Attach B - Small Business Participation Data Form.xlsx

Part I

The Proposer is required to provide information concerning utilization of micro businesses, small businesses, women-owned businesses, minority-owned businesses and service-disabled veteran-owned businesses proposed for this project as well as on past projects. Failure to complete and return this form with the response to the RFP will result in the proposing firm being considered “non-responsive”.

PART I – DEFINITIONS

The definitions below are applicable to vendors doing business with the Commonwealth of Virginia. Federal definitions shall govern with respect to meeting federally funded highway construction and other federally financed programs.

Education.

Micro Business: A small business certified as such by the Virginia Department of Small Business and Supplier Diversity (DSBSD). For purposes of DSBSD micro certification, the business must have no more than 25 employees and has no more than $3 million in average annual revenue over the three-year period prior to certification.

Minority Individual: An individual who is a citizen of the United States or a legal resident alien and who satisfies one or more of the following definitions:

1. African American: A person having origins in any of the original peoples of Africa and who is regarded as such by the community of which this person claims to be a part.

2. Asian American: A person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands, including but not limited to Japan, China, Vietnam, Samoa, Laos, Cambodia, Taiwan, Northern Mariana Islands, the Philippines, a U.S. territory of the Pacific, India, Pakistan, Bangladesh, or Sri Lanka, and who is regarded as such by the community of which this person claims to be a part.

3. Hispanic American: A person having origins in any of the Spanish-speaking peoples of Mexico, South or Central America, or the Caribbean Islands or other Spanish or Portuguese cultures and who is regarded as such by the community of which this person claims to be a part.

4. Native American: A person having origins in any of the original peoples of North America and who is regarded as such by the community of which this person claims to be a part or who is recognized by a tribal organization.

Minority-Owned Business: A business certified as such by the Virginia Department of Small Business and Supplier Diversity (DSBSD). The Code of Virginia defines this to include businesses that are at least 51 percent owned by one or more minority individuals who are U.S. citizens or legal resident aliens, or in the case of a corporation, partnership, or limited liability company or other entity, at least 51 percent of the equity ownership interest in the corporation, partnership, or limited liability company or other entity is owned by one or more minority individuals who are U.S. citizens or legal resident aliens, and both the management and daily business operations are controlled by one or more minority individuals, or any historically black college or university, regardless of the percentage ownership by minority individuals or, in the case of a corporation, partnership, or limited liability company or other entity, the equity ownership interest in the corporation, partnership, or limited liability company or other entity.

Service Disabled Veteran: A veteran who (i) served on active duty in the United States military ground, naval, or air service, (ii) was discharged or released under conditions other than dishonorable, and (iii) has a service-connected disability rating fixed by the United States Department of Veterans Affairs.

Service Disabled Veteran-Owned Business: A business certified as such by the Virginia Department of Small Business and Supplier Diversity (DSBSD). The Code of Virginia defines this to include businesses that are at least 51 percent owned by one or more service disabled veterans or, in the case of a corporation, partnership, or limited liability company or other entity, at least 51 percent of the equity ownership interest in the corporation, partnership, or limited liability company or other entity is owned by one or more individuals who are service disabled veterans and both the management and daily business operations are controlled by one or more individuals who are service disabled veterans.

Small Business: A business certified by the Virginia Department of Small Business and Supplier Diversity (DSBSD) as compliant with Code of Virginia, §§ 2.2-1604 and 2.2-4310. The Code of Virginia defines a “small business” as one that is at least 51% independently owned and controlled by one or more individuals, or in the case of a cooperative association organized pursuant to Chapter 3 (§ 13.1-301 et seq.) of Title

13.1 as a nonstock corporation, controlled by one or more members, who are U.S. citizens or legal resident aliens, and together with affiliates, has 250 or fewer employees or average gross receipts of $10 million or less averaged over the previous three years. One or more of the individual owners or members shall control both the management and daily business operations of the small business.

Women-Owned Business: A business certified as such by the Virginia Department of Small Business and Supplier Diversity (DSBSD). The Code of Virginia defines this to include businesses which are at least 51 percent owned by one or more women who are U.S. citizens or legal resident aliens, or in the case of a corporation, partnership, or limited liability company or other entity, at least 51 percent of the equity ownership interest is owned by one or more women who are U.S. citizens or legal resident aliens, and both the management and daily business operations are controlled by one or more women.

Part II

OFFEROR / PROPOSER:

Firm Name:

Contact Person:

Phone Number:

DPOR Registration # :

PROPOSAL FOR:

Agency:

Project Title:

Project Code No.:

Is the Proposer a Micro Business?

Is the Proposer a Small Business?

Is the Proposer a Woman-Owned Business?

Is the Proposer a Minority-Owned Business?

Is the Proposer a Service-Disabled Veteran-Owned Small Business?

REMARKS / COMMENTS:

Part III

Part IV