5-3. Exhibit A-2 Utilization Plan 0% (2022).pdf

MWBE Utilization Plan rev 5/22

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.

Federal Identification No.: ___________________________________________

Location of Work: __________________________________________________

RFP or Bid No.: __________________________________________________

M/WBE Goals in the Contract: 0%

Offeror’s Name: _____________________________________________________

Address: __________________________________________________________

City, State, Zip Code: _________________________________________________

Telephone Number: __________________________________________________

NYS Contract System Identification No: ________________________________

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

MBE

WBE

3. NYS ESD CERTIFIED

MBE

WBE

4. NYS ESD CERTIFIED

MBE

WBE

5. NYS ESD CERTIFIED

MBE

WBE

MWBE Utilization Plan rev 5/22

6. NYS ESD CERTIFIED

MBE

WBE

7. NYS ESD CERTIFIED

MBE

WBE

8. NYS ESD CERTIFIED

MBE

WBE

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.

TELEPHONE NO.: EMAIL ADDRESS:

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:_____________