3-PA1858 Intent to Perform.pdf

INTENT TO PERFORM CONTRACT AS A M/WBE SUBCONTRACTOR1 (Revised 04-01-2023)

Submission of the Intent to Perform as a M/WBE Subcontractor form for each M/WBE firm shall constitute a representation by the Prime Contractor to the Airport Board that it believes such M/WBE to be certified as a M/WBE to perform the work as designated, the M/WBE has a place of business in the Airport Board’s market area and the M/WBE is not affiliated with the Contractor as defined herein. It shall also represent a commitment by the Contractor that if it is awarded the Contract, it will enter in a subcontract with such M/WBE for the work described at the approximate price and percentage set forth.

PRIME CONTRACTOR / CONSULTANT

Contract / Solicitation Number:

Name of Prime Contractor:

Address, City, State and Zip Code:

The Prime Contractor designates the following person as their high-level official designated to administer and coordinate the efforts to carry out the M/WBE policy on behalf of the Prime Contractor.

Name: Title:

E-Mail Address: Phone Number:

DECLARATION OF PRIME CONTRACTOR

I HEREBY DECLARE AND AFFIRM that as a duly authorized representative of the Prime Contractor stated above, I have personally reviewed the material and facts set forth in this form. To the best of my knowledge, information and belief, the facts and representations contained in this form are true and the owner or authorized agent of the M/WBE firm stated above signed this form in the place indicated, and no material facts have been omitted. The undersigned affirms that the Prime Contractor has no ownership or financial interest in the M/WBE subcontracting firm stated below. Except as authorized by the Vice President of Business Diversity & Development Department or his designee, the undersigned shall enter into a formal agreement (which shall include all audit and records provisions required by the Board) with the listed M/WBE firm for work as indicated by this form within ten (10) business days after receipt of the contract executed by the Airport. The undersigned will, if requested, provide said Vice President or his designee a copy of that agreement within five (5) business days of the written request. Pursuant to State Law, any person [entity] who makes a false or fraudulent statement in connection with the participation of a M/WBE in any locally funded project or otherwise violates applicable program requirements may be referred for prosecution.

Signature of Prime Contractor: Date

M/WBE SUBCONTRACTOR / SUBCONSULTANT / SUPPLIER AT ANY TIER

The Airport requires that minority/women business enterprises be certified as M/WBEs by an approved certification agency as defined in the M/WBE Program Policy and Procedures. Effective 06-01-2020, in addition to having a valid certification, M/WBEs must have a place of business in the Airport’s market area1 at the time of bid/proposal submission for credit towards meeting a contract goal.

Does the undersigned M/WBE subcontractor have a place of business in the Airport’s market area?

Yes No

Is the undersigned M/WBE subcontractor affiliated with the Prime Contractor as defined in the M/WBE Program Policies and Procedures?

Yes No

Name of M/WBE Subcontractor:

Address, City, State and Zip Code:

Contact Person:

E-Mail Address: Phone Number:

Scope of Work: (where applicable specify “supply” or “install” or both)

Price and Percentage: $ ( %)

M/WBE Certification #: Certification Agency:

If the M/WBE shown above is not a direct first tier subcontractor, subconsultant or supplier to the Prime Contractor shown above, please indicate the name of the subcontractor, subconsultant or supplier and tier level that will be utilizing your participation for M/WBE credit.

Percentage (%) of the proposed subcontract described above will be sublet and/or awarded to a Non-M/WBE subcontractor. (Complete this box ONLY if subcontracting to a Non-M/WBE subcontractor.) ______ %

DECLARATION OF M/WBE SUBCONTRACTOR

I HEREBY DECLARE AND AFFIRM that as a duly authorized representative of the Subcontractor stated above, the facts and representations contained in this form are true. The undersigned affirms that the Prime Contractor has no ownership or financial interest in the M/WBE subcontracting firm stated above. I also agree, for good and valuable consideration (including the opportunity to participate in this solicitation as a proposed subcontractor), the receipt and sufficiency of which is hereby acknowledged, that if the Subcontractor performs any work for the Prime Contractor as the result of a contract awarded to the Prime Contractor for this solicitation, the Subcontractor will maintain and the Board shall have the right to examine and make copies of all records, documents, books, statements, checks, invoices, and any other supporting evidence deemed necessary by the Board to substantiate compliance with the terms of this Contract, including any Change Orders. Such right of examinations shall include, but not be limited to, reasonable access to and cooperation by all Subcontractor personnel.

Subcontractor agrees to provide the Board with retrievals of computer-based records or transactions that the Board determines to be necessary to conduct any audits. Subcontractor agrees that there shall be no charge to the Board for Subcontractor's costs of providing records, documents, and assistance for audits, and to provide to the Board within seven (7) calendar days all records, documents, retrievals, and other assistance requested.

Signature of M/WBE Subontractor Date

1 Any named person, firm, partnership, corporation, association or joint venture as herein provided identified as providing work, labor, services, supplies, equipment, materials or any combination of the foregoing, under contract to a prime contractor on an Airport contract at any tier.

2 The Airport’s market area is defined as the North Texas Commission twelve-county area of Dallas, Tarrant, Collin and Denton counties.

Instructions for Intent to Perform as a M/WBE Subcontractor Form

(Note: This form requires both the prime contractor and the M/WBE subcontractor to complete, sign and date prior to bid/proposal submission.)

PRIME CONTRACTOR/CONSULTANT

Contract/Solicitation Number: Enter the Ref. # or Solicitation No. from Bonfire Portal.

Name of Prime Contractor: Enter name of Company bidding or proposing.

Address, City, State and Zip Code: Enter physical address for company.

The Prime Contractor designates the following person to administer and coordinate the efforts to carry out the M/WBE policy on behalf of the Prime Contractor.

Name: Enter the first and last name of the Prime Contractor’s designated representative as required above.

Title: Enter title of Prime Contractor’s designated representative.

E-Mail Address: Enter the email address for the Prime Contractor’s designated representative.

Phone Number: Enter a phone number for the Prime Contractor’s designated representative.

DECLARATION OF PRIME CONTRACTOR

Signature of Prime Contractor: The Prime Contractor’s designated representative must sign this form.

Date: Enter date of executed Prime Contractor signature.

M/WBE SUBCONTRACTOR / SUBCONSULTANT / SUPPLIER AT ANY TIER

Does the undersigned M/WBE subcontractor have a physical place of business in the Airport’s relevant market area? Select Yes or No Is the undersigned M/WBE subcontractor affiliated with the Prime Contractor as defined in the M/WBE Program Policies and Procedures? Select Yes or No Name of M/WBE Subcontractor: Enter the company name of the M/WBE subcontractor or supplier.

Address, City, State and Zip Code: Enter the physical place of business address located in the Airport’s relevant market area for the M/WBE subcontractor/supplier.

Contact Person: Enter the first and last name of the M/WBE subcontractor/supplier designated representative.

Email Address: Enter email address for the M/WBE subcontractor/supplier designated representative.

Phone Number: Enter the phone number for the M/WBE subcontractor/supplier designated representative.

Scope of Work: Provide a brief description of the scope of work or services to be performed by the M/WBE subcontractor. Where applicable, specify ‘supply’ or ‘install’ or both.

Price and Percentage:

• Request for Bids: Enter the subcontractor/supplier dollar amount and associated percentage of work to be performed by the M/WBE subcontractor/supplier. The percentage should be calculated against the Prime Contractor’s total dollar amount bid and match the dollar amount and percentage noted on the Final Schedule of Subcontractors.

• Request for Proposals: Note the Price as Not Applicable or N/A and enter the percentage of work to be performed by the M/WBE subcontractor/supplier. The percentage should be calculated against the Prime Contractor’s total percentage proposed (100%) and match the percentage noted on the Final Schedule of Subcontractors.

M/WBE Certification #: Enter the certification number shown on the M/WBE subcontractor/supplier certificate.

Certification Agency: Enter the name or abbreviation of the certification agency shown on the M/WBE subcontractor/supplier certificate.

If the M/WBE subcontractor identified above is not the direct first tier subcontractor, subconsultant or supplier to the Prime Contractor shown above, please indicate the name of the subcontractor, subconsultant or supplier and tier level that will be utilizing your participation for M/WBE credit: Enter the subcontractor’s name and tier level that will be utilizing the services of the M/WBE subcontractor.

The percentage (%) of the proposed subcontract described above will be sublet and/or awarded to a Non-M/WBE subcontractor.

(Complete this box ONLY if subcontracting to a Non-M/WBE subcontractor.): Enter the percentage of work that will be subcontracted to a Non-M/WBE subcontractor only if applicable.

DECLARATION OF M/WBE SUBCONTRACTOR

Signature of M/WBE Subcontractor/Supplier: The M/WBE Subcontractor/Supplier’s designated person must sign this form.

Date: Enter date of executed M/WBE Subcontractor/Supplier signature.

NOTE: Sample forms available for reference at:

https://www.dfwairport.com/business/opportunities/bdd/ > Business Resources https://www.dfwairport.com/business/opportunities/bdd/