Attachment D-1A .pdf

Attachment D-1A Minority Business Enterprise (MBE) Utilization and Fair Solicitation Affidavit &

MBE Participation Schedule

If a bidder or offeror fails to complete accurately or submit the MBE utilization affidavit or MBE participation schedule, an agency’s procurement officer, after consultation with the agency’s minority business liaison, shall notify the bidder or offeror of the deficiency and require the bidder or offeror to submit an amended MBE utilization affidavit, MBE participation schedule, or both within three business days.

If, within three business days, the bidder or offeror fails to submit the amended form or forms correcting the deficiency identified, the procurement officer may determine, in the case of a bid, that the bid is not responsive or, in the case of a proposal, that the proposal is not reasonably susceptible of being selected for award.

For detailed instructions on completing this Affidavit, please refer to Appendix 4A of the solicitation.

Part 1 – MBE Utilization and Fair Solicitation Affidavit

Solicitation Number:

Solicitation MBE Goal:

Solicitation Subgoals (If subgoals do not apply, please input 'NA' for each field):

______% African American-Owned MBE Firms ______% Hispanic American-Owned MBE Firms

______% Asian American-Owned MBE Firms ______% Women-Owned MBE Firms

IN CONNECTION WITH THE BID/PROPOSAL SUBMITTED IN RESPONSE TO THE SOLICITATION INDICATED

ABOVE, I AFFIRM THE FOLLOWING MBE PARTICIPATION:

I acknowledge and intend to MEET IN FULL OR EXCEED both the overall certified Minority

Business Enterprise (MBE) participation goal and all applicable subgoals. Therefore, I am not seeking a waiver pursuant to COMAR 21.11.03.11. I acknowledge that by selecting and agreeing to meet the stated goal and all applicable subgoals (if any), I must complete the MBE Participation Schedule (Part 2) and the Signature Page (Part 3) to be considered for award.

OR

After making good faith outreach efforts prior to making this submission, I conclude that I am unable to achieve the MBE participation goal and/or subgoals. I hereby request a waiver, in whole or in part, of the overall goal and/or subgoals. Access Waiver Guidance here.

I acknowledge that by requesting a partial waiver of the stated goal and/or one or more of the stated subgoals (if any), I must complete the MBE Participation Schedule (Part 2) and the Signature Page (Part 3) for the portion of the goal and/or subgoal for which I am not seeking a waiver in order to be considered for award. Similarly, I acknowledge that by requesting a full waiver of the stated goal and the stated subgoals (if any), I must complete the Signature Page (Part 3) to be considered for award.

Attachment D-1A – MBE Forms Page 1 Effective Date: September 1, 2026 https://procurement.maryland.gov/wp-content/uploads/sites/12/2026/08/Appendix-4A-Effective-9-1-26.pdf https://procurement.maryland.gov/wp-content/uploads/sites/12/2026/08/Attachment-D-MBE-Forms-Effective-9-1-26.pdf

_______% (50% max) = ________

Attachment D-1A.

Minority Business Enterprise (MBE) Utilization and Fair Solicitation Affidavit &

MBE Participation Schedule

Part 2 – MBE Participation Schedule

For detailed instructions on completing this participation schedule, please refer to Appendix 4A of the solicitation.

Note: MBE Prime Contractors, who are self performing, must complete both Section A and Section B.

Prime Contractor

Project/Solicitation Number

Project Description

SECTION A: For MBE Primes ONLY (including MBE Primes in a Joint Venture)

MBE Prime Name:

MBE Certification Number: _________________

NAICS: _________________________________

MBE Prime Classification:

If the MBE Prime is counting its self-performed work towards any subgoal, select the appropriate classification for the subgoal:

African American Hispanic American Asian American Native American Women-Owned Other MBE Classification

Brief description of the work to be performed by MBE Prime Contractor:

Section A1 (MBE Prime Self-Performance):

The percentage of total contract value to be performed with your own forces and counted towards the overall MBE goal cannot exceed 50% of the overall goal. For example, if an overall goal is set at 20%, an MBE Prime may perform a maximum of 10% of the overall goal (50% of the established 20% goal). Details.

Percentage of Total Contract Value to Be Performed by MBE Prime (auto-calculation):

Overall Participation Goal ________%

Category of Work and Calculations:

Select one category that applies to the type of work your firm is self-performing to calculate the amount being counted towards achieving the MBE Participation Goal(s):

Supplier, Wholesaler, and/or Regular Dealer (count 60%) Enter the percentage amount for work in which the MBE Prime is being utilized in this category. The percentage entered should match that of the 50% maximum overall participation goal computed in Section A1. [Details]

Total Percentage as Supplier: _______% 60% = _______%

Manufacturer (count 100%) Enter the percentage amount for work in which the MBE Prime is being utilized in this category. The percentage entered should match that of the 50% maximum overall participation goal computed in Section A1. [Details]

Total Percentage as Manufacturer: _______%

Furnish & Install and/or Other Services (count 100%) Enter the percentage amount for work in which the MBE Prime is being utilized in this category. The percentage entered should match that of the 50% maximum overall participation goal computed in Section A1. [Details]

Total Percentage as Furnish & Install/Other Services: _______%

Broker (count reasonable fees / commission only) Enter the percentage amount for work in which the MBE Prime is being utilized in this category. [Details]

Total Percentage as a Broker: %

Attachment D-1A – MBE Forms Page 2 Effective Date: September 1, 2026 https://procurement.maryland.gov/wp-content/uploads/sites/12/2026/08/Appendix-4A-Effective-9-1-26.pdf https://procurement.maryland.gov/wp-content/uploads/sites/12/2026/08/Appendix-4A-Effective-9-1-26.pdf https://procurement.maryland.gov/wp-content/uploads/sites/12/2026/08/Appendix-4A-Effective-9-1-26.pdf https://procurement.maryland.gov/wp-content/uploads/sites/12/2026/08/Appendix-4A-Effective-9-1-26.pdf https://procurement.maryland.gov/wp-content/uploads/sites/12/2026/08/Appendix-4A-Effective-9-1-26.pdf https://procurement.maryland.gov/wp-content/uploads/sites/12/2026/08/Appendix-4A-Effective-9-1-26.pdf s: _______%

SECTION B: For ALL MBE Subcontractors and Third-Tier Contractors

MBE Firm Name: Percentage of Total Contract Value to Be Performed by MBE Firm:

Participation Goal for MBE Firm: ________% MBE Certification Number: _________________

Category of Work and Calculations: NAICS: _________________________________ Select one category that applies to the type of work this

MBE Firm Email Address: subcontractor is performing to calculate the amount being counted towards achieving the MBE Participation Goal(s):

Supplier, Wholesaler, and/or Regular Dealer (count 60%) MBE Classification(Select All That Apply): Enter the percentage amount for work in which the subcontractor is being utilized in this category. The percentage entered should match African American-Owned that of the participation goal entered for this MBE Firm above. [Details] Hispanic American-Owned Asian American-Owned Total Percentage as Supplier: _______% 60% = _______% Native American-Owned Women-Owned Manufacturer (count 100%) Other MBE Classification Enter the percentage amount for work in which the subcontractor is being utilized in this category. The percentage entered should match Brief description of the work to be performed by that of the participation goal entered for this MBE Firm above. [Details] MBE Firm:

Total Percentage as Manufacturer

Furnish & Install and/or Other Services (count 100%) Enter the percentage amount for work in which the subcontractor is being utilized in this category. The percentage entered should match that of the participation goal entered for this MBE Firm above. [Details]

Indicate Subcontractor Type:

This MBE firm is a subcontractor Total Percentage as Furnish & Install/Other Service

This MBE firm is a third-tier contractor Broker (count reasonable fees / commission only) Third-tier subcontracting requires either preapproval Enter the percentage amount for work in which the subcontractor is as specified in the solicitation or separate written being utilized in this category. [Details] approval in accordance with policy. [Details]

Total Percentage as a Broker: _______% This third-tier contractor will be working with this subcontractor: Prime Contractor's Attestation to Subcontractor Engagement:

As Prime Contractor, I acknowledge and attest to having engaged with the listed MBE and intend to continue engagement if this solicitation results in the award of a contract. As Prime Contractor, I agree to State check-ins to verify subcontractor engagement.

MBE Participation Schedule

For instructions and applicable worksheets to assist in completing any part of this D-1A form, including worksheets and/or tutorials to calculate percentages for MBEs being utilized in certain job categories (i.e. 60% Rule), please refer to Appendix 4A of the solicitation.

Attachment D-1A – MBE Forms Page 3 Effective Date: September 1, 2026 https://procurement.maryland.gov/wp-content/uploads/sites/12/2026/08/Appendix-4A-Effective-9-1-26.pdf https://procurement.maryland.gov/wp-content/uploads/sites/12/2026/08/Appendix-4A-Effective-9-1-26.pdf https://procurement.maryland.gov/wp-content/uploads/sites/12/2026/08/Appendix-4A-Effective-9-1-26.pdf https://procurement.maryland.gov/wp-content/uploads/sites/12/2026/08/Appendix-4A-Effective-9-1-26.pdf https://procurement.maryland.gov/wp-content/uploads/sites/12/2026/08/Appendix-4A-Effective-9-1-26.pdf https://procurement.maryland.gov/wp-content/uploads/sites/12/2026/08/Appendix-4A-Effective-9-1-26.pdf

SECTION B: For ALL MBE Subcontractors and Third-Tier Contractors

MBE Firm Name: Percentage of Total Contract Value to Be Performed by MBE Firm:

Participation Goal for MBE Firm: ________% MBE Certification Number: _________________

Category of Work and Calculations: NAICS: _________________________________ Select one category that applies to the type of work this

MBE Firm Email Address: subcontractor is performing to calculate the amount being counted towards achieving the MBE Participation Goal(s):

Supplier, Wholesaler, and/or Regular Dealer (count 60%) MBE Classification(Select All That Apply): Enter the percentage amount for work in which the subcontractor is being utilized in this category. The percentage entered should match African American-Owned that of the participation goal entered for this MBE Firm above. [Details] Hispanic American-Owned Asian American-Owned Total Percentage as Supplier: _______% 60% = _______% Native American-Owned Women-Owned Manufacturer (count 100%) Other MBE Classification Enter the percentage amount for work in which the subcontractor is being utilized in this category. The percentage entered should match Brief description of the work to be performed by that of the participation goal entered for this MBE Firm above. [Details] MBE Firm:

Total Percentage as Manufacturer

Furnish & Install and/or Other Services (count 100%) Enter the percentage amount for work in which the subcontractor is being utilized in this category. The percentage entered should match that of the participation goal entered for this MBE Firm above. [Details]

Indicate Subcontractor Type:

This MBE firm is a subcontractor Total Percentage as Furnish & Install/Other Services: _______%

This MBE firm is a third-tier contractor Broker (count reasonable fees / commission only) Third-tier subcontracting requires either preapproval Enter the percentage amount for work in which the subcontractor is as specified in the solicitation or separate written being utilized in this category. [Details] approval in accordance with policy. [Details]

Total Percentage as a Broker:

This third-tier contractor will be working with this subcontractor: Prime Contractor's Attestation to Subcontractor Engagement:

MBE Participation Schedule

As Prime Contractor, I acknowledge and attest to having engaged with the listed MBE and intend to continue engagement if this solicitation results in the award of a contract. As Prime Contractor, I agree to State check-ins to verify subcontractor engagement.

To list additional MBE firms as part of Section B within Part 2 – MBE Participation Schedule, please add continuation sheets of this page (Page 2, Section B) to this section as needed and select the box below. Additional pages of this section are available for download here. Submit each additional page as a separate attachment. Do not combine pages into a single file.

Select this box if you are adding continuation sheets to list additional MBE firms.

For instructions and applicable worksheets to assist in completing any part of this D-1A form, including worksheets and/or tutorials to calculate percentages for MBEs being utilized in certain job categories (i.e. 60% Rule), please refer to Appendix 4A of the solicitation.

Attachment D-1A – MBE Forms Page 4 Effective Date: September 1, 2026 https://procurement.maryland.gov/wp-content/uploads/sites/12/2026/08/Appendix-4A-Effective-9-1-26.pdf https://procurement.maryland.gov/wp-content/uploads/sites/12/2026/08/Appendix-4A-Effective-9-1-26.pdf https://procurement.maryland.gov/wp-content/uploads/sites/12/2026/08/Appendix-4A-Effective-9-1-26.pdf https://procurement.maryland.gov/wp-content/uploads/sites/12/2026/08/Appendix-4A-Effective-9-1-26.pdf https://procurement.maryland.gov/wp-content/uploads/sites/12/2026/08/Appendix-4A-Effective-9-1-26.pdf https://procurement.maryland.gov/wp-content/uploads/sites/12/2026/08/Appendix-4A-Effective-9-1-26.pdf https://content.govdelivery.com/attachments/MDDGS/2026/08/31/file_attachments/3764697/Subcontractor%20Page%20Only%20-%20Attachment%20D-1A%20-%20Effective%209-1-26%20-%20Compressed%20%281%29.pdf

Attachment D-1A.

Minority Business Enterprise (MBE) Utilization and Fair Solicitation Affidavit &

MBE Participation Schedule

Part 3 – Signature Page To Complete the Affidavit and Participation Schedule Committing to MBE(s) or Requesting a Waiver, the Bidder/Offeror Must Sign Below:

I solemnly affirm under the penalties of perjury that:

i. I have reviewed the instructions for the MBE Utilization & Fair Solicitation Affidavit and MBE Participation Schedule;

ii. All MBE certified firms listed have consented to be included in this bid or proposal;

iii. The information contained in the MBE Utilization & Fair Solicitation Affidavit and MBE Participation Schedule is true to the best of my knowledge, information, and belief; and

iv. I acknowledge and commit to meeting the MBE participation goal as indicated on this completed participation schedule and stated below.

Total MBE Commitment %

Bidder/Offeror Name (Print or Type) Signature of Authorized Representative

Address Printed Name and Title

City, State, and ZIP Code Date

SUBMIT THIS ENTIRE COMPLETED FORM WITH YOUR BID/PROPOSAL

Attachment D-1A – MBE Forms Page 5 Effective Date: September 1, 2026