11-4. DBE Program Form.docx

DOCX document 88 KB Posted

Attached to
Financial Auditing Services
Solicitation number
269-2025-162
Issued by
Mecklenburg County, Charlotte City, North Carolina

About this file

This is a Disadvantaged Business Enterprise (DBE) Program Form List of Subcontractors submitted to the North Carolina Department of Transportation (NCDOT) in connection with a Financial Auditing Services contract opportunity for a North Carolina city. The form requires bidders to document their commitment to DBE and non-DBE subcontractor and supplier utilization in compliance with the Federal Disadvantaged Business Opportunity Program. Bidders must complete the form by identifying each subcontractor or supplier, providing their name and address, contact person, firm age, description of work, NAICS code, NCDOT reporting number, total projected cost, and percentage of bid amount. The form includes rows for multiple subcontractors and requires bidders to indicate the annual gross receipts category for each firm, with options ranging from less than $500,000 to over $5 million.

If a bidder fails to meet the DBE utilization goal established for the project, documentation of the company's good faith efforts must be attached to the proposal. This form is mandatory and must be submitted with all bids. The form serves as the mechanism through which prime contractors demonstrate their subcontracting strategy and commitment to involving disadvantaged business enterprises in the performance of the contract work, as required by federal transportation funding regulations.

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Text version

DBE PROGRAM FORM

LIST OF SUBCONTRACTORS - FORM A – Continuation Project DBE and non-DBE Subcontractor / Supplier Utilization Commitment Federal Disadvantaged Business Opportunity Program.

Note: This MUST be submitted with your bid. Make copies as needed.

If your company failed to meet the DBE Utilization Goal for this Project, you MUST attach documentation of your company’s Good Faith Efforts with your Proposal.

Company Name: Project Name: ______________________________________________

Subcontractor/Supplier’s Name & Address
Contact

Person Age of Firm

Description of Work

NAICS Code

NCDOT

Reporting #

Total Projected $ % of Bid Amount

Annual Gross Receipts:Less than $500,000
$500,000 - $1M$1-2M$2-5MOver $5M
Annual Gross Receipts:Less than $500,000
$500,000 - $1M$1-2M$2-5MOver $5M
Annual Gross Receipts:Less than $500,000
$500,000 - $1M$1-2M$2-5MOver $5M
Annual Gross Receipts:Less than $500,000
$500,000 - $1M$1-2M$2-5MOver $5M
Annual Gross Receipts:Less than $500,000
$500,000 - $1M$1-2M$2-5MOver $5M
Annual Gross Receipts:Less than $500,000
$500,000 - $1M$1-2M$2-5MOver $5M
Annual Gross Receipts:Less than $500,000
$500,000 - $1M$1-2M$2-5MOver $5M

File details come from the government source that posted it. Updated .