5-3. Exhibit A-2 Utilization Plan 0% (2022).pdf
PDF 330 KB Posted
- Attached to
- GIFT CARD PROGRAM FOR GRANT PURPOSES
- Solicitation number
- 202521
- Issued by
- Erie County, New York
About this file
This is an M/WBE Utilization Plan form for Erie County Medical Center Corporation (ECMCC) in New York, designed for submission with proposals or negotiated contracts related to a gift card program for grant purposes. The form requires detailed information about certified Minority and Women-Owned Business Enterprise (MWBE) subcontractors and suppliers that will participate in the contract, including their names, addresses, contact information, federal identification numbers, classification status, and a comprehensive description of the work or services to be provided. Offerors must complete all required fields identifying the contract value, location of work, RFP or bid number, and NYS Contract System identification information. The form includes space for up to eight MWBE entries and requires the offeror's signature and attestation of compliance with NYS Executive Law Article 15-A and 5 NYCRR Part 143.
The contract opportunity specifies an M/WBE goal of 0%, indicating no mandatory minority or women-owned business participation requirement for this particular solicitation. The form serves as a compliance document that must be submitted within 48 hours of notice if the respondent is identified as the apparent lowest responsible bidder in an Invitation for Bid (IFB) process. Failure to submit complete and accurate information may result in a finding of noncompliance, rejection of the bid or proposal, or potential termination of the contract. The ECMCC M/WBE administrator reviews the submission and issues either a notice of acceptance or deficiency, with the form capturing approval status, contract award date, estimated completion date, and the amount obligated under the contract.
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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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