Appendix C - DBE Form - 37-25-037.pdf
PDF 101 KB Posted
- Attached to
- Traffic Signal Modernization - Engineering Services State and local contract opportunity
- Solicitation number
- 37-25-037
- Issued by
- Wayne County, Michigan
About this file
The document is a Disadvantaged Business Enterprise (DBE) Participation Form for Wayne County, Michigan, related to a Traffic Signal Modernization project involving professional engineering services. The county has established a DBE participation goal of 8 percent for this contract, with 6% allocated to Women's Business Enterprises (WBEs) and 2% to Minority Business Enterprises (MBEs). Bidders are required to detail the responsibilities of each DBE participant and provide proof of certification or certification application through the Michigan United Certification Program (MUCP).
The form requires bidders to specify the percentage of DBE participation, provide detailed information about each DBE firm's role, and include supporting documentation such as the type of support provided, legal relationship documents, and resumes of principal(s). Failure to complete the form may result in the bid or proposal being deemed non-responsive and rejected without further evaluation. Bidders must indicate whether participating DBE firms are certified by Wayne County or the Michigan Department of Transportation (MDOT), and must submit proof of certification or certification application. For assistance, bidders can contact the Human Relations department at the provided phone number.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| Appendix A - Price Sheet.xlsx | XLSX spreadsheet | |
| RFP 37-25-037 - Traffic Signal Design.docx | DOCX document | |
| W-9 Form v10-18.pdf | ||
| attachment-download.doc | DOC document | |
| Appendix D - Debarment Form.pdf | ||
| First Tier Subcontractor_designation_form-final 8-2023.pdf |
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Text version
DISADVANTAGED BUSINESS ENTERPRISE (DBE)
PARTICIPATION FORM
Failure to complete this form may result in your bid or proposal being deemed nonresponsive and rejected without any further evaluation.
(Make additional copies if more than two DBE firms are participating.)
1. The County has set a goal of 8 percent for participation by Disadvantaged Business Enterprises (DBE) for this contract, with 6% allocated to WBEs and 2% to MBEs.
2. List the % level of DBE Participation proposed: ___% WBE ___% MBE Total DBE=___%
3. Describe, in detail, the responsibilities of each DBE participant (attach additional sheets, if necessary) (To be counted towards the DBE goal, a firm must either be certified or have applied for certification by the due date on the cover of this document.)
DBE Name: % of Total Contract:
Address:
Contact Name: Phone #:
Detailed Description of Responsibilities:
Is the business certified as an DBE by an agency participating in the Michigan United Certification Program (MUCP) _____ YES _____ NO If no, have they applied for certification with an agency participating in the MUCP _____ YES _____ NO. Proof of certification or documentation from a certifying agency confirming receipt of DBE certification application must be submitted with this form.
Is the Business an MBE ___ YES ___ NO? If yes, who certified the Business? ___ Wayne County ___
MDOT
Is the Business a WBE ___ YES ___ NO? If yes, who certified the Business? ___ Wayne County ___
MDOT
Include the following (if applicable):
• The support (financial, technical, management, training, etc.) provided by the Proposer to each DBE partner.
• A copy of the documents that contain the proposed legal relationship between Proposer and each DBE participant (if applicable).
• Provide a resume for the principal(s) of the firms identified above.
DBE Name: % of Total Contract:
Address:
Contact Name: Phone #:
Detailed Description of Responsibilities:
Is the business certified as an DBE by an agency participating in the Michigan United Certification Program (MUCP) _____ YES _____ NO If no, have they applied for certification with an agency participating in the MUCP _____ YES _____ NO. Proof of certification or documentation from a certifying agency confirming receipt of DBE certification application must be submitted with this form.
Is the Business an MBE ___ YES ___ NO? If yes, who certified the Business? ___ Wayne County ___ MDOT Is the Business a WBE ___ YES ___ NO? If yes, who certified the Business? ___ Wayne County ___ MDOT
Include the following (if applicable):
• The support (financial, technical, management, training, etc.) provided by the Bidder to each DBE partner.
• A copy of the documents that contain the proposed legal relationship between Bidder and each DBE participant (if applicable).
• Provide a resume for the principal(s) of the firms identified above.
For assistance, or for more information on the DBE program or the MUCP, contact Human Relations at 313-224-5021.
File details come from the government source that posted it. Updated .