5-3. Exhibit A-2 Utilization Plan 0% (2022).pdf
PDF 330 KB Posted
- Attached to
- CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP)/ BILEVEL POSITIVE AIRWAY PRESSURE (BIPAP) EQUIPMENT
- Solicitation number
- 202522
- 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) related to a procurement for CPAP and BiPAP equipment and accessories. The contract opportunity involves providing CPAP and BiPAP devices along with necessary accessories including tubing, filters, humidifiers, and compatible stands, with an initial order of ten devices and potential for additional purchases during the contract period. The form requires offerors to submit detailed information regarding certified M/WBE subcontractors and suppliers who will participate in the contract, including their names, addresses, classifications, Federal Identification Numbers, and specific descriptions of work to be performed. The utilization plan must be submitted with the proposal, within the proposal submission deadline, or within 48 hours of notice that the respondent is the apparent lowest responsible bidder for an Invitation for Bid (IFB).
This particular utilization plan form indicates an M/WBE goal of 0% for the contract, meaning there is no mandatory minority or women-owned business participation requirement for this specific procurement. The form requires comprehensive documentation from offerors regarding any M/WBE participation they voluntarily elect to include, with space for up to eight certified subcontractors or suppliers and their respective dollar values or percentages of the total contract value. Submission of the completed form constitutes the offeror's acknowledgement and agreement to comply with M/WBE requirements under New York State Executive Law Article 15-A and 5 NYCRR Part 143. Failure to provide complete and accurate information may result in noncompliance findings, bid rejection, or contract termination.
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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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