5-MBE_Utilization_Form.docx

DOCX document 24 KB Posted

Attached to
On Call Storm Drain Maintenance
Solicitation number
2026-ITB-356
Issued by
New Haven County, Connecticut

About this file

This is an MBE Utilization Form for the City of New Haven, Connecticut, required as part of the submission process for the On Call Storm Drain Maintenance contract. The form mandates that contractors provide a complete listing of all subcontractors to be used on the project, including their names, addresses, types of work, dollar amounts, outreach methods used to secure them, and appropriate company classifications. Contractors must certify that they have reviewed the City of New Haven's minority and women-owned small business goals and have achieved the required 25 percent participation goal. The form requires contractor signature and approval from the City's relevant department.

Failure to complete and submit this MBE Utilization Form will result in a non-responsive bid determination and rejection of the submission. This documentation is a critical compliance requirement for all bidders on this contract and must be properly completed at the time of submission.

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Text version

City of New Haven MBE Utilization Documentation – Sub-Contractor Listing Project Name and ID:

The Contractor herewith submits a complete list of all Subcontractors to be used on the project by name address, type of work, dollar amount, outreach method used to secure subcontractor and appropriate company classification. This form must be completed as part of your submission. Your submission will be deemed non-responsive if the form is not completed and your response will be rejected.

I am representing Certify that I have read the City of New Haven's goals Name Company for use of minority and women owned small businesses and I have achieved the Goal of 25% participation.

Signature Type Name & Title Date Approved by S

CD

- Signature Print Name and Title Date

Name of Contractor
Address
Telephone
Contact
Type of Work
Dollar

Amount Type of Outreach

MBE
WBE

Rev 9/25/2024[DOCUMENT TITLE] | [Document subtitle]

File details come from the government source that posted it. Updated .