5-MBE_Utilization_Form.docx

This is a Minority Business Enterprise (MBE) Utilization Documentation form issued by the City of New Haven, Connecticut, for subcontractor listing on an on-call permanent road patching contract. The form requires contractors to submit a complete list of all subcontractors to be utilized on the project, including company names, addresses, types of work, dollar amounts, outreach methods used to secure subcontractors, and appropriate company classifications. Contractors must certify that they have reviewed the City of New Haven's goals for minority and women-owned small business participation and have achieved the required 25% participation goal. Submission of the completed form is mandatory, and failure to complete and submit the form will result in a non-responsive bid rejection.

The form requires contractor identification information, including name, address, and telephone contact details, and must be signed by an authorized representative with name, title, and date. The form includes designation columns for identifying subcontractors as either Minority Business Enterprises (MBE) or Women Business Enterprises (WBE). The completed documentation must be approved by the City of New Haven's relevant approval authority, with signature, printed name, title, and date. The form was last revised on September 25, 2024.