5-3. Exhibit A-2 Utilization Plan 0% (2022).pdf
PDF 330 KB Posted
- Attached to
- INSURANCE BROKER & CLAIM MANAGEMENT
- Solicitation number
- 202604
- Issued by
- Erie County, New York
About this file
This is a Minority and Women-Owned Business Enterprise (M/WBE) Utilization Plan form for Erie County Medical Center Corporation (ECMCC) in New York. The form is designed for vendors responding to ECMCC solicitations to document their engagement of certified M/WBE subcontractors and suppliers. Respondents must submit the completed form with their proposal, as a negotiated contract, or within 48 hours of receiving notice that they are the apparent lowest responsible bidder for an Invitation for Bid (IFB). The form requires detailed information about each certified M/WBE participant, including the company name, address, contact information, federal identification number, classification as either a Minority-Owned Business Enterprise (MBE) or Women-Owned Business Enterprise (WBE), a detailed description of the supplies or services to be provided, and the corresponding dollar value or percentage of the subcontract or services. The form accommodates up to eight M/WBE entities and requires the signature and date from the preparer along with the preparer's printed name and title.
For this particular solicitation, the M/WBE utilization goal is set at 0 percent, indicating no mandatory M/WBE participation requirement for this contract. The form requires respondents to acknowledge their understanding of and agreement to comply with M/WBE requirements under New York State Executive Law Article 15-A and 5 NYCRR Part 143. Submission of the form constitutes the offeror's commitment to these compliance obligations. The form includes a section for ECMCC's M/WBE office to review and approve the utilization plan and issue either a notice of acceptance or deficiency. Failure to submit complete and accurate information may result in findings of noncompliance, 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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