24-25-01 RFQ for On-Call Services 2024.pdf

REQUEST FOR QUALIFICATIONS (RFQ)

FOR ENGINEERING/ARCHITECTURAL

ON-CALL SERVICES

Project Management Department City of Greenville, NC

July 1, 2024

I. Overview and Purpose

The City of Greenville, NC, desires to obtain Civil Engineering, Architecture, and Landscape Architecture services for the Project Management Department. The Department desires to supplement its existing professional staff to accomplish its mission of developing and executing various types of Capital Improvement Projects and Facility Improvement Projects. Other City departments may utilize this contract as needed.

The firm(s) will provide design and study support to the city for projects; total compensation for the contract shall not exceed $850,000. Initial term of the contract shall be two years from date of execution with an option for a one year extension.

Proposals may be submitted from a single prime consultant or a team. Regardless of whether a single prime consultant or a team of firms submits, the prime consultant shall be located within 30 miles of the Greenville city limits. If a team submits, it is strongly encouraged, but not required, that subconsultants also be located within the same 30 mile limit when appropriate expertise is available in the area.

II. Scope of Work (Consultant Responsibilities)

Typical types of work could include, but are not limited to, the following:

• Design services for emergency repairs for city infrastructure;

• Design services for work related to new or existing buildings, parks, or other facilities;

• Design services for project related site plans;

• Design services for repair of storm water drainage systems;

• Design services for projects to construct streets, sidewalks, and bike lanes;

• Geotechnical engineering services;

• Surveying services;

• Environmental permitting services;

• Capacity Analysis (Roadway Links, Signalized and Unsignalized Intersections, Roundabouts);

• Traffic Signal Design;

• Traffic Signal Operations (Phasing, Timing, Interconnection/Coordination);

• Signing, Pavement Marking, and Traffic Control Plans for Highway Improvements;

• Traffic Management Plans;

• Miscellaneous Traffic Studies, Safety Investigations, and Traffic Engineering Field Work Support;

• Transportation Planning;

• Obtaining right-of-way or easements for projects;

• Research City records to determine status of existing roads, rights-of-way, and easements;

• Analyze road/drainage system failures to determine cause and corrective actions.

III. Deliverables

Deliverables will be determined based upon each task order, and may include, but not be limited to:

• Design plans

• Specifications

• Digital files

• Survey data

• Engineering reports

• Schedules

• Cost estimates

IV. Conflict of Interest:

Each proposer shall affirm that no official or employee of the firm or team is directly or indirectly interested in this proposal for any reason of personal gain. Due to the nature of this on-call contract, this statement shall be affirmed with each individual task order that is executed under the contract.

V. Supervision of Consultant

The on-call consultant will be under the supervision of the City of Greenville’s Executive Director of City Projects and Recreation Services or his designee.

VI. Minority Business Enterprises and Women’s Business Enterprises

It is the policy of the City of Greenville to provide minorities and women equal opportunity for participating in all aspects of the City’s contracting and procurement programs, including but not limited to, construction projects, supplies and materials purchase, and professional and personal service contracts. In accordance with this policy, the City has adopted a Minority and Women Business Enterprise (MWBE) Plan and subsequent program, outlining verifiable goals.

The City has established a 4% Minority Business Enterprise (MBE) and 4% Women Business Enterprise (WBE) goal for the participation of MWBE firms in supplying goods and services for the completion of this project. All firms submitting qualifications and/or proposals agree to employ “good faith efforts” towards achieving these goals and supply other information as requested in the “MWBE Professional Services Forms” included in Attachment A. Failure to complete the MWBE forms may be cause to deem the submittal nonresponsive.

Questions regarding the City’s MWBE Program should be directed to the MWBE Office at (252) 329-4862.

VII. Equal Employment Opportunity Clause

The City has adopted an Equal Employment Opportunity Clause, which is incorporated into all specifications, purchase orders, and contracts, whereby a vendor agrees not to discriminate against any employee or applicant for employment on the basis of race, color, religion, sex, national origin or ancestry. By submitting qualifications and/or proposals, the firm is attesting that they are an Equal Opportunity Employer.

Federal law (Rehabilitation Act and ADA) prohibits handicapped discrimination by all governmental units. By submitting a proposal, the vendor is attesting to its policy of nondiscrimination regarding the handicapped.

VIII. E-Verify Compliance

By submitting a proposal, BIDDER acknowledges that compliance with the requirements of Article 2 of Chapter 64 of the North Carolina General Statutes is required by the Contractor and its Subcontractors by North Carolina law and the provisions of the Contract Documents. The BIDDER represents that the BIDDER and its Subcontractors are in compliance with the requirements of Article 2 of Chapter 64 of the North Carolina General Statutes. Article 2 of Chapter 64 of the North Carolina General Statutes requires employers, that transact business in the State of North Carolina and employ 25 or more employees in the State of North Carolina, to electronically verify the legal employment status of an employee through the federal E-Verify program after hiring the employee to work in the State of North Carolina.

IX. Iran Divestment Act

As a result of the Iran Divestment Act of 2015 (Act), Article 6E, N.C. General Statute § 147-86.55, the State Treasurer published the Final Divestment List (List) which includes the final companies and persons engaged in investment activities in Iran and will be updated every 180 days. The list can be found at https://www.nctreasurer.com/inside-the-department/OpenGovernment/Pages/Iran-Divestment-Act- Resources.aspx.

By submitting the Proposal, the Contractor certifies that, as of the date of this bid, it is not on the then current List created by the State Treasurer. The Contractor must notify the Department immediately if, at any time before the award of the contract, it is added to the List.

As an ongoing obligation, the Contractor must notify the Department immediately if, at any time during the contract term, it is added to the List. Consistent with § 147-86.59, the Contractor shall not contract with any person to perform a part of the work if, at any time the subcontract is signed, that person is on the then-current List.

During the term of the Contract, should the Department receive information that a person is in violation of the Act as stated above, the Department will take action as appropriate and provided for by law, rule or contract.

X. Special Conditions: Federal Requirements This Contract may be funded in whole or in part with federal funding. As such, federal laws, regulations, policies and related administrative practices apply to this Contract on services where federal funding applies. The most recent of such federal requirements, including any amendments made after the execution of this Contract shall govern the Contract, unless the federal government determines otherwise. This section identifies the federal requirements that may be applicable to this contract. The Vendor is responsible for complying with all applicable provisions, updates or modifications that occur in the future relating to these clauses.

The federal requirements contained in the most recent version of the Uniform Administrative Requirements for federal awards (Uniform Rules) codified at 2.C.F.R., Part 200, including any certifications and contractual provisions required by any federal statutes or regulation referenced therein to be included in this contract are deemed incorporated into this contract by reference and shall be incorporated into any sub-agreement or subcontract executed by the Vendor pursuant to its obligations under this Contract. The Vendor and its sub-contractors, if any, hereby represent and covenant that they are have complied and shall comply in the future with the applicable provisions of the original contract then in effect and with all applicable federal, state, and local laws, regulations, and rules and local policies and procedures, as amended from time to time, relating to Work to be performed under this contract.

No Obligation by Federal Government The Federal Government is not a party to this contract and is not subject to any obligations or liabilities to the non-Federal entity, contractor, or any other party pertaining to any matter resulting from the contract.

Program Fraud and False or Fraudulent Statements or Related Acts The contractor acknowledges that 31 U.S.C. Chap. 38 (Administrative Remedies for False Claims and Statements) applies to the contractor’s actions pertaining to this contract.

Access to Records The following accesses to records requirements apply to this contract:

1. The contractor agrees to provide the City of Greenville, the Comptroller General of the United States, or any of their authorized representative’s access to any books, documents, papers, and records of the Contractor which are directly pertinent to this contract for the purposes of making audits, examinations, excerpts, and transcriptions.

2. The Contractor agrees to permit any of the foregoing parties to reproduce by any means whatsoever or to copy excerpts and transcriptions as reasonably needed.

3. The contractor agrees to provide City access to construction or other work sites pertaining to the work being completed under the contract.

Changes Any change in the contract cost, modification, change order, or constructive change must be allowable, allocable, within the scope of its funding, grant or cooperative agreement, and reasonable for the completion of project scope. All changes and/or amendments to the contract will be outlined in detail, formalized in writing, and signed by the authorized representative of each party. A Contractor’s failure to do so shall constitute a material breach of the contract.

Termination for Convenience (General Provision)

The City may terminate this contract, in whole or in part, at any time by written notice to the Contractor when it is in the City's best interest. The Contractor shall be paid its costs, including contract close-out costs, and profit on work performed up to the time of termination. The Contractor shall promptly submit its termination claim to the City to be paid the Contractor. If the Contractor has any property in its possession belonging to the City, the Contractor will account for the same, and dispose of it in the manner the City directs.

Termination for Default [Breach or Cause] (General Provision) If the Contractor does not deliver supplies in accordance with the contract delivery schedule, or, if the contract is for services, the Contractor fails to perform in the manner called for in the contract, or if the Contractor fails to comply with any other provisions of the contract, the City may terminate this contract for default. Termination shall be effected by serving a notice of termination on the contractor setting forth the manner in which the Contractor is in default. The contractor will only be paid the contract price for supplies delivered and accepted, or services performed in accordance with the manner of performance set forth in the contract.

If it is later determined by the City that the Contractor had an excusable reason for not performing, such as a strike, fire, or flood, events which are not the fault of or are beyond the control of the Contractor, the City, after setting up a new delivery of performance schedule, may allow the Contractor to continue work, or treat the termination as a termination for convenience.

Opportunity to Cure (General Provision) The City in its sole discretion may, in the case of a termination for breach or default, allow the Contractor ten

(10) calendar days in which to cure the defect. In such case, the notice of termination will state the time period in which cure is permitted and other appropriate conditions.

If Contractor fails to remedy to the City’s satisfaction the breach or default of any of the terms, covenants, or conditions of this Contract within ten (10) calendar after receipt by Contractor of written notice from the City setting forth the nature of said breach or default, the City shall have the right to terminate the Contract without any further obligation to Contractor. Any such termination for default shall not in any way operate to preclude the City from also pursuing all available remedies against Contractor and its sureties for said breach or default.

Waiver of Remedies for any Breach In the event that the City elects to waive its remedies for any breach by Contractor of any covenant, term or condition of this Contract, such waiver by the City shall not limit the City’s remedies for any succeeding breach of that or of any other term, covenant, or condition of this Contract.

Equal Opportunity “During the performance of this contract, the contractor agrees as follows:

1. The contractor will not discriminate against any employee or applicant for employment because of race, color, religion, sex, or national origin. The contractor will take affirmative action to ensure that applicants are employed, and that employees are treated during employment without regard to their race, color, religion, sex, or national origin. Such action shall include, but not be limited to the following: Employment, upgrading, demotion, or transfer; recruitment or recruitment advertising;

layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided setting forth the provisions of this nondiscrimination clause.

2. The contractor will, in all solicitations or advertisements for employees placed by or on behalf of the contractor, state that all qualified applicants will receive considerations for employment without regard to race, color, religion, sex, or national origin.

3. The contractor will send to each labor union or representative of workers with which he has a collective bargaining agreement or other contract or understanding, a notice to be provided advising the said labor union or workers' representatives of the contractor's commitments under this section, 3 and shall post copies of the notice in conspicuous places available to employees and applicants for employment.

4. The contractor will comply with all provisions of Executive Order 11246 of September 24, 1965, and of the rules, regulations, and relevant orders of the Secretary of Labor.

5. The contractor will furnish all information and reports required by Executive Order 11246 of September 24, 1965, and by rules, regulations, and orders of the Secretary of Labor, or pursuant thereto, and will permit access to his books, records, and accounts by the administering agency and the Secretary of Labor for purposes of investigation to ascertain compliance with such rules, regulations, and orders.

6. In the event of the contractor's noncompliance with the nondiscrimination clauses of this contract or with any of the said rules, regulations, or orders, this contract may be canceled, terminated, or suspended in whole or in part and the contractor may be declared ineligible for further Government contracts or federally assisted construction contracts in accordance with procedures authorized in Executive Order 11246 of September 24, 1965, and such other sanctions as may be imposed and remedies invoked as provided in Executive Order 11246 of September 24, 1965, or by rule, regulation, or order of the Secretary of Labor, or as otherwise provided by law.

7. The contractor will include the portion of the sentence immediately preceding paragraph (1) and the provisions of paragraphs (1) through (7) in every subcontract or purchase order unless exempted by rules, regulations, or orders of the Secretary of Labor issued pursuant to section 204 of Executive Order 11246 of September 24, 1965, so that such provisions will be binding upon each subcontractor or vendor. The contractor will take such action with respect to any subcontract or purchase order as the administering agency may direct as a means of enforcing such provisions, including sanctions for noncompliance: Provided, however, that in the event a contractor becomes involved in, or is threatened with, litigation with a subcontractor or vendor as a result of such direction by the administering agency the contractor may request the United States to enter into such litigation to protect the interests of the United States.”

Energy Conservation The contractor agrees to comply with mandatory standards and policies relating to energy efficiency which are contained in the state conservation plan issued in compliance with the Energy Policy and Conservation Act.

Suspension and Debarment This Contract is a covered transaction for purposes of 49 CFR Part 29. As such, the Contractor is required to verify that none of the Contractor, its principals, as defined at 49 CFR 29.995, or affiliates, as defined at 49 CFR 29.905, are excluded or disqualified as defined at 49 CFR 29.940 and 29.945.

The Contractor is required to comply with 49 CFR 29, Subpart C and must include the requirement to comply with 49 CFR 29, Subpart C in any lower tier covered transaction it enters into.

Suspension and Debarment Certification By signing and submitting its bid or proposal, the bidder or proposer certifies as follows:

The certification in this clause is a material representation of fact relied upon by the City. If it is later determined that the bidder or proposer knowingly rendered an erroneous certification, in addition to remedies available to the City, the Federal Government may pursue available remedies, including but not limited to suspension and/or debarment.

The bidder or proposer agrees to comply with the requirements of 49 CFR 29, Subpart C while this offer is valid and throughout the period of any Contract that may arise from this offer. The bidder or proposer further agrees to include a provision requiring such compliance in its lower tier covered transactions.

Byrd Anti-Lobbying Amendment, 31 U.S.C. § 1352 (as amended) Each tier certifies to the tier above that it will not and has not used Federal appropriated funds to pay any person or organization for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, officer or employee of Congress, or an employee of a Member of Congress in connection with obtaining any Federal contract, grant, or any other award covered by 31 U.S.C. § 1352. Each tier shall also disclose any lobbying with non-Federal funds that takes place in connection with obtaining any Federal award.

Such disclosures are forwarded from tier to tier up to the recipient who in turn will forward the certification(s) to the awarding agency.

XI. Proposal Requirements

All proposals are limited to 15 pages inclusive of the cover letter, and shall be typed on 8-1/2” x 11” sheets, single spaced, one sided. In order to reduce costs and to facilitate recycling, binders, dividers, tabs, etc. are prohibited. One staple in the upper left-hand corner is preferred. Proposals containing more than 15 pages will not be considered.

Proposal Format:

• Cover Letter

• Briefly describe why your firm is interested and should be considered for this project. Also, provide contact information for any questions or additional requests for information that may arise during the review of your proposal.

• Consultant Background o Provide the following information for the lead consultant and any proposed sub-consultants: Firm names, background, history, number of years in business, size of firm, number of employees dedicated to this project and their proposed responsibilities to this project. Please include applicable professional registrations of team members as well as any specialized experience in applicable areas.

• Experience o List a minimum of three recent projects similar to this one completed by your firm or team. The list should include project name, a brief description of the project, total project budget, design budget, client name and client contact information.

• Project Approach o Briefly outline your technical and procedural approach for the design project. Also, describe key issues and potential problems facing various types of work included herein. Please provide a description of the degree or level of involvement in the planning and design process for the team members identified above.

• Equal Employment Opportunity Statement o The City of Greenville does not discriminate in administering any of its programs and activities. The consultant awarded the contract for work on this project is required to insure that no person shall be denied employment, fair treatment or be discriminated against on the basis of race, sex, religion, age, national origin or handicap. (Please include a copy of any EEO policy or statement adopted by your firm).

• Availability - address availability of staff to handle the project

• Hourly Rate Schedule - Provide a unit rate fee schedule indicative of experience.

• Please provide necessary MWBE documentation which is provided in this RFQ. This documentation is not included in the 15-page requirement for the RFQ.

XII. Consultant Selection Criteria

Criteria for the selection of the Consultant will include, but not necessarily be limited to:

• Quality of response to the RFQ;

• Approach chosen and description of how Consultant and/or team will meet City’s intent for the service (i.e. quick response time for emergency repairs or assignments that may require work outside regular business hours);

• Applicable experience of Consultant and/or team proposed by the Consultant;

• Qualifications of individual(s) proposed for the duties.

XIII. Proposal Submission and Deadline

Interested firms are invited to submit four (4) hard copies and one searchable PDF electronic copy of its response to this RFQ no later than 2:00 p.m. on Thursday, August 08, 2024, to the following address:

Mark Nottingham, AICP Project Management Department City of Greenville 2000 Cedar Ln Greenville, NC 27858

Proposals should be placed in an envelope with “City of Greenville On-Call RFQ” on the outside.

Each firm submitting a proposal shall agree to comply with all applicable state, federal and municipal laws, rules, regulations and ordinances governing this project, including any other requirements that may be dictated by state or federal agencies participating in project funding.

The City of Greenville reserves the right to reject any or all proposals.

For questions regarding this Request for Qualifications, contact Mr. Mark Nottingham at (252) 329-4242 or at mnottingham@greenvillenc.gov

Revised 2015

City of Greenville/Greenville Utilities Commission Minority and Women Business Enterprise Program

City of Greenville MWBE Guidelines for Professional Service On-Call Contracts

$50,000 and above

These instructions shall be included with each bid solicitation.

ATTACHMENT A

City of Greenville/Greenville Utilities Commission Minority and Women Business Enterprise Program

MWBE Guidelines for Professional Service Contracts $50,000 and above

Policy Statement It is the policy of the City of Greenville and Greenville Utilities Commission to provide minorities and women equal opportunity for participating in all aspects of the City’s and Utilities’ contracting and procurement programs, including but not limited to, construction projects, supplies and materials purchases, and professional and personal service contracts.

Goals and Good Faith Efforts Service providers responding to this solicitation shall comply with the MWBE program by making Good Faith Efforts to achieve the following aspirational goals for participation.

CITY

MBE WBE

Professional Services 4% 4%

Submitters shall submit MWBE information with their submissions on the forms provided. This information will be subject to verification by the City prior to contract award. As of July 1, 2009, contractors, subcontractors, suppliers, service providers, or MWBE members of joint ventures intended to satisfy City MWBE goals shall be certified by the NC Office of Historically Underutilized Businesses (NC HUB) only. Firms qualifying as “WBE” for the City’s goals must be designated as a “women-owned business” by the HUB Office.

Firms qualifying as “MBE” for the City’s goals must be certified in one of the other categories (i.e.: Black, Hispanic, Asian American, American Indian, Disabled, or Socially and Economically Disadvantaged). According to new Statewide Uniform Certification (SWUC) Guidelines, ethnicity supersedes gender; therefore, firms who are certified as both a “WBE” and “MBE” will satisfy the “MBE” category only. Each goal must be met separately. Exceeding one goal does not satisfy requirements for the other.

The City shall accept NCDOT certified firms on federally funded projects only.

Please note: A service provider may utilize any firm desired. However, for participation purposes, all MWBE firms who wish to do business as a minority must be certified by NC HUB. A complete database of NC HUB certified firms may be found at http://www.doa.nc.gov/hub/

Instructions

The submitter shall provide the following forms:

FORM 1—Sub-Service Provider Utilization Plan This form provides the amount of sub-contracted work proposed for the project and subsequent task orders for MWBE firms according to needed discipline and anticipated task order. This proposed participation is based on the current scope of work for each anticipated task and discipline required.

Submitter must turn in this form with submission. If the submitter does not customarily subcontract elements of this type of project, do not complete this form. Instead complete FORM 2.

FORM 2--Statement of Intent to Perform work without Sub-Service Providers This form provides that the submitter does not customarily subcontract work on this type of project.

Sub-Service Provider Utilization Commitment Submitted by the selected service provider for each task order, this form lists the MWBE firms committed to participate on this order. This commitment will reflect any changes in the Plan due to adjustments in project scope.

NOTE: A firm is expected to maintain the level of participation listed in FORM 1 for each task order and firm used to satisfy required discipline in the – Sub-Service Provider Utilization Plan – unless there is a negotiated change in the service required by the City. A firm is also encouraged to increase MWBE participation in the Utilization Commitment as a result of ongoing Good Faith Efforts.

Proof of Payment Certification

Proof of payment must be submitted by the selected service provider with each payment application, listing payments made to sub-consultants. This form is not provided with the submission.

In addition to the forms provided above, each service provider must provide a discussion of its diverse business policies and procedures to include the good faith efforts it employed to utilize minority and women-owned firms on this project. This discussion must include:

1. Outreach efforts that were employed by the firm to maximize the utilization of MWBE’s.

2. A history of MWBE firms used on similar projects; and

3. The percentage participation of MWBE firms on these projects.

NOTE: Those service providers submitting FORM 2 should discuss and provide documentation to justify 100% performance without the use of sub-consultants (both majority and minority) per the statements of the form.

Minimum Compliance Requirements: All written statements, signed forms, or intentions made by the Submitter shall become a part of the agreement between the Submitter and the City for performance of contracts. Failure to comply with any of these statements, signed forms, or intentions or with the minority business guidelines shall constitute a breach of the contract. A finding by the City that any information submitted (either prior to award of the contract or during the performance of the contract) is inaccurate, false, or incomplete, shall also constitute a breach of the contract. Any such breach may result in termination of the contract in accordance with the termination provisions contained in the contract. It shall be solely at the option of the City whether to terminate the contract for breach or not. In determining whether a Submitter has made Good Faith Efforts, the City will evaluate all efforts made by the Submitter and will determine compliance in regard to quantity, intensity, and results of these efforts.

Sub-Service Provider Utilization Plan

FORM 1

(Must be included with submission if subcontracting any portion of work)

We _________________________________________________________, do certify that on the (Company Name)

______________________________________________ we will seek to contract with certified MBE firms

(Project Name) and WBE firms as task orders permit through this contract.

Name, Address, & Phone Number of Sub-

Service Provider

*MWBE

Category

Work description

*Minority categories: Black, African American (B), Hispanic or Latino (L), Asian American (A) American Indian (I), Female (F) Socially and Economically Disadvantaged (S) Disabled (D)

The undersigned intends to enter into a formal agreement with MWBE firms for work listed in this schedule conditional upon execution of a contract with the current scope proposed by the Owner.

The undersigned hereby certifies that he/she has read the terms of this agreement and is authorized to bind the submitter to the agreement herein set forth.

Date: ______________________

Name & Title of Authorized Representative_____________________________________________

Signature of Authorized Representative________________________________________________

Statement of Intent to Perform work without

Sub-Service Providers

FORM 2

(Must be included with submission if not subcontracting any portion of work)

We, __________________________________________________, hereby certify that it is our intent to perform 100% of the work required for the ______________________________________ contract.

In making this certification, the Proposer states the following:

i. It is a normal and customary practice of the Proposer to perform all elements of this type of contract with its own workforce and without the use of sub-consultants. The Proposer has substantiated this by providing documentation of at least three (3) other projects within the last five (5) years on which they have done so.

Check box to indicate documentation is attached.

ii. The Proposer has a valid business reason for self-performing all work on the Contract as opposed to subcontracting with a MWBE. The Proposal must describe the valid business reason for self-performing, and the Proposer must submit with its Bid or Proposal documentation sufficient to demonstrate to the

Authority reasonable satisfaction the validity of such assertions.

Check box to indicate documentation is attached.

iii. If it should become necessary to subcontract some portion of the work at a later date, the Proposer will notify the City and institute good faith efforts to comply with all requirements of the MWBE program in providing equal opportunities to MWBEs to subcontract the work. The firm will also submit a Request to

Change MWBE Participation Form (even if the final sub-consultant is not MWBE).

The undersigned hereby certifies that he or she has read the terms of this certification and is authorized to bind the Proposer in accordance herewith.

Date: __________________

Sub-Service Provider Utilization Commitment (Must be submitted with each task order)

We _________________________________________________________, do certify that on the (Company Name)

______________________________________________ we will expend a minimum of ______% of the total dollar amount of the contract with certified MBE firms and a minimum of ______% of the total dollar amount of the work with WBE.

Name, Address, & Phone Number of Sub-

Service Provider

*MWBE

Category

Work description % of Work

*Minority categories: Black, African American (B), Hispanic or Latino (L), Asian American (A) American Indian (I), The undersigned will enter into a formal agreement with MWBE firms for work listed in this schedule. Failure to fulfill this commitment may constitute a breach of contract.

The undersigned hereby certifies that he/she has read the terms of this commitment and is authorized to bind the submitter to the commitment herein set forth.

Date:______________________

REQUEST TO CHANGE MWBE PARTICIPATION

(Submit changes only if recipient of intent to award letter, continuing through project completion.)

Project: ______________________________________________________________________

Bidder or Prime Consultant: ____________________________________________________

Name & Title of Authorized Representative: _______________________________________

Address: ________________________________ Phone #: ___________________________

________________________________________ Email Address: ______________________

Original Total Contract Amount: $_____________________________________

Total Contract Amount (including approved change orders or amendments): $__________________

Will this request change the dollar amount of the contract? Yes No

If yes, give the total contract amount including change orders and proposed change: $________________

The proposed request will do the following to overall MWBE participation (please check one):

Increase Decrease No Change

Name of sub-consultant: _________________________________________________________

Service provided: _______________________________________________________

Proposed Action:

___Replace sub-consultant

___Perform work in-house

For the above actions, you must provide one of the following reasons (Please check applicable reason):

___ The listed MBE/WBE, after having had a reasonable opportunity to do so, fails or refuses to execute a written contract.

___The listed MBE/WBE is bankrupt or insolvent.

___The listed MBE/WBE fails or refuses to perform his/her subcontract or furnish the listed materials.

___The work performed by the listed sub-consultant is unsatisfactory according to industry standards and is not in accordance with the plans and specifications; or the sub-consultant is substantially delaying or disrupting the progress of the work.

If replacing sub-consultant:

Name of replacement sub-consultant: _______________________________________________

Is the sub-consultant a certified MWBE? ___Yes ___No

If no, please attach documentation of outreach efforts employed by the firm to utilize an MWBE.

Dollar amount of original consultant contract $________________

Dollar amount of amended consultant contract $ _______________

Other Proposed Action:

___Increase total dollar amount of work ___Add as an additional sub-consultant*

___Decrease total dollar amount of work ___Other

Please describe reason for requested action: _________________________________________

*If adding additional sub-consultant:

Is the sub-consultant a certified MWBE? ___Yes ___No

If no, please attach documentation of outreach efforts employed by the firm to utilize an MWBE.

Dollar amount of original consultant contract $________________

Dollar amount of amended consultant contract $ _______________

Interoffice Use Only:

Approval __Y __N

Date___________________

Signature_______________

Pay Application No. ______

Purchase Order No. ______

Proof of Payment Certification

MWBE Contractors, Suppliers, Service Providers

Project Name: ________________________________________________

Prime Service Provider: _____________________________________________

Current Contract Amount (including change orders): $_________________

Requested Payment Amount for this Period: $_______________________

Is this the final payment? ___Yes ___No

Firm Name MWBE

Category*

Total Amount Paid from this Pay Request

Total Contract

Amount

Total Amount

Remaining

*Minority categories: Black, African American (B), Hispanic or Latino (L), Asian American (A) American Indian (I), Date:_____________________ Certified By: __________________________________________ Name

Title

Signature