5-3. Exhibit A-2 Utilization Plan 0% (2022).pdf
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- Attached to
- INTERNET PROTOCOL (IP) BROKERAGE
- Solicitation number
- 202608
- Issued by
- Erie County, New York
About this file
This is a Minority/Women-Owned Business Enterprise (M/WBE) Utilization Plan form for Erie County Medical Center Corporation (ECMCC) in New York. The document serves as a template for respondents to proposals, negotiated contracts, or invitations for bids to detail their use of certified M/WBE subcontractors and suppliers. Respondents must submit the completed form with their proposal, within their negotiated contract submission, or within 48 hours of ECMCC notification that they are the apparent lowest responsible bidder. The form requires offerors to provide detailed descriptions of supplies and services to be provided by each certified M/WBE, including the subcontractor or supplier name, address, email, telephone number, classification, federal identification number, work description, and dollar value or percentage of the subcontract. The document includes space for up to eight M/WBE entries and requires the preparer's signature, name, title, and date.
The M/WBE goals for this particular contract are set at 0%, indicating no utilization requirement for minority or women-owned businesses on this specific opportunity. The form notes that submission 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. ECMCC reviews the completed utilization plan and may issue notices of deficiency or acceptance accordingly. The document also specifies that utilization of certified M/WBEs for non-commercially useful functions cannot be counted toward M/WBE requirements.
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Text version
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:_____________
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