5-3. Exhibit A-2-ECMCC- Boilerplate Language - Utilization Plan 20-10 wit....pdf
PDF 212 KB Posted
- Attached to
- GRAPHIC DESIGN AND VISUAL CONTENT SERVICES
- Solicitation number
- 202609
- Issued by
- Erie County, New York
About this file
This is an M/WBE (Minority/Women-Owned Business Enterprise) Utilization Plan form template issued by Erie County Medical Center Corporation (ECMCC) for a graphic design and visual content services contract. The form is designed to be submitted with proposals or within 48 hours of notice that a respondent is the apparent lowest responsible bidder. The contract supports ECMCC's marketing, branding, wayfinding, interior and exterior signage, and visual communications initiatives throughout ECMCC facilities on an as-needed basis. The form requires offerors to provide detailed information including company identification, location of work, contract value, and a comprehensive listing of certified M/WBE subcontractors and suppliers, including their names, addresses, contact information, classification, federal identification numbers, and detailed descriptions of work to be performed.
The contract establishes specific M/WBE participation requirements, with an overall M/WBE requirement of 30 percent, comprised of a 20 percent Minority-Owned Business Enterprise (MBE) requirement and a 10 percent Women-Owned Business Enterprise (WBE) requirement. The utilization plan must identify all certified M/WBE subcontractors and suppliers and specify the dollar value or percentage of subcontracts and services each will provide. Submission of the completed form constitutes the offeror's acknowledgement and agreement to comply with M/WBE requirements under NYS Executive Law Article 15-A and 5 NYCRR Part 143. Failure to submit complete and accurate information may result in findings of noncompliance, bid rejection, or contract termination. Utilization of certified MWBEs for non-commercially used functions cannot be counted toward M/WBE requirements.
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Text version
MWBE Utilization Plan rev 12/21
EXHIBIT A-2
M/WBE UTILIZATION PLAN
INSTRUCTIONS: This form must be submitted with any proposal or proposed negotiated contract or within 48 hours of notice from ECMCC that the respondent is the apparent lowest responsible bidder to an IFB. This Utilization Plan must contain a detailed description of the supplies and/or services to be provided by each certified Minority or Women-
Owned Business Enterprise (MWBE) under the contract. Attach additional sheets if necessary.
Offeror’s Name: _____________________________________________________ Federal Identification No.: ___________________________________________
Email Address: _____________________________________________________ Location of Work: ___________________________________________
Address: __________________________________________________________ RFP or Bid No.: __________________________________________________
City, State, Zip Code: _________________________________________________ M/WBE Requirement in the Contract: 30%
Telephone Number: __________________________________________________ MBE Requirement in the Contract: 20%
NYS Contract System Identification No: ____________________________________________ WBE Requirement in the Contract: 10%
NYS Contract System point of contact User: ________________________________________________ Contract Value: ____________________________________________________
1. Certified M/WBE Subcontractors/Suppliers
Name, Address, Email Address, Telephone No.
2. Classification 3. Federal ID No. 4. Detailed Description of Work (Attach additional sheets, if necessary)
5. Dollar Value or percentage of
Subcontracts/
Supplies/Services
1.
NYS ESD CERTIFIED
MBE
WBE
2. NYS ESD CERTIFIED
3.
4. NYS ESD CERTIFIED
5.
MWBE Utilization Plan rev 12/21
6. NYS ESD CERTIFIED
7.
8. NYS ESD CERTIFIED
PREPARED BY (Signature):
DATE:
NAME AND TITLE OF PREPARER (Print or Type):
SUBMISSION OF THIS FORM CONSTITUTES THE OFFEROR’S ACKNOWLEDGEMENT AND AGREEMENT TO COMPLY WITH THE M/WBE REQUIREMENTS SET FORTH UNDER NYS EXECUTIVE LAW, ARTICLE 15-A, 5 NYCRR PART 143, AND THE ABOVE-REFERENCED SOLICITATION. FAILURE TO SUBMIT COMPLETE AND ACCURATE INFORMATION MAY RESULT IN A FINDING OF NONCOMPLIANCE
AND/OR REJECTION OF YOUR BID/PROPOSAL AND/OR POSSIBLE TERMINATION OF YOUR CONTRACT. UTILIZATION OF CERTIFIED MWBES FOR NON-COMMERCIALLY USEF FUNCTIONS MAY NOT
BE COUNTED TOWARD MWBE REQUIREMENTS.
FOR ECMCC M/WBE USE ONLY
REVIEWED BY:
DATE:
UTILIZATION PLAN APPROVED: YES NO Date:
Contract No.: Project No. (if applicable):
Contract Award Date:
Estimated Date of Completion:
Amount Obligated Under the Contract:
Description of Work:
NOTICE OF DEFICIENCY ISSUED: YES NO Date:______________
NOTICE OF ACCEPTANCE ISSUED: YES NO Date:_____________
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