1-Submittal B - Affidavit and Subcontractor Participation Plan 0341-2025-10-RFP.pdf

Bu si ne ss E nt er pr is e Pr og ra m

Af fid av it

Su bc on tra ct or

Pa rti ci pa tio n

Pl an

7/13/17

AFFIDAVIT

REQUIRED OF ALL PROPOSERS/BIDDERS

(This Affidavit will become part of the contract for the selected Proposer/Bidder) The City of Los Angeles, Los Angeles World Airports (LAWA) is committed to creating an environment that provides all individuals and businesses open access to the business opportunities available at LAWA.

MANDATORY BUSINESS ENTERPRISE PARTICIPATION LEVELS:

This Project has the following mandatory participation levels:

SBE %

LBE %

LSBE %

DVBE %

If awarded the contract, the selected Proposer/Bidder commits to achieving the following participation levels on the Project:

SBE ______%

LBE ______%

LSBE _____%

DVBE _____%

Achievement level(s) will be calculated as the percentage of the total contract amount for which SBEs, LBEs, LSBEs or DVBEs were utilized. The selected Proposer/Bidder’s performance on the applicable business enterprise levels will be monitored throughout the duration of the contract, and the business enterprise achievement levels will be calculated at the end of the contract term.

SUBCONTRACTORS:

As applicable, the selected Proposer/Bidder will be required to comply with California’s “Subletting and Subcontracting Fair Practices Act” (Public Contract Code Sections 4100 et seq.) (www.leginfo.ca.gov/cgi-bin/calawquery?codesection=pcc&codebody=&hits=20).

Any reduction, increase, or other change to the SBE, LBE, LSBE or DBVE Subcontract amounts without prior written approval of Procurement Services Division (PSD) is considered an Unauthorized Subcontractor Substitution, and the selected Proposer/Bidder may be subject to a penalty. A subcontract dollar value increased or reduced solely as the result of a Change Order issued by LAWA to add or delete from the original scope of work shall not be subject to a penalty for an Unauthorized Subcontractor Substitution.

Proposers/Bidders must list all Subcontractors on LAWA’s Subcontractor Participation Plan and include all requested information. Only PSD is authorized to grant either initial approval of Subcontractor(s) or additions, deletions, and substitutions.

PENALTIES:

Violation of the SBE, LBE, LSBE and DVBE Program Rules and Regulations (http://www.lawa.org/welcome_LAWA.aspx?id=146) may result in financial penalties.

At the end of each project, LAWA may withhold as disputed funds 15% of the total dollar value of all subcontract(s) that appear to be in violation of the SBE, LBE, LSBE or DVBE Programs and 15% of the total dollar value of all subcontract(s) where work was performed on the project without, or prior to, approval by LAWA.

REPORTING REQUIREMENTS:

The selected Proposer/Bidder shall submit to LAWA, on a monthly basis, together with its invoice the Subcontractor Utilization Report listing the SBE, LBE, LSBE or DVBE subcontractors utilized during the reporting period. LAWA will not process or pay selected Proposer/Bidder’s subsequent invoices if the Subcontractor Utilization Reports are not submitted with the monthly invoice.

The Contractor must submit the Final Subcontracting Report to PSD within fifteen (15) calendar days after a request for the report by PSD. Failure to comply shall result in the assessment of liquidated damages in the amount of $100.00 per day by LAWA.

CERTIFICATION

The Bidder/Proposer certifies that it/he/she has read and understood the SBE, LBE, LSBE and DVBE Program Rules and Regulations (located at http://www.lawa.org/welcome_LAWA.aspx?id=146) and further certifies that, if awarded the Contract, it/he/she shall fully comply with LAWA’s SBE, LBE, LSBE and DVBE Programs.

Company Name, Address and Phone Number

Signature of Officer or other Authorized Representative Date

Print Name and Title of Officer or Other Authorized Representative

Project Title http://www.leginfo.ca.gov/cgi-bin/calawquery?codesection=pcc&codebody=&hits=20 http://www.lawa.org/welcome_LAWA.aspx?id=146 http://www.lawa.org/welcome_LAWA.aspx?id=146

INSTRUCTIONS FOR SUBCONTRACTOR PARTICIPATION PLAN

ATTENTION:

You MUST list ALL anticipated subcontractors, regardless of their dollar amount or percent proposed, and regardless of whether they are certified or not.

You MUST fill out ALL applicable fields completely for the Bidder/Proposer and all subcontractors. Failure to provide complete and legible information on this form may result in your firm not receiving full certification credit. You may add pages as needed.

Project Title – The name of the project at the time of bid or proposal.

Bid/Proposal Amount – Total amount bidder/proposer proposed for the project.

Company Information – The complete name, address, phone number (including area code), Federal Tax Identification Number, email and contact person for the bidder/proposer and each subcontractor, vendor or supplier.

• Ethnicity – African American, Hispanic American, Native American, Asian- Pacific Islander, Subcontinent Asian Indian, Asian American, Aleut, Eskimo, Caucasian

• Gender – Male, Female

• Certification Type* – ACDBE (Airport Concession Disadvantaged Business Enterprise) DBE (Disadvantaged Business Enterprise) DVBE (Disabled Veteran Business Enterprise) LBE (Local Business Enterprise) LSBE (Local Small Business Enterprise)** MBE (Minority Business Enterprise) SBE (Small Business Enterprise) WBE (Woman Business Enterprise) *Any firm that is not certified as an ACDBE, DBE, DVBE, LBE, LSBE, MBE, SBE or WBE is considered an OBE (Other Business Enterprise).

**LSBE designation is only for firms that are certified as both SBE and LBE.

• Certifying Agency – Agency that issued the certification City of Los Angeles (Department of Public Works) CALIF DGS (State of California Department of General Services) CALTRANS (California Department of Transportation) METRO (L.A. County Metropolitan Transportation Authority) SBA (Federal Small Business Administration) DVA (Department of Veterans Affairs) USWCC (US Women’s Chamber of Commerce) WBEC-WEST (Women’s Business Enterprise Council – WEST) NWBOC (National Women Business Owners Corporation

Description of Project Services – A brief description of the work the bidder/proposer or subcontractor will perform.

NAICS – North American Industry Classification System codes listed at http://www.census.gov/epcd/www/naics.html

In order to receive credit for ACDBE/DBE/DVBE/LBE/LSBE/MBE/WBE/SBE participation, the companies must be certified in the NAICS code for the specific work they will perform on the contract.

Amount Proposed – Indicate the anticipated amount to be paid to the subcontractor over the term of the contract.

Proposed Percentage – Calculate the subcontractor’s share of the contract by dividing the Subcontractors Proposed Amount by the Bid/Proposal Amount.

Please note: For projects with ACDBE or DBE goals, the Code of Federal Regulations, Title 49, Part 26.55(e) allows only 60% of the Amount Proposed to be used in the calculation for a subcontractor who is a regular dealer/supplier.

Signature/Date – This form must be signed by a responsible person capable of committing the firm contractually.

Participation Level Proposed by Bidder/Proposer – Indicate the level of ACDBE/DBE/DVBE/LBE/LSBE/MBE/WBE/SBE participation proposed by Bidder/Proposer.

Goal(s) Stated in the Request for Bid/Proposal – The ACDBE/DBE/DVBE/LBE/LSBE/MBE/WBE/SBE goal(s) established by Procurement Services Division for the Request for Bid/Proposal.

For information regarding the certification process, please call the Department of Public Works, Centralized Certification Section at (213) 847-2684.

Rev 8/9//17 http://www.census.gov/epcd/www/naics.html

SUBCONTRACTOR PARTICIPATION PLAN

ATTENTION:

You MUST list ALL anticipated subcontractors, regardless of their dollar amount or percent proposed, and regardless of whether they are certified or not.

You MUST fill out ALL applicable fields completely for the Prime and all subcontractors. Failure to provide complete and legible information on this form may result in your firm not receiving full certification credit.

Project Title: _____________________________________________________________ Today’s Date:________________

BIDDER/PROPOSER COMPANY INFORMATION BID/PROPOSAL AMOUNT DESCRIPTION OF PROJECT SERVICES

NAME: ETHNICITY:

ADDRESS: GENDER:

CITY/STATE/ZIP: FEDERAL TAX ID #:

CONTACT NAME: EMAIL:

TELEPHONE NO:

CERTIFICATION TYPE: ACDBE DBE DVBE MBE LBE LSBE SBE WBE

CERTIFYING AGENCY: CITY OF L.A. CALIF DGS CALTRANS METRO SBA

DVA USWCC NWBOC WBEC-WEST OTHER ___________________________

NAICS:

SUBCONTRACTOR COMPANY INFORMATION $ PROPOSED % PROPOSED DESCRIPTION OF PROJECT SERVICES

NAME: ETHNICITY:

ADDRESS: GENDER:

CITY/STATE/ZIP: FEDERAL TAX ID #:

CONTACT NAME: EMAIL:

TELEPHONE NO:

CERTIFICATION TYPE: ACDBE DBE DVBE MBE LBE LSBE SBE WBE

CERTIFYING AGENCY: CITY OF L.A. CALIF DGS CALTRANS METRO SBA

DVA USWCC NWBOC WBEC-WEST OTHER ___________________________

NAICS:

NAME: ETHNICITY:

ADDRESS: GENDER:

CITY/STATE/ZIP: FEDERAL TAX ID #:

CONTACT NAME: EMAIL:

TELEPHONE NO:

CERTIFICATION TYPE: ACDBE DBE DVBE MBE LBE LSBE SBE WBE

CERTIFYING AGENCY: CITY OF L.A. CALIF DGS CALTRANS METRO SBA

DVA USWCC NWBOC WBEC-WEST OTHER ___________________________

NAICS:

Rev 09/22/2023

SUBCONTRACTOR COMPANY INFORMATION PROFILE INFORMATION $ PROPOSED % PROPOSED DESCRIPTION OF PROJECT SERVICES

NAME: ETHNICITY:

ADDRESS: GENDER:

CITY/STATE/ZIP: EMAIL:

CONTACT NAME: FEDERAL TAX ID #:

TELEPHONE NO:

CERTIFICATION TYPE: ACDBE DBE DVBE MBE LBE LSBE SBE WBE

CERTIFYING AGENCY: CITY OF L.A. CALIF DGS CALTRANS METRO SBA

DVA USWCC NWBOC WBEC-WEST OTHER ___________________________

NAICS:

NAME: ETHNICITY:

ADDRESS: GENDER:

CITY/STATE/ZIP: EMAIL:

CONTACT NAME: FEDERAL TAX ID #:

TELEPHONE NO:

CERTIFICATION TYPE: ACDBE DBE DVBE MBE LBE LSBE SBE WBE

CERTIFYING AGENCY: CITY OF L.A. CALIF DGS CALTRANS METRO SBA

DVA USWCC NWBOC WBEC-WEST OTHER ___________________________

NAICS:

NAME: ETHNICITY:

ADDRESS: GENDER:

CITY/STATE/ZIP: EMAIL:

CONTACT NAME: FEDERAL TAX ID #:

TELEPHONE NO:

CERTIFICATION TYPE: ACDBE DBE DVBE MBE LBE LSBE SBE WBE

CERTIFYING AGENCY: CITY OF L.A. CALIF DGS CALTRANS METRO SBA

DVA USWCC NWBOC WBEC-WEST OTHER ___________________________

NAICS:

NAME: ETHNICITY:

ADDRESS: GENDER:

CITY/STATE/ZIP: EMAIL:

CONTACT NAME: FEDERAL TAX ID #:

TELEPHONE NO:

CERTIFICATION TYPE: ACDBE DBE DVBE MBE LBE LSBE SBE WBE

CERTIFYING AGENCY: CITY OF L.A. CALIF DGS CALTRANS METRO SBA

DVA USWCC NWBOC WBEC-WEST OTHER ___________________________

NAICS:

SUBCONTRACTOR COMPANY INFORMATION PROFILE INFORMATION $ PROPOSED % PROPOSED DESCRIPTION OF PROJECT SERVICES

NAME: ETHNICITY:

ADDRESS: GENDER:

CITY/STATE/ZIP: EMAIL:

CONTACT NAME: FEDERAL TAX ID #:

TELEPHONE NO:

CERTIFICATION TYPE: ACDBE DBE DVBE MBE LBE LSBE SBE WBE

CERTIFYING AGENCY: CITY OF L.A. CALIF DGS CALTRANS METRO SBA

DVA USWCC NWBOC WBEC-WEST OTHER ___________________________

NAICS:

I certify under the penalty of perjury that the information contained on this form is true and correct and that the firms listed are the subcontractors anticipated to be utilized if this project is awarded to the above prime contractor. I agree to comply with any applicable provisions for additions and substitutions, and I further understand and agree that any and all changes or substitutions must be authorized by the LAWA Procurement Services Division prior to their implementation. An amended Subcontractor Participation Plan is required for any substitution or change to Subcontractors listed on the originally submitted Plan.

Participation Level(s) Proposed by Bidder/Proposer:

ACDBE

DBE

DVBE

LBE

LSBE

MBE/WBE

SBE

SIGNATURE DATE

Goal(s) Stated in the Request for Bid/Proposal:

ACDBE

DBE

DVBE

LBE

LSBE

MBE/WBE

SBE PRINT NAME TITLE PHONE