10-H. MWSBE Utilization Form.pdf
PDF 183 KB Posted
- Attached to
- Mallard Creek WRRF NPW Filter System
- Solicitation number
- FY26-ITB-10
- Issued by
- Mecklenburg County, Charlotte City, North Carolina
About this file
This is a Minority/Woman-owned Small Business Enterprise (M/W/SBE) Utilization Form required by the City for bid submission on the Mallard Creek Water Resource Recovery Facility NPW Filter System contract in Charlotte, North Carolina. The form mandates that bidding companies identify their own certification status as a Minority-owned Business Enterprise (MBE), Woman-owned Business Enterprise (WBE), and/or Small Business Enterprise (SBE), along with the certifying agency and certification validity dates. Bidders must document all outreach efforts undertaken to identify and maximize MWSBE participation during both the bid preparation phase and the anticipated contract performance period. The form requires companies to list all intended MWSBE subcontractors with descriptions of their work or materials, vendor identification numbers, and corresponding utilization percentages by classification.
The form does not specify pricing terms, contract duration, or award details, as it serves solely as a compliance and documentation tool. However, it reflects the City's strong commitment to promoting diverse business participation in procurement opportunities. Bidders must provide the estimated total contract value and have a designated representative sign and date the completed form as part of their bid submission package. The form emphasizes that companies should exhaust all reasonable efforts to identify viable MWSBE subcontracting opportunities for this project.
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Required Forms
M/W/SBE UTILIZATION
The City maintains a strong commitment to the inclusion of MWSBEs in the City’s contracting and procurement process when there are viable subcontracting opportunities.
Companies must submit this form with their bid outlining any supplies and/or services to be provided by each City-certified Small Business Enterprise (SBE), and/or City-registered Minority-owned Business Enterprise (MBE) and Woman-owned Business Enterprise (WBE) for the Contract. If the Company is a City-registered MWSBE, note that on this form.
The City recommends you exhaust all efforts when identifying potential MWSBEs to participate on this
ITB.
Company Name:
Please indicate if your company is any of the following:
____ MBE ____WBE ____SBE ____ None of the above
If your company has been certified with any of the agencies affiliated with the designations above, indicate which agency, the effective and expiration date of that certification below:
Agency Certifying: _______________________ Effective Date: _________ Expiration Date: _________
Identify outreach efforts that were employed by the firm to maximize inclusion of MWSBEs to be submitted with the firm’s bid:
Identify outreach efforts that will be employed by the firm to maximize inclusion during the contract period of the Contract:
[Form continues on next page]
Required Forms
List below all MWSBEs that you intend to subcontract to while performing the Services:
Subcontractor Name Description of work or materials Indicate “M,” “S,” and/or “W”
City Vendor #
Total MBE Utilization %
Total WBE Utilization %
Total SBE Utilization %
Total MWSBE Utilization %
Representative (signed): ________________________________________________________
Date Representative Name
Estimated Total Contract Value
M/W/SBE UTILIZATION
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