5-3. Exhibit A-2 Utilization Plan 0% (2022).pdf
PDF 330 KB Posted
- Attached to
- IN-PERSON AND WRITTEN INTERPRETATIVE SERVICES
- Solicitation number
- 202601
- Issued by
- Erie County, New York
About this file
This is an M/WBE Utilization Plan form issued by Erie County Medical Center Corporation (ECMCC) in New York in connection with a contract solicitation for in-person and written interpretative services for non-English speakers, deaf, and hearing-impaired individuals requiring American Sign Language (ASL) interpretation and translation services. The form must be submitted with any proposal or negotiated contract, or within 48 hours of notice that the respondent is the apparent lowest responsible bidder to an Invitation for Bid (IFB). The utilization plan requires offerors to provide detailed descriptions of supplies and services to be provided by each certified Minority or Women-Owned Business Enterprise (MWBE) subcontractor or supplier participating in the contract, including the subcontractor's name, address, email, telephone number, classification, Federal Identification Number, detailed work description, and dollar value or percentage of subcontracts or supplies and services.
For this particular contract opportunity, the M/WBE goal is set at 0%, indicating no minority or women-owned business enterprise participation requirement. The form requires the offeror to identify whether each subcontractor or supplier is NYS ESD certified as an MBE or WBE, with space for up to eight participating entities. Submission of the completed form constitutes the offeror's acknowledgment and agreement to comply with M/WBE requirements under NYS Executive Law Article 15-A and 5 NYCRR Part 143. ECMCC's review process includes approval or rejection of the utilization plan, with notice of deficiency or acceptance issued to the offeror following evaluation. Failure to submit complete and accurate information may result in noncompliance findings, bid rejection, or possible 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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