10-IFB 26-1-23301 Vol.3 (3a-d) DBE Participation.pdf

Madison County Transit IFB Volume 3 of 5

DBE UTILIZATION PLAN

a) Policy

It is a Madison County Mass Transit District policy to ensure that DBEs, as defined in 49 CFR Part 26, have an equal opportunity to receive and participate in USDOT-assisted contracts.

b) Obligation The contractor agrees to ensure that disadvantaged businesses as defined in 49 CFR Part 26 have the maximum opportunity to participate in the performance of contracts or subcontracts financed in whole or in part with Federal funds. The contractor shall take all necessary and reasonable steps in accordance with 49 CFR Part 26 and the Contractor DBE Special Provision (IFB Vol. 1 INTRO 23) to ensure that said businesses have the maximum opportunity to compete for and perform under this contract. The contractor shall not discriminate on the basis of race, color, national origin, or sex in the award and performance of contracts.

c) Project and Bid Identification Complete the following information concerning the project bid.

Project:

Bid Due Date:

Location: Street City, State County Madison Total Bid Amount:

Contract DBE Goal:

Percentage Dollar Amount

Example: $500,000 (Total Bid Amount) X 3.33% (Percentage) = $16,650 (Minimum “Dollar Amt” to meet DBE goal)

d) Assurance I, acting in my capacity as an officer of the undersigned bidder (or bidders if joint venture), hereby assure Madison County Mass Transit District that on this project, my company: (check one box and provide %)

Meets or exceeds the contract DBE goal and has provided documented participation as follows:

• Disadvantaged Business Participation %

• Attached are the duly signed DBE Participation Statements on form BID 5, required by the

Contractor DBE Special Provision evidencing availability and the Contractor’s commitment to use of each business participating in the plan and assuring that each business will perform a commercially useful function in the work of the contract.

Failed to meet contract award goal and has included Good Faith Effort documentation to meet the goal and that my company has provided participation as follows:

• Disadvantaged Business Participation %

• Attached is all the information required by the Contractor DBE Special Provision including

Good Faith Efforts. Also attached are duly signed DBE Participation Statements on form BID 5, required by the Contractor DBE Special Provision evidencing availability and the Contractor’s commitment to use of each business participating in the plan and assuring that each business will perform a commercially useful function in the work of the contract for firms that are participating to the extent of the above percentage.

Company __________________________________________________

By________________________________________________________

Title ______________________________________________________

Date_________________________________________________________

DBE PARTICIPATION STATEMENT

a) Instructions This form must be completed for each disadvantaged business participating in the prime contractor’s DBE Utilization Plan. This form shall be submitted in accordance with the Contractor DBE Special Provision (IFB Vol. 1 INTRO 23). If additional space is needed, complete an additional form for the firm.

Name of DBE Firm: Contact number:

Address: Contact person:

Age of firm:

E-Mail address: ___________________________________________________________________________________

Ethnic Classification: Gross Receipts:

Black American Asian Pacific American Native American under $500,000 $2 mil to $5 mil Hispanic American Non-Minority Non-Minority $500,000 to $1 mil above $5 mil

Native American Subcontinent Asian American $1 mil to $2 mil

b) Work (Regular Dealers/Suppliers and Distributors must complete and submit “DBE Regular Dealer/Distributor Affirmation Form”.)

Please indicate: ____Joint Venture ____Manufacturer ____Distributor (40%)

____Regular Dealer (60%) ____Subcontractor ____Trucking

Pay Item No. NAICS Code Description of Work Quantity Unit Price Total

Total $

c) Partial Payment Items For any of the above items which are partial pay items (see Calculating DBE Participation in the Contractor DBE Special Provision (IFB Vol. 1 INTRO 23) specifically describe the work and subcontract dollar amount below.

d) Commitment

When a DBE is to be a second-tier subcontractor, or if the first-tier DBE subcontractor is going to be subcontracting a portion of its subcontract, it must be clearly indicated on the DBE Participation Statement, and the details of the transaction fully explained.

In the event a DBE subcontractor second-tiers a portion of its subcontract to one or more subcontractors during the work of a contract, the prime must submit a DBE Participation Statement, with the details of the transaction(s) fully explained.

The undersigned certify that the information included herein is true and correct, and that the DBE firm agrees to perform a commercially useful function in the work of the contract item(s) listed above and to execute a contract with the prime contractor. The undersigned further understand that no changes to this statement may be made without prior approval from Madison County Transit (MCT) and that complete and accurate information regarding actual work performed on this project and the payment therefore must be provided to MCT.

Signature for Contractor ___ 1st Tier ___ 2nd Tier Signature for DBE Firm ___ 1st Tier ___ 2nd Tier

Title Title

Date Date

OFFICE USE ONLY

IL UCP Directory: yes / no NAICS code(s):

Reviewed by: Date:

DBE Unavailability Form If the DBE goal was not fully met, the bidder must complete this form and/or provide other evidence of good faith efforts.

Bidder’s documents should show that it took all necessary and reasonable steps to achieve a DBE goal or other requirement of 49 CFR 26 which, by their scope, intensity, and appropriateness to the objective, could reasonably be expected to obtain sufficient DBE participation even if they were not fully successful.

Suggested actions that show good faith effort are identified in Contractor DBE Special Provision (INTRO 23).

I, ________________________________________, ________________________________ of (Name) (Title)

_________________________________________, certify that on ______________, I contacted (Name of bidding company) (Date)

___________________________________ to obtain a bid for the work items listed below to be (DBE Subcontractor) performed on this project.

WORK ITEMS SOUGHT FORM OF BID SOUGHT

(i.e., unit price, materials & labor, labor only)

To the best of my knowledge and belief, said DBE subcontractor was unavailable (exclusive of unavailability due to lack of agreement on price) for work on this project, or was unable to prepare a bid for the following reason(s):

Signature of person that contacted DBE firm: _________________________________________

[make additional copies of this form as needed]

OMB Control #2105-0586 (Exp. 5/31/2027) Bidder Name:

U.S. Department of

DBE Regular Dealer/Distributor Affirmation Form Contract Name/Number:

Transportation

Sections 26.53(c)(1) of Title 49 Code of Federal Regulations requires recipients to make a preliminary counting determination for each DBE listed as a regular dealer or distributor to assess its eligibility for 60 or 40 percent credit, respectively, of the cost of materials and supplies based on its demonstrated capacity and intent to perform as a regular dealer or distributor, as defined in section 26.55(e)(2)(iv)(A),(B),(C), and (3) under the contract at issue. The regulation requires the recipient's preliminary determination to be made based on the DBE’s written responses to relevant questions and its affirmation that its subsequent performance of a commercially useful function will be consistent with the preliminary counting of such participation. The U.S. Department of Transportation is providing this form as a tool for recipients, prime contractors, regular dealers, and distributors to use to carry out their respective responsibilities under this regulation. The form may be used by each DBE supplier whose participation is submitted by a bidder for regular dealer or distributor credit on a federally-assisted contract with a DBE participation goal. The form may also be used by prime contractors in connection with DBE regular dealer or distributor participation submitted after a contract has been awarded provided such participation is subject to the recipient's prior evaluation and approval. If this form is used, it should be accompanied by the bidder's commitment, contract, or purchase order showing the materials the DBE regular dealer or distributor is supplying. Use of this tool is not mandatory. If a recipient chooses a different method for complying with Section 26.53(c)(1), it must include that method in its DBE Program Plan.

DBE Name: Total Subcontract/Purchase Order Amount:

Authorized DBE Representative (Name and Title): NAICS Code(s) Related to the Items to be Sold/Leased:

1. Will all items sold or leased be provided from the on-hand inventory at your establishment? YES NO (If "YES," you have indicated that your performance will satisfy the regular dealer requirements and may be counted at 60%. STOP here. Read and sign the affirmation below. If "NO" Continue.)

a) Are you selling bulk items (e.g., petroleum products, steel, concrete, concrete products, sand, gravel, asphalt, etc.) or items not typically stocked due to their unique characterisics (aka specialty items)?

YES NO (If "YES," Go to Question 2. If "NO" Continue.)

b) Will at least 51% of the items you are selling be provided from the inventory maintained at your establishment, and will the minor quantities of items delivered from and by other sources be of the general character as those provided from your inventory?

(If "YES," you have indicated that your performance will satisfy the regular dealer requirements andYES NO* may be counted at 60%. STOP here. Read and sign the affirmation below.

*If 1.,1.a), and 1. b) above are "NO," your performance on the whole will not satisfy the regular dealer requirements;

therefore, only the value of items to be sold or leased from inventory can be counted at 60%. (Go to Question 3. to determine if the items delivered from and by other sources are eligible for Distributor credit.)

2. Will you deliver all bulk or specialty items using distribution equipment you own (or under a long-term lease) and operate?

YES NO1

(If "YES," you have indicated that your performance will satisfy the requirements for a regular dealer of bulk items and may be counted at 60%. STOP here. Read and sign the affirmation below.)

1 If "NO," your performance will not satisfy the requirements for a regular dealer of bulk items; the value of items to be sold or leased cannot be counted at 60%. (Go to Question 3.)

3. Will the written terms of your purchase order or bill of lading from a third party transfer responsibility, including risk for loss or damage, to your company at the point of origin (e.g. a manufacture's facility) ? YES2 NO3

a) Will you be using sources other than the manufacturer (or other seller) to deliver or arrange delivery of the items sold or leased ? YES2 NO3

2 If your responses to 3 and 3.a) are "YES," you have indicated that your performance will satisfy the requirements of a distributor;

therefore, the value of items sold or leased may be counted at 40%.

3 If you responded "NO" to either 3 or 3.a), counting of your participation is limited to the reasonable cost of fees or commissions charged, including transportation charges for the delivery of materials or supplies; the cost of materials or supplies may not be counted.

I affirm that the information that I provided above is true and correct and that my company's subsequent performance of a commercially useful function will be consistent with the above responses. I further affirm that my company will independently negotiate price, order specified quantities, and pay for the items listed in the bidder's commitment. This includes my company's responsibility for the quality of such items in terms of necessary repairs, exchanges, or processing of any warranty claims for damaged or defective materials.

Printed Name and Signature of DBE Owner/Authorized Representative:

The bidder acknowledges its responsibility for verifying the information provided by the DBE named above and ensuring that the counting of the DBE's participation is accurate. Any shortfall caused by errors in counting are the responsibility of the bidder.

Printed Name and Signature of Bidder's Authorized Representative:

David.Chandler Sticky Note Accepted set by David.Chandler

David.Chandler Sticky Note Completed set by David.Chandler

David.Chandler Sticky Note None set by David.Chandler