4-K. CBI Form 3 Subcon Utilization Form Rail Geometry Testing.pdf

Version 06-2020

CBI FORM 3: Subcontractor / Supplier Utilization Commitment

This form MUST be submitted at the time of Bid Opening.

Copy this CBI Form 3 as needed.

Per Part B, Section 3 and Part C, Section 3 of the CBI Policy, the Subcontractor/Supplier Utilization Commitment (CBI Form 3), captures information regarding MBEs, WBEs, SBEs, and other subcontractors and suppliers that the Bidder intends to use on the Contract FOR ALL TIERS.

Bidder Name:

Project Name:

Project Number:

Established MBE Goal: Established WBE Goal: Established SBE Goal:

List below all MBEs, WBEs, and/or SBEs (Non-Hauling Services) that you intend to use on this Contract. NOTE: You will only receive credit for

SBEs that are currently certified with the City as of the Bid Opening Date. Furthermore, you will only receive credit for MBEs and WBEs that are registered with the City as of Bid Opening Date.

MBE/WBE/SBE

Vendor Name

(Non-Hauling Services)

Description of work / materials

NIGP Code

Vendor # Total Projected

Utilization ($)

For all hauling services on this Contract, list below all MBEs, WBEs, and SBEs that you intend to provide such work and the Total Projected Utilization

MBE/WBE/SBE

Vendor Name

(Hauling Services)

Description of work / materials

NIGP Code

Vendor #

Total

Projected Utilization ($)

Total Subcontractor / Supplier Utilization

(including MBEs, WBEs, SBEs, and Non-MWSBEs)

Total MBE Utilization $

Total WBE Utilization $

Total SBE Utilization $

Total Bid Amount (including Contingency) $

Percent MBE Utilization* (Total MBE Utilization divided by Total Bid Amount) %

Percent WBE Utilization* (Total WBE Utilization divided by Total Bid Amount) %

Percent SBE Utilization* (Total SBE Utilization divided by Total Bid Amount) %

* The Utilization percentage stated MUST be rounded to (2) decimal places.

Version 06-2020

CBI FORM 3: Subcontractor / Supplier Utilization Commitment

List below all non-MWSBE (subcontractors and suppliers) that you intend to use on this Contract

Vendor Name Description of work / materials NIGP Commodity Code Vendor # Projected Utilization

(if known) ($)

Letters of Intent submitted upon notice from the City

Per Part B, Section 3.6 and Part C, Section 2 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), Bidders must submit a separate Letter of Intent ( CBI Form 4) for each MBE, WBE, and/or SBE listed on CBI Form 3. Each Letter of Intent must be executed by each MBE, WBE, and/or SBE and the Bidder.

The City shall not count proposed MBE, WBE, and/or SBE utilization for which it has not received a Letter of Intent by this deadline. Per

Part B, Section 3.3, a Regular Dealer as defined in the CBI Policy shall only count 60% of all expenditures towards the established

Subcontracting Goal(s). In addition, a Hauler, Broker, or Packager shall only count fees or commissions charged for providing a

Commercially Useful Function by the MBE, WBE, and/or SBE towards the established Subcontracting Goal(s). The Bidder is still obligated to pay the MBE, WBE, and/or SBE the full amount listed on the Contract with the MBE, WBE, and/or SBE regardless of what percentage is actually counted towards the MBE, WBE, and/or 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 Part D of the CBI Policy, you must comply with the following:

• You must maintain the level of MBE, WBE, and/or SBE participation proposed on this CBI Form 3 (and CBI Form 3A, if applicable) throughout the duration of the Contract, except as specifically allowed in Part D.

• If you need to terminate or replace a MBE, WBE, and/or SBE, you must comply with Part D, Section 5.

• 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 Part D, Section 6.

• A Letter of Intent (CBI Form 4) must also be submitted for each MBE, WBE, and/or 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 that you use on this contract must be registered in the City’s vendor database. You will need to provide the vendor number for each subcontractor or supplier used on this contract as a condition for receiving payment on this Contract.

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,

(b) Failure to properly document such compliance in the manner and within the time periods established by the CBI Policy shall constitute grounds for rejection of your bid.

Signature of Authorized Official Printed Name Title Submittal Date