3-MBEWBE Forms 1 - 3 Complete Package Dec 2024.pdf

COOK COUNTY

, 0 F'ICE'. 0 THE'.

C!liff Procurement Officer MBE/WBE UTILIZATION PLAN -FORM 1

BIDDER/PROPOSER HEREBY STATES that all MBE/WBE firms included in this Plan are certified MBEs/WBEs by at least one of the entities listed in the General Conditions - Section 19.

I. BIDDER/PROPOSER MBE/WBE STATUS: (check the appropriate line)

II.

Bidder/Proposer is a certified MBE or WBE firm. (If so, attach copy of current Letter of Certification)

Bidder/Proposer is a Joint Venture and one or more Joint Venture partners are certified MBEs or WBEs. (If so, attach copies of Letter(s) of Certification, a copy of Joint Venture Agreement clearly describing the role of the MBE/WBE firm(s) and its ownership interest in the Joint Venture and a completed Joint Venture Affidavit.

Bidder/Proposer is not a certified MBE or WBE firm, nor a Joint Venture with MBE/WBE partners, but will utilize MBE and WBE firms either directly or indirectly in the performance of the Contract. (If so, complete Sections II below and the Letter(s) of Intent- Form 2).

Direct Participation of MBE/WBE Firms D Indirect Participation of MBE/WBE Firms

NOTE: Where goals have not been achieved through direct participation, Bidder/Proposer shall include documentation outlining efforts to achieve Direct Participation at the time of Bid/Proposal submission. Indirect Participation will only be considered after all efforts to achieve Direct Participation have been exhausted. Only after written documentation of Good Faith Efforts is received will Indirect Participation be considered.

MBEs/WBEs that will perform as subcontractors/suppliers/consultants include the following:

MBE/WBE Firm: __________________________ _

Address: ____________________________ _

E-mail: _____________________________ _

Contact Person: _____________ Phone: ___________ _

Dollar Amount Participation:$ _______________________ _

Percent Amount of Participation: ______________________ %

*Letter of Intent attached? Yes *Current Letter of Certification attached? Yes

No No

MBE/WBE Firm: _________________________ _

Address: ____________________________ _

E-mail: _____________________________ _

Contact Person: _____________ Phone: ___________ _

Dollar Amount Participation:$ _______________________ _

Percent Amount of Participation: ______________________ %

*Letter of Intent attached? Yes *Current Letter of Certification attached? Yes

Attach additional sheets as needed.

No No

* Letter(s) of Intent and current Letters of Certification must be submitted at the time of bid.

M/WBE Utilization Plan - Form 1 Revised: 12/03/2024

COOK COUNTY

0 F'ICE:: OF' THE::

Chief Procurement

Officer MBE/WBE LETTER OF INTENT • FORM 2

M/WBE Firm: ___________ _

Contact Person:

Address: _____________ _

City/State: _______ Zip: ____ _

Phone: ______ _ Fax: _____ _

Email: ______________ _

Participation: □Direct □ indirect

Certifying Agency: __________ _

Certification Expiration Date: ________ _

Ethnicity: ______________ _

Bid/Proposal/Contract#: _________ _

FEIN#: _____________ _

Will the M/WBE firm be subcontracting any of the goods or services of this contract to another firm?

D No D Yes - Please attach explanation. Proposed Subcontractor(s): ___________ _

The undersigned M/WBE is prepared to provide the following Commodities/Services for the above named ProjecU Contract: (If more space is needed to fully describe MIWBE Firm's proposed scope of work and/or payment schedule, attach additional sheets)

Indicate the Dollar Amount, Percentage, and the Terms of Payment for the above-described Commodities/ Services:

THE UNDERSIGNED PARTIES AGREE that this Letter of Intent will become a binding Subcontract Agreement for the above work, conditioned upon (1) the Bidder/Proposer's receipt of a signed contract from the County of Cook; (2) Undersigned Subcontractor remaining compliant with all relevant credentials, codes, ordinances and statutes required by Contractor, Cook County, and the State to participate as a MBE/WBE firm for the above work. The Undersigned Parties do also certify that they did not affix their signatures to this document until all areas under Description of Service/ Supply and Fee/Cost were completed.

Signature (MIWBE) Signature (Prime Bidder/Proposer)

Print Name Print Name

Firm Name Firm Name

Date Date

Subscribed and sworn before me Subscribed and sworn before me this_ day of _______ , 20_. this_ day of _______ , 20_.

Notary Public _________ _ Notary Public __________ _

SEAL SEAL

M/WBE Letter of Intent - Form 2 Revised: 12/4/24

PETITION FOR PARTIAL OR FULL WAIVER – FORM 3

Bidder/Proposer: _____________________________________________________________________________

Contract No./Title: _____________________________________________________________________________

A. BIDDER/PROPOSER HEREBY REQUESTS:

FULL MBE WAIVER PARTIAL MBE WAIVER

FULL WBE WAIVER PARTIAL WBE WAIVER

FULL DBE WAIVER PARTIAL DBE WAIVER

B. REASON FOR PARTIAL/FULL WAIVER REQUEST:

Bidder/Proposer shall check each item applicable to its overall reason for a waiver request.

Additionally, supporting documentation shall be submitted with this request.

(1) Lack of sufficient qualified MBEs and/or WBEs capable of providing the goods or services required by the contract.

(2) The specifications and necessary requirements for performing the contract make it impossible or economically infeasible to divide the contract to enable the contractor to utilize MBEs and/or WBEs in accordance with the applicable participation.

(3) Price(s) quoted by potential MBEs and/or WBEs are above competitive levels and increase cost of doing business and would make acceptance of such MBE and/or WBE bid economically impracticable, taking into consideration the percentage of total contract price represented by such MBE and/or WBE bid.

(4) There are other relevant factors making it impossible or economically infeasible to utilize MBE and/or WBE firms.

GOOD FAITH EFFORT TRANSPARENCY REPORT

C. GOOD FAITH EFFORTS TO OBTAIN PARTICIPATION (attach sheets as necessary as Schedule 1) Bidder/Proposer shall explain and detail the following Good Faith Efforts undertook to meet Cook County’s contract specific goals.

1. Please attach to this form a detailed list of any and all PCEs, stating the PCE certification (MBE and/or WBE as defined by the Cook County Municipal Code) and with whom from the contacted PCEs the Bidder/Proposer engaged, contacted, and/or communicated with in the County’s Market Place;

Timelines:

a. When the Bidder/Proposer knew of the bid;

b. When the Bidder/Proposer contacted the PCE(s);

c. When the Bidder/Proposer formulated its bid and utilization plan;

and

d. When was the bid request due date.

2. The number of timely attempts to contact PCEs providing the type of supplies, equipment, goods, and/or services required for the Procurement, including but not limited to;

a. Dates of each contact attempt for each contacted PCE;

b. Whom, if anyone, the Bidder/Proposer communicated and/or corresponded (including written, virtual, digital, electronic, and other feasible methods of communication);

c. The number of unsuccessful attempts to communicate or correspond with PCEs; and

d. Attach copies of all solicitations to contacted PCEs.

3. How the Bidder/Proposer proposed to divide the procurement requirements into small tasks and/or quantities into economically feasible units to promote PCE participation.

4. Whether and to what degree the requesting party will endeavor to maximize indirect participation.

5. Detailed explanation of use, if any, of the Center of Business Enterprise Development Compliance services and staff.

6. Detailed explanation of timely notification and usage of services and assistance provided by community, minority, and/or women business organizations.

7. Attach any other documentation relative to Good Faith Efforts in complying with MBE and WBE participation.

GOOD FAITH EFFORT TRANSPARENCY REPORT

By signing below, I affirm under penalty of perjury the information provided in the Petition for Full or Partial Waiver/Good Faith Effort Transparency Report is truthful, accurate, and complete, to the best of my knowledge and capacity. I agree any finding of false, fraudulent, and/or otherwise misleading information will automatically disqualify the request for a waiver and County's Center of Business Enterprise Development reserves the right to pursue additional actions and/or remedies against the requesting Bidder/Proposer.

Signature and Title of Bidder/Proposer Title Date

Revised 12/04/24

Cook County M /WBE Certification Reciprocal Affidavit

Firm Name ___________________________________________________________________________

Address _____________________________________ City_____________________________________

County___________________________ State ________________________ Zip ___________________

Phone (____)___________________________ Email _________________________________________

I __________________________________________, ________________________________________ (Authorized Representative) (Print Title) of _________________________________________ do hereby affirm:

(Name of Firm)

________________________________________ is a Minority and/or Women Business Enterprise currently (Name of Firm) certified by the City of Chicago as: [ ] Black- [ ] Hispanic- [ ] Asian- [ ] Woman-owned business.

With respect to __________________________________, the personal net worth of the qualifying (Name of Firm)

(51%) individual(s) does not exceed $2, , .

meets the requirements of

Chapter 34, Article IV of the Cook County Procurement Code. (As per Section 34-263 of the Cook County Procurement Share of assets held

The average annual gross receipts of _________________________________________, (Name of Firm) as derived from tax filings over the five most recent years, does not exceed the Small Business Size Standards published by the U.S. Small Business Administration found in Title 13, Code of Federal Regulations, Part 121.

(http://www.sba.gov/content/small-business-size-standards)

Upon penalty of perjury, I __________________________________ affirm that, to the best of my knowledge (Authorized Representative) and belief, the information herein is true and accurate.

Signature___________________________ Title___________________________ Date______________

Subscribed and sworn to before me this __________ day of __________________/ _________ (Month) (Year)

My Commission Expires ___________________________

PLEASE NOTE: This affidavit is good for a period of one year from the date of sworn signature. Any changes to your firm within that year may require a new form.

Revised 12/04/24