13-I. MWSBE Utlization Form (CBI Forms 34).pdf

Charlotte Business Inclusion (CBI) - Form 3

SUBCONTRACTOR / SUPPLIER UTILIZATION COMMITMENT

This Form must be completed and submitted at the time of Proposal opening.

Failure to properly complete and submit Form 3 with the Proposal constitutes grounds for rejection of the Proposal.

Copy this CBI Form 3 as needed.

Per Section 3.5 of the CBI Administrative Procedures Manual, the Subcontractor/Supplier Utilization Commitment (CBI Form 3), captures information regarding the M/W/SBEs and other subcontractors and suppliers that the Proposer intends to use on the Contract for all tiers.

M/W/SBEs must satisfy the requirements of Section 2 of the CBI Administrative Procedures Manual in order to count the work they intend to perform on the contract with its own current workforce towards the Contract Goal and must list itself below.

Proposer Name:

Project Name: Unspecified Real Estate Appraisal and Real Estate Appraisal Review Services MWBE Goal: MBE Goal:

MSBE Goal: WBE Goal:

MWSBE Goal: SBE Goal:

List below all M/W/SBEs that you intend to use on this Contract. NOTE: You will only receive credit for M/W/SBEs that are currently certified with the City as of the Proposal Opening Date.

M/W/SBE Vendor Name (Non-Hauling Services) Description of work / materials NIGP Code

Subcontractor / Supplier Utilization Commitment List below all non-M/W/SBEs (subcontractors and suppliers) that you intend to use on this Contract.

Vendor Name Description of work / materials NIGP Code

Charlotte Business Inclusion (CBI) - Form 3

SUBCONTRACTOR / SUPPLIER UTILIZATION COMMITMENT

(Continued)

Letters of Intent submitted upon notice from the City Per Section 3.5 of the CBI Administrative Procedures Manual, within three (3) business days after receiving a request from the City (or within such longer time as may be communicated by the City in writing), Proposers must submit a separate Letter of Intent (CBI Form 4) for each M/W/SBE listed on CBI Form 3. Each Letter of Intent must be executed by both the M/W/SBE and the Proposer. The City shall not count proposed M/W/SBE utilization for which it has not received a Letter of Intent by this deadline. The Proposer is still obligated to pay the M/W/SBE the full amount listed on the Contract with the M/W/SBE regardless of what percentage is actually counted towards the M/W/SBE Goal.

Adding subcontractors or suppliers after submitting this form Nothing in this certification shall be deemed to preclude you from entering into subcontracting arrangements after submission of this form. However, per the CBI Administrative Procedures Manual, you must comply with the following:

• You must maintain the level of M/W/SBE participation stated in the Contract throughout the duration of the Contract, except as specifically allowed in Section 5

• If you need to terminate or replace a M/W/SBE, you must comply with Section 5.3

• If the scope of work on the Contract increases, or if you elect to subcontract any portion of work not identified on this form as being subcontracted, then you must comply with Section 5.4

• A Letter of Intent (CBI Form 4) must also be submitted for each M/W/SBE you add subsequent to contract award.

All Subcontractors and Suppliers must be registered with the City of Charlotte.

Pursuant to the City’s Vendor Registration Policy, each subcontractor or supplier (non-MBE/SBE, WBEs, SBEs and MBEs) that you use on this contract must be registered in the City’s vendor database.

Signature Your signature below indicates that the undersigned firm certifies and agrees that:

(a) It has complied with all provisions of the CBI Policy and Administrative Procedures Manual; and,

(b) Failure to properly document such compliance in the manner and within the time periods established by the CBI Policy and

Administrative Procedures Manual shall constitute grounds for rejection of your proposal.

Signature of Authorized Official Print Name Title Submittal Date

Charlotte Business Inclusion (CBI) - Form 4

LETTER OF INTENT

Per Part B, Section 3.4 and Part C, Section 2.1 of the CBI Policy, within three (3) business days after receiving a request from the City (or within such longer time as may be communicated by the City in writing), a Proposer must submit a separate Letter of Intent for each MBE, WBE, or SBE listed on CBI Form 3 and, if applicable, CBI Form 3A.

Project Name:

Project Number:

To be completed by the Proposer

Name of Proposer: Vendor #:

Address:

Contact Person: Email:

Telephone: Fax:

If the Bidder has entered into a Quick Pay Agreement, in association with this Letter of Intent and as defined in the CBI Policy, please attach a copy of the executed Agreement with the undersigned MBE, WBE, or SBE.

Identify in complete detail, the scope of work to be performed or item(s) to be supplied by the MBE, WBE, or SBE.

Cost of work to be performed by MBE, WBE, or SBE: $

To be completed by MBE, WBE, or SBE

Name of MBE, WBE or SBE

Address:

Contact Person:

Telephone:

Vendor#:

Email:

Fax:

Upon execution of a Prime Contract with the City for the above referenced project, the Proposer certifies that it intends to utilize the MBE, WBE, or SBE listed above, and that the description, cost and percentage of work to be performed by the MBE, WBE, or SBE as described above is accurate. The MBE, WBE, or SBE firm certifies that it has agreed to provide such work/supplies for the amount stated above.

Proposer:

Date:

Signature and Title

MBE/WBE/SBE:

(Circle one)

Date:

Signature and Title