Appendix MWBE-2.pdf

STAFFING PLAN

Submit with Bid or Proposal – Instructions on page 2

Solicitation No.: Reporting Entity: Report includes Contractor’s/Subcontractor’s:

□ Work force to be utilized on this contract

□ Total work force

Offeror’s Name: □ Offeror

□ Subcontractor

Subcontractor’s name________________Offeror’s Address:

Enter the total number of employees for each classification in each of the EEO-Job Categories identified

Work force by Gender Work force by

Race/Ethnic Identification

EEO-Job Category Total Work force

Total Total Total

Male Female X White Black Hispanic Asian Native

American Disabled Veteran

(M) (F) (X) (M) (F) (X) (M) (F) (X) (M) (F) (X) (M) (F) (X) (M) (F) (X) (M) (F) (X) (M) (F) (X)

Officials/Administrators

Professionals

Technicians

Sales Workers

Office/Clerical

Craft Workers

Laborers

Service Workers

Temporary /Apprentices

Totals

PREPARED BY (Signature): TELEPHONE NO.:

EMAIL ADDRESS:

DATE:

NAME AND TITLE OF PREPARER (Print or Type): Submit completed with bid or proposal MWBE 101 (Rev 03/11)

Appendix MWBE-2

General instructions: All Offerors and each subcontractor identified in the bid or proposal must complete an EEO Staffing Plan (MWBE 101) and submit it as part of the bid or proposal package. Where the work force to be utilized in the performance of the State contract can be separated out from the contractor’s and/or subcontractor’s total work force, the Offeror shall complete this form only for the anticipated work force to be utilized on the State contract. Where the work force to be utilized in the performance of the State contract cannot be separated out from the contractor’s and/or subcontractor’s total work force, the Offeror shall complete this form for the contractor’s and/or subcontractor’s total work force.

Instructions for completing:

1. Enter the Solicitation number that this report applies to along with the name and address of the Offeror.

2. Check off the appropriate box to indicate if the Offeror completing the report is the contractor or a subcontractor.

3. Check off the appropriate box to indicate work force to be utilized on the contract or the Offerors’ total work force.

4. Enter the total work force by EEO job category.

5. Break down the anticipated total work force by gender and enter under the heading ‘Work force by Gender’

6. Break down the anticipated total work force by race/ethnic identification and enter under the heading ‘Work force by Race/Ethnic Identification’. Contact the OMWBE Permissible contact(s) for the solicitation if you have any questions.

7. Enter information on disabled or veterans included in the anticipated work force under the appropriate headings.

8. Enter the name, title, phone number and email address for the person completing the form. Sign and date the form in the designated boxes.

RACE/ETHNIC IDENTIFICATION

Race/ethnic designations as used by the Equal Employment Opportunity Commission do not denote scientific definitions of anthropological origins. For the purposes of this form, an employee may be included in the group to which he or she appears to belong, identifies with, or is regarded in the community as belonging. However, no person should be counted in more than one race/ethnic group. The race/ethnic categories for this survey are:

• WHITE (Not of Hispanic origin) All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.

• BLACK a person, not of Hispanic origin, who has origins in any of the black racial groups of the original peoples of Africa.

• HISPANIC a person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race.

• ASIAN & PACIFIC a person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent or the Pacific Islands.

ISLANDER

• NATIVE INDIAN (NATIVE a person having origins in any of the original peoples of North America, and who maintains cultural identification through tribal AMERICAN/ ALASKAN affiliation or community recognition.

NATIVE)

OTHER CATEGORIES

• DISABLED INDIVIDUAL any person who: - has a physical or mental impairment that substantially limits one or more major life activity(ies)

- has a record of such an impairment; or

- is regarded as having such an impairment.

• VIETNAM ERA VETERAN a veteran who served at any time between and including January 1, 1963 and May 7, 1975.

• GENDER Male, Female, or X