13-Attachment J. DBE-14 Commitment Form.pdf

DEPARTMENT OF

ADMINISTRATIVE SERVICES

Office of Economic Inclusion oeicompliance@milwaukeecountywi.gov

(414) 278-4747

1 | P a g e

DBE-14

Federally Funded Form must be filled out completely and accurately.

Office of Economic Inclusion (OEI)

COMMITMENT TO CONTRACT WITH DBE

DBE Information DBE Firm Name: Prime/Sub Options: (SELECT ONE) Firm Address: (Cannot be a PO Box) EIN Number:

Project Information Project Name: Project No:

Total Contract Amount (less allowances): $ DBE Goal:

Type of Contract: (SELECT ONE)

Scope of Work Scope of Work Detailed Description:

Applicable NAICS:

Work Scope Description: NAICS:

Work Scope Description: NAICS:

Work Scope Description: NAICS:

1. DBE Contract Amount: 2. % of Total Contract:

1. The total project contract amount is an estimate based on the outcome of negotiation between the Prime and Milwaukee County. In some situations, the DBE sub-contract amount might NOT be based on the total project contract amount.

2. The percentage is based on the eligible scope of services that DBE participation can reasonably be obtained, which might not be based on the total project contract amount. The commitment percentage is the key indicator of DBE participation. The Pass/Fail determination is based on the percentage stated in the RFP/BID. If the Prime is using one or multiple TBE companies the sum of the percentages MUST satisfy the minimum percentage stated in the RFP/BID. Note the percentage indicated on this document will be viewed by OEI the Prime’s COMMITMENT to the DBE company.

Bidder/Proposer Commitment (To be completed by firm committing work to DBE)

I certify that the DBE firm quoted the identified service(s) and cost(s). I further acknowledge our firm having negotiated with, and having received confirmation, on partnering, pricing and delivery from the DBE firm listed herein. (Prime Contractor/Consultant Firm Name) (Phone)_________________, or one of our subs, will enter into contract with the DBE firm listed, for the service(s) and amount(s) specified when awarded this contract. The information on this form is true and accurate to the best of my knowledge. I further understand that falsification, fraudulent statement, or misrepresentation will result in appropriate sanctions under applicable law.

Signature of Authorized Representative Name & Title of Authorized Representative Date DBE Affirmation

(To be completed by DBE Owner/Authorized Representative)

- I affirm that our firm is certified as (SELECT ONLY ONE)

- I affirm this firm is owned by a (SELECT ONLY ONE)

- I affirm that the majority owner’s ethnicity is (SELECT ONLY ONE)

- I affirm that the Wisconsin UCP has certified our company as a DBE, and that our company is currently listed in the Wisconsin UCP Directory.

- I acknowledge and accept this commitment to contract with my firm for the service(s) and dollar amount(s) specified herein, as put forth by

- (Prime or sub firm name)

- I understand and accept that this commitment is for service(s) to be rendered in completion of the project specified herein to be completed with my own forces.

- I affirm that approval from OEI will be obtained prior to subletting any portion of this work awarded to my firm on this project.

- Have you done work with Milwaukee County in the past?

Signature of Authorized DBE Representative Name & Title of Authorized DBE Representative Phone Number Date

*If additional space is needed, please attach a separate sheet.

Commitment number of Participation: ___ __ Project Total

Approved: _________________________________________________________ Date: ___________________

OEI Use Only

YES NO

CAGE Code:

mailto:oeicompliance@milwaukeecountywi.gov

COMMITMENT TO CONTRACT WITH DBE

ADDITIONAL INFORMATION & REQUIREMENTS:

1. The Directory of Certified DBE firms eligible for credit toward the satisfaction of this project’s DBE goal will be found at the following link and can be searched by Name and/or NAICS code.

http://wisconsindot.gov/Pages/doing-bus/civil-rights/dbe/certified-firms.aspx

2. CONTRACT ADJUSTMENTS: The successful Bidder/Proposer will maintain the approved DBE participation level during the term of the contract with the County, including any additional work on the contract, e.g., change orders, addendums, scope changes, or fee increases.

3. WRITTEN CONTRACTS WITH DBEs: The County requires that the successful Bidder/Proposer enter into contract, directly or through subs, as stated in this form. Agreements must be submitted to the County within 7 days of receipt of the Notice-To-Proceed. By executing this commitment, you are certifying that you have had contact with the named DBE firm and that they will be hired if you are awarded the contract by the County.

4. SUBSTITUTIONS, DBE SUBCONTRACTING WORK, TRUCKING FIRMS: The successful Bidder/Proposer must submit written notification of desire for substitution to the DBE affected, and send a copy to the County, stating the reason(s) for the request. The DBE will have five (5) business days to provide written objection/acceptance of the substitution. The “right to correct” must be afforded any DBE objecting to substitution/termination for less than good cause as determined by the County. Approval must be obtained from the County prior to making any substitutions. DBEs are also required to notify and obtain approval from the County prior to seeking to subcontract out work on this project. In the case of DBE trucking firms, credit will be given for trucks leased from other DBE firms; however, if the DBE leases trucks from non-DBE firms, the commission or fee will be counted for DBE crediting.

5. REQUESTS FOR PAYMENT: The successful Bidder/Proposer must indicate on the Continuation Sheet (AIA form G703, or equivalent) the work being performed by DBE by either a) placing the word “DBE” behind the work item or b) breaking out the work done by DBEs at the end of the report. The successful Bidder/Proposer shall notify DBE firms of the date on which they must submit their invoices for payment.

6. DBE UTILIZATION REPORTS: The successful Bidder/Proposer will enter payments to subs and suppliers directly into the County’s online reporting system on a monthly basis. These entries will cover payments made during the preceding month and will include zero-dollar ($0) entries where no payment has occurred.

If you have any questions related to Milwaukee County’s DBE Program, please contact:

414.278.4851 or oeicompliance@milwaukeecountywi.gov http://wisconsindot.gov/Pages/doing-bus/civil-rights/dbe/certified-firms.aspx mailto:oeicompliance@milwaukeecountywi.gov