum Amount Payable: <br />Index of Exhibits <br />Exhibit A <br />Exhibit B <br />Exhibit C <br />Exhibit D <br />Exhibit E <br />Exhibit F <br />Exhibit G <br />Exhibit H <br />Exhibit J <br />Scope of Work <br />DBE Participation <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Agreement Number: <br />– <br />–