7-MWBE Utilization Plan Commitment Form - 25 0298.pdf

MINORITY- AND WOMAN-OWNED BUSINESS ENTERPRISE

UTILIZATION COMMITMENT FORM

The undersigned has satisfied the requirements of the specifications in the following manner (please check the appropriate space):

The bidder is committed to M/WBE participation on this project equal to or greater than the goal stated in the bid and has submitted WITH ITS BID and attached hereto a Letter of Intent for each M/WBE subcontractor listed on the utilization plan.

OR -

The bidder is unable to meet the goal, is committed to a minimum of ______% M/WBE participation on this contract, and has submitted WITH ITS BID and attached hereto documentation of the bidder’s Good Faith Efforts. Vendors shall also provide a Letter of Intent for each M/WBE listed on the utilization plan.

Bidder:

By:

Signature Date

Address:

Zip Code:

Telephone No.:

Email address:

**Bidders that are M/WBE and completing the percentage of the goal as the prime for this project shall submit this completed form and their certification(s).

**Bidders may utilize the Letter of Intent form provided within this package or may submit vendors own letterhead.

M/WBE UTILIZATION PLAN

The M/WBE Utilization Plan must be completed and submitted by the time specified in the solicitation documents. Refer to the M/WBE Utilization Plan TIP SHEET for guidance on completing these forms. If the goal was not achieved, Good Faith Efforts documentation must be submitted with the M/WBE Utilization Plan.

All steps regarding the Good Faith Efforts MUST be documented and submitted with the M/WBE Utilization Plan if the goal is not met. Attach additional sheets as necessary.

Section I — Project Identification and Goal

Section II — Prime Company Information

I certify that the information included in this Utilization Plan is true and complete to the best of my knowledge and belief. I further understand and agree that this Utilization Plan shall become a part of my contract with Harris County.

Name and Title of Authorized Representative

Signature Date

For County Use Only:

I have reviewed this Utilization Plan and found that the Bidder HAS or HAS NOT complied as per the County M/WBE Policy.

Reviewer Date:

Tips: Use the name of the firm as listed in the directory.

Ensure the firm is certified in the area in which they are participating on this project by one of the approved agencies, and include a copy of the certification.

Ensure the firm’s participation is in line with the scope and germane to the project. Page 2 of 6

Project Name

Solicitation Number

Project Goal

M/WBE %

Name of Company Address City, State Zip Phone Name of Contact Person Email address for Contract Person

Telephone number for Contract Person Is prime company M/WBE certified? (MBE/WBE, DBE, HUB, or 8(a))

Yes No MBE/WBE Joint Venture

For County Use Only:

Verified Goal Attainment:

M/WBE %

Section III — Utilization Plan Summary

M/WBE(s): (MBE/WBE, DBE, HUB, or 8(a)) %

Non-Certified Subcontractor(s) %

%Total Participation (must equal 100%)

Is the stated M/WBE goal of the solicitation met? (If no, provide an explanation below, attach the Good Faith Efforts documentation)

Yes No

Explanation for not meeting the M/WBE Goal:

Goals: Proposed Participation

%Bidder’s own participation in project

Section IV — Disclosure of M/WBE Participation Please list all M/WBE subcontractors below & Duplicate as Needed

Tips: Use the name of the firm as listed in the certified directory.

Ensure the firm is certified by one of the approved agencies.

Ensure the firm’s participation is in line with the NAICS/NIGP code it is certified for.

Ensure the firm meets Significant Local Presence requirements.

Refer to Harris County M/WBE Policy for trucking companies to be used on the contract. Trucking companies must meet policy requirements to count for M/WBE goal credit.

Name of MBE/WBE Certified Firm

Must be certified by one of the approved agencies:

Certification MUST be current Copy of certificate must be submitted with this form o City of Houston (MBE/WBE) o Texas Unified Certification Program (DBE) o State of Texas Comptroller (HUB) o U.S. Small Business Administration 8(a)

Address/ City / State / Zip

Name of Contact Person

Email address for Contact Person

Telephone number for Contact Person

Percent of Total Contract Value

Description of services (must match NAICS/NIGP code)

6-digit NAICS/NIGP code for work to be performed

Name of MBE/WBE Certified Firm

Must be certified by one of the approved agencies:

-Certification MUST be current -Copy of certificate must be submitted with this form o City of Houston (MBE/WBE) o Texas Unified Certification Program (DBE) o State of Texas Comptroller (HUB) o U.S. Small Business Administration 8(a)

Address/ City / State / Zip

Name of Contact Person

Email address for Contact Person

Telephone number for Contact Person

Percent of Total Contract Value

Description of services (must match NAICS/NIGP code)

6-digit NAICS/NIGP code for work to be performed

Name of MBE/WBE Certified Firm

Must be certified by one of the approved agencies:

-Certification MUST be current -Copy of certificate must be submitted with this form o City of Houston (MBE/WBE) o Texas Unified Certification Program (DBE) o State of Texas Comptroller (HUB) o U.S. Small Business Administration 8(a)

Address/ City / State / Zip

Name of Contact Person

Email address for Contact Person

Telephone number for Contact Person

Percent of Total Contract Value

Description of services (must match NAICS/NIGP code)

6-digit NAICS/NIGP code for work to be performed

Name of MBE/WBE Certified Firm

Must be certified by one of the approved agencies:

-Certification MUST be current -Copy of certificate must be submitted with this form o City of Houston (MBE/WBE) o Texas Unified Certification Program (DBE) o State of Texas Comptroller (HUB) o U.S. Small Business Administration 8(a)

Address/ City / State / Zip

Name of Contact Person

Email address for Contact Person

Telephone number for Contact Person

Percent of Total Contract Value

Description of services (must match NAICS/NIGP code)

6-digit NAICS/NIGP code for work to be performed

Section IV — Disclosure of M/WBE Participation Please list all M/WBE subcontractors below & Duplicate as Needed

Tips: Use the name of the firm as listed in the certified directory.

Ensure the firm is certified by one of the approved agencies.

Ensure the firm’s participation is in line with the NAICS/NIGP code it is certified for.

Ensure the firm meets Significant Local Presence requirements.

Refer to Harris County M/WBE Policy for trucking companies to be used on the contract. Trucking companies must meet policy requirements to count for M/WBE goal credit.

SECTION V — Disclosure of Non-Certified Sub-consultants Duplicate As Needed

Name of Non-Certified Firm

Address/ City / State / Zip

Name of Contact Person

Email address for Contact Person

Telephone number for Contact Person

Percent of Subcontract

Description of services

6-digit NAICS code for work to be performed

Name of Non-Certified Firm

Address/ City / State / Zip

Name of Contact Person

Email address for Contact Person

Telephone number for Contact Person

Percent of Subcontract

Description of services

6-digit NAICS code for work to be performed

Name of Non-Certified Firm

Address/ City / State / Zip

Name of Contact Person

Email address for Contact Person

Telephone number for Contact Person

Percent of Subcontract

Description of services

6-digit NAICS code for work to be performed

LETTER OF INTENT TO SUBCONTRACT

Project Number

Project Title

______________________________________ (“Contractor”) agrees to enter a contractual agreement with ________________________________________ (“M/WBE Subcontractor”), who will provide the following goods/services in connection with the above-referenced contract:

Pursuant to Harris County’s M/WBE policy, only M/WBE firms which are currently certified with one of Harris County’s recognized certifying agencies may be counted towards meeting the M/WBE goal at the subcontracting level.

Insert a brief narrative describing the goods/services to be provided. Broad categorizations (e.g., “electrical,” “plumbing,” etc.) or the listing of the NAICS Codes in which M/WBE Subcontractor is certified are insufficient and may result in this Letter of Intent to Subcontract not being accepted.

for an estimated amount of $_____________________ or _______________% of the total estimated contract value.

The parties acknowledge that any obligation of the prime contractor to enter into a subcontract agreement or purchase order with the subcontractor is expressly contingent upon the prime contractor entering into a contract with Harris County for the work as defined in the bid/proposal.

This document must be completed in its entirety by the Contractor and signed by both the Contractor and the M/WBE Subcontractor.

Any false statements or misrepresentations regarding information submitted on this form may be a criminal offense in violation of Section 37.10 of the Texas Penal Code.

Contractor agrees to utilize M/WBE Subcontractor in the capacities indicated herein, and M/WBE Subcontractor agrees to work on the above-referenced contract in the capacities indicated herein, contingent upon award of the contract to Contractor.

Signature: Contractor Signature: M/WBE Subcontractor

Print Name Print Name

Title Date Title Date

Revised March 2022