Attachment_D-Form_E_GFE_MBEDBE_Form_E.pdf

GFE Form E (07/12/12)

MDOT MBE/DBE FORM E

GOOD FAITH EFFORTS GUIDANCE AND DOCUMENTATION

PART 2 – CERTIFICATION REGARDING GOOD FAITH EFFORTS DOCUMENTATION

PAGE __ OF ___

Prime Contractor Project Description Solicitation Number

PARTS 3, 4, AND 5 MUST BE INCLUDED WITH THIS CERTIFICATE ALONG WITH ALL DOCUMENTS SUPPORTING YOUR WAIVER

REQUEST.

I hereby request a waiver of (1) the Minority Business Enterprise (MBE) participation goal and/or subgoal(s), (2) the Disadvantaged Business Enterprise (DBE) participation goal, or (3) a portion of the pertinent MBE/DBE participation goal and/or MBE subgoal(s) for this procurement.1 I affirm that I have reviewed the Good Faith Efforts Guidance MBE/DBE Form E. I further affirm under penalties of perjury that the contents of Parts 3, 4, and 5 of MDOT MBE/DBE Form E are true to the best of my knowledge, information and belief.

Company Name Signature of Representative

Address Printed Name and Title

City, State and Zip Code Date

1 MBE participation goals and subgoals apply to State-funded procurements. DBE participation goals apply to federally-funded procurements. Federally-funded contracts do not have subgoals.

PART 3 – IDENTIFIED ITEMS OF WORK BIDDER/OFFEROR MADE AVAILABLE TO

MBE/DBE FIRMS

Identify those items of work that the bidder/offeror made available to MBE/DBE Firms. This includes, where appropriate, those items the bidder/offeror identified and determined to subdivide into economically feasible units to facilitate the MBE/DBE participation. For each item listed, show the anticipated percentage of the total contract amount. It is the bidder’s/offeror’s responsibility to demonstrate that sufficient work to meet the goal was made available to MBE/DBE Firms, and the total percentage of the items of work identified for MBE/DBE participation equals or exceeds the percentage MBE/DBE goal set for the procurement. Note: If the procurement includes a list of bid items identified during the goal setting process as possible items of work for performance by MBE/DBE Firms, the bidder/offeror should make all of those items of work available to MBE/DBE Firms or explain why that item was not made available. If the bidder/offeror selects additional items of work to make available to MBE/DBE Firms, those additional items should also be included below.

Identified Items of Work Was this work listed in the procurement?

Does bidder/offeror normally self-perform this work?

Was this work made available to MBE/DBE Firms?

If no, explain why?

□ Yes □ No □ Yes □ No

□ Yes □ No

Please check if Additional Sheets are attached.

PART 4 – IDENTIFIED MBE/DBE FIRMS AND RECORD OF SOLICITATIONS

Identify the MBE/DBE Firms solicited to provide quotes for the Identified Items of Work made available for MBE/DBE participation. Include the name of the MBE/DBE Firm solicited, items of work for which bids/quotes were solicited, date and manner of initial and follow-up solicitations, whether the MBE/DBE provided a quote, and whether the MBE/DBE is being used to meet the MBE/DBE participation goal. MBE/DBE Firms used to meet the participation goal must be included on the MBE/DBE Participation Schedule, Form B. Note: If the procurement includes a list of the MBE/DBE Firms identified during the goal setting process as potentially available to perform the items of work, the bidder/offeror should solicit all of those MBE/DBE Firms or explain why a specific MBE/DBE was not solicited. If the bidder/offeror identifies additional MBE/DBE Firms who may be available to perform Identified Items of Work, those additional MBE/DBE Firms should also be included below. Copies of all written solicitations and documentation of follow-up calls to MBE/DBE Firms must be attached to this form. If the bidder/offeror used a Non-MBE/DBE or is self-performing the identified items of work, Part 4 must be completed.

Name of Identified MBE/DBE Firm & MBE Classification

Describe Item of Work Solicited

Initial Solicitation Date & Method

Follow-up Solicitation Date & Method

Details for Follow-up Calls

Quote Rec’d

Quote Used

Reason Quote Rejected

Firm Name:

MBE Classification (Check only if requesting waiver of MBE subgoal.)

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

Date:

□ Mail

□ Facsimile

□ Email

Date:

□ Phone

□ Mail

□ Facsimile

□ Email

Time of Call:

Spoke With:

□ Left Message

□ Yes

□ No

□ Yes

□ No

□ Used Other

MBE/DBE

□ Used Non-

MBE/DBE

□ Self-performing

Firm Name:

MBE Classification (Check only if requesting waiver of MBE subgoal.)

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

Date:

□ Mail

□ Facsimile

□ Email

Date:

□ Phone

□ Mail

□ Facsimile

□ Email

Time of Call:

Spoke With:

□ Left Message

□ Yes

□ No

□ Yes

□ No

□ Used Other

MBE/DBE

□ Used Non-

MBE/DBE

PART 5 – ADDITIONAL INFORMATION REGARDING REJECTED MBE/DBE QUOTES

This form must be completed if Part 3 indicates that a MBE/DBE quote was rejected because the bidder/offeror is using a Non-MBE/DBE or is self-performing the Identified Items of Work. Provide the Identified Items Work, indicate whether the work will be self-performed or performed by a Non-MBE/DBE, and if applicable, state the name of the Non-MBE/DBE. Also include the names of all MBE/DBE and Non-MBE/DBE Firms that provided a quote and the amount of each quote.

Describe Identified Items of Work Not Being Performed by MBE/DBE (Include spec/section number from bid)

Self-performing or Using Non-MBE/DBE (Provide name)

Amount of Non-

MBE/DBE

Quote

Name of Other Firms who Provided Quotes & Whether MBE/DBE or Non-MBE/DBE

Amount Quoted

Indicate Reason Why MBE/DBE Quote Rejected & Briefly Explain

□ Self-performing

□ Using Non-MBE/DBE

□ MBE/DBE

□ Non-MBE/DBE

□ Price

□ Capabilities

□ Other

□ Non- MBE/DBE

□ Using Non- MBE/DBE