2-CCS - Appendix B.pdf

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Attached to
RFP 1156 Moving Services
Solicitation number
RFP 1156 Moving Services
Issued by
Milwaukee County, Mattoon Village, Wisconsin

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This document is an Appendix B Prime Vendor Information Sheet dated January 2016, which appears to be part of a project procurement process for the MPS (Milwaukee Public Schools) project. The form is designed to collect comprehensive vendor and team member demographic and certification information, with a focus on tracking Historically Underutilized Business (HUB) participation. The document requires prime vendors to provide details about their company's employee demographics, minority and women-owned business certifications, and specific team member information including project assignments, ethnicity, gender, residency status, and percentage of project dollars.

The form mandates that prime vendors submit an Affirmative Action Statement and provide detailed information about each team member assigned to the project. Vendors must disclose their certification status for Minority Business Enterprise (MBE), Women Business Enterprise (WBE), and other small business categories such as SBA-8A, Small Business Enterprise (SBE), Disadvantaged Business Enterprise (DBE), and Disabled Veteran-Owned Small Business (DVSOB). The document is structured to collect statistical data for reporting purposes and appears to emphasize diversity and local participation in the project team composition.

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Jan2016

APPENDIX B

Prime Vendor Information Sheet Page 1 of 1

This form should be filled out by the PRIME vendor with prime vendor company information regardless of whether there is a HUB participation requirement listed.

Prime HUBs must identify the actual percentage of service/product they will provide. Only that percentage of service/product actually provided by the HUB prime will count toward HUB participation.

You are also encouraged to fill out additional forms for each of your subcontractors. The information in this appendix will be used for statistical reporting purposes only.

Total number of all employees within your company:

Number of minority employees within your company:

Number of women employees within your company:

1. Please include a copy of each firm’s [prime and subcontractor] Affirmative Action Statement.

2. Please provide the following information for each individual assigned as a team member on the MPS project (both prime vendor team and subcontractor team): Name, project assignment, ethnicity, gender, resident (r) or non-resident (nr) of Milwaukee, and hours/percent of project dollars.

Resident/ % of

Name of Team Member Project Assignment Ethnicity M/F Non-resident Project Dollars

Are you a certified MBE firm?

Yes No Certifying Agency______________________________________

Are you a certified WBE firm?

Are you a certified SBA-8A

SBE, DBE, DVSOB firm?

Certifying Agency:
Are you a certified WBE firm: Off
undefined: Off
Certifying Agency_2:
Certifying Agency_3:
Total number of all employees within your company:
Number of minority employees within your company:
Number of women employees within your company:
Name of Team Member 1:
Name of Team Member 2:
Name of Team Member 3:
Name of Team Member 4:
Name of Team Member 5:
Name of Team Member 6:
Name of Team Member 7:
Name of Team Member 8:
Name of Team Member 9:
Name of Team Member 10:
Name of Team Member 11:
Name of Team Member 12:
Name of Team Member 13:

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