Attachment E CMD LBE Form 2A_1.pdf
PDF 315 KB Posted
- Attached to
- DPH | Radiology Registry
- Solicitation number
- SFGOV-0000012046
- Issued by
- San Francisco County, California
About this file
This is a Contract Monitoring Division (CMD) Attachment 2 form issued by the City and County of San Francisco for Architecture, Engineering, and Professional Services contracts. The form serves as the CMD Contract Participation Form that must be submitted with proposals for the Department of Public Health's Radiology Registry Request for Proposals. The RFP seeks qualified firms to provide professional temporary radiology technologists and radiology support staff to the San Francisco Health Network, including Zuckerberg San Francisco General Hospital & Trauma Center, Laguna Honda Hospital, Jail Health Services, and SFHN Ambulatory Care sites. All referred staff must be credentialed and competent per the Scope of Work requirements. The proposal deadline is September 16, 2026 at 2:00 PM PT, with the deadline for questions set for September 8, 2026, and an estimated Q&A addendum posting on September 11, 2026. The estimated contract start date is January 1, 2027, with an estimated award announcement in October 2026 and Health Commission presentation in December 2026.
The form requires proposers, joint venture partners, subconsultants, vendors, and lower sub-tier entities to document their participation and identify their Local Business Enterprise (LBE) status across multiple categories including Micro, Small, and SBA-LBE classifications. Specific LBE sub-participation requirements must be met, with the RFP/RFQ identifying which LBE size categories apply. The form includes rating bonus options ranging from 2% to 10% for qualifying LBE participants, joint ventures, and neighborhood/zip code LBE programs for contracts estimated between $400,000 and $10,000,000. Proposers must declare under penalty of perjury the accuracy of consultant utilization and work portions listed, and all LBE firm vendor numbers must be verified through the CMD LBE website at http://www.sfgov.org/cmd.
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Text version
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11/01/2025
CITY AND COUNTY OF SAN FRANCISCO
CONTRACT MONITORING DIVISION
CHAPTER 14B
CMD ATTACHMENT 2
Architecture, Engineering, and Professional Services
FORM 2A: CMD CONTRACT PARTICIPATION FORM
Section 1: This form must be submitted with the proposal or the proposal may be deemed non-responsive and rejected. Proposer, each Joint Venture partner, Subconsultants, Vendors, and lower sub tiers must be listed on this form. The RFP/RFQ will state which LBE size category (e.g., Micro, Small, and/or SBA-LBE) can be used to meet the LBE sub participation requirement(s). All LBE Proposers/JVs with LBE participation must meet the LBE sub participation requirement(s). Any LBE Proposer/JV with LBE participation may not count its participation towards meeting the LBE sub participation requirement(s). Be sure to check the appropriate box for Rating Bonus under Section 2. If more space is needed for Section 1, attach additional copies of this form.
*Type: Identify if Prime (P), JV partner (J), Subconsultant (S), or Vendor (V)
TY
PE
Firm
Portion of Work
(Describe Scope(s) of
Work)
% of Work
Indicate LBE or Non-LBE. If LBE, Micro, Small, or
SBA.
% of LBE Subwork (Carry-Over from % OF
Work Column)
Micro Small SBA
Total % of Work: 100% Total LBE Sub Participation: % % %
I declare, under penalty of perjury under the laws of the State of California, that I am utilizing the above Consultants for the portions of work and amounts as reflected in the proposal for this Contract.
Owner/Authorized Representative (Signature): _____________________ Date: _________________________
Print Name and Title: _____________________________________________________________________________
** See CMD website: http://www.sfgov.org/cmd for each firm’s status
Contract No.:
Contract Title: LBE SUBPARTICIPATION REQUIREMENT(S)
Firm: Micro and Small-LBE Sub Requirement – ___%
Contact Person: Micro, Small, SBA-LBE Sub Requirement – ___%
Address: Micro-LBE Sub Requirement - ___%
City/ZIP: Small-LBE Sub Requirement – ___%
Phone, Email: SBA-LBE Sub Requirement – ___%
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Section 2. Rating Bonus
Check applicable boxes.
A. NO Rating Bonus Requested 0%
B. Contracts with an Estimated Cost in Excess of $400,000 and Less Than or Equal to $10,000,000. See instructions in Sections 2.01 and 2.02.
Micro or Small-LBE 10%
Joint Venture 7.5%
Joint Venture 5%
Joint Venture (Micro or Small-LBEs only) 10%
SBA-LBE 5%
C. Contracts with an Estimated Cost in Excess of the Delegated Purchasing Amount ($20,000 as of July 1, 2024) and Less Than or Equal to $10,000,000. The below rating bonuses DO NOT apply to Chapter 21 contracts and only apply to Chapter 6 contracts, including Chapter 6.40. See instructions in Section
2.01 for details. This Neighborhood/Zip Code LBE Program shall apply to projects located within the jurisdictional boundary of San Francisco. The program shall not apply to Job Order Contracts (JOC), As- Needed contracts, or other contracts where no specific project location is specified at the time of proposal. The RFP/RFQ will clearly state whether the Pilot Neighborhood/Zip Code LBE Program is applicable to the specific project. A Proposer may receive up to a maximum rating bonus of 13% depending on the particular application.
Prime Neighborhood/Zip Code LBE rating bonus:
Prime Neighborhood LBE (or a JV where the Neighborhood LBE JV partner(s)’ participation is at least 40%) 1%
OR
Prime Zip Code LBE (or a JV where the Prime Zip Code LBE JV partner(s)’ participation is at least 40%) 1.5%
Subconsulting Neighborhood/Zip Code LBE rating bonus:
Sub Neighborhood LBE 0.5%
OR
Sub Zip Code LBE 1.5%
D. Contracts in Excess of $10,000,000 and Less Than or Equal to $20,000,000. See instructions in Section 2.01.
Micro, Small, or SBA-LBE 2%
E. Mentor-Protégé Program Bid Discount/Rating Bonus. The Mentor Protégé rating bonus is not applicable to professional services contracts. However, for this CMD Attachment 2, the Mentor Protégé rating bonus/bid discount is applicable for Design-Build and/or CM/GC projects only. See instructions in Section 2.01.
Mentors of the Mentor-Protégé Program 1%
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Section 3. Proposer, Joint Venture Partners, Subconsultant, and Vendor Information
Provide information for each firm listed in Section 1 of this form. Firms which have previously worked on City contracts may already have a vendor number. Vendor numbers of LBE firms are located on the CMD LBE website at http://www.sfgov.org/cmd. Use additional sheets if necessary.
FIRM NAME: VENDOR #:
ADDRESS: FEDERAL ID #:
CITY, ST, ZIP: PHONE: EMAIL:
SERVICE:
| Contract No: |
| Contract Title: |
| Firm: |
| Contact Person: |
| Address: |
| CityZIP: |
| Phone Email: |
| Micro and SmallLBE Sub Requirement: Off |
| Text30: |
| Micro Small SBALBE Sub Requirement: Off |
| Text31: |
| MicroLBE Sub Requirement: Off |
| Text32: |
| SmallLBE Sub Requirement: Off |
| Text33: |
| SBALBE Sub Requirement: Off |
| Text34: |
| Text201: |
| FirmRow1: |
| Portion of Work Describe Scopes of WorkRow1: |
| Text205: |
| Indicate LBE or NonLBE If LBE identify MBE WBE or OBE AND Micro Small or SBA: |
| Text35: |
| Text39: |
| Text45: |
| Text202: |
| FirmRow2: |
| Portion of Work Describe Scopes of WorkRow2: |
| Text206: |
| Indicate LBE or NonLBE If LBE identify MBE WBE or OBE AND Micro Small or SBA_2: |
| Text36: |
| Text40: |
| Text46: |
| Text203: |
| FirmRow3: |
| Portion of Work Describe Scopes of WorkRow3: |
| Text207: |
| Indicate LBE or NonLBE If LBE identify MBE WBE or OBE AND Micro Small or SBA_3: |
| Text37: |
| Text41: |
| Text47: |
| Text204: |
| FirmRow4: |
| Portion of Work Describe Scopes of WorkRow4: |
| Text208: |
| Indicate LBE or NonLBE If LBE identify MBE WBE or OBE AND Micro Small or SBA_4: |
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| Text1: |
| Date: |
| Print Name and Title: |
| NO Rating Bonus Requested 0: Off |
| Micro or SmallLBE 10: Off |
| Joint Venture 75: Off |
| Joint Venture 5: Off |
| Joint Venture Micro or SmallLBEs only 10: Off |
| SBALBE 5: Off |
| Prime Neighborhood LBE or a JV where the Neighborhood LBE JV partners participation is at: Off |
| Prime Zip Code LBE or a JV where the Prime Zip Code LBE JV partners participation is at least: Off |
| Sub Neighborhood LBE 05: Off |
| Sub Zip Code LBE 15: Off |
| Micro Small or SBALBE 2: Off |
| Mentors of the MentorProtégé Program 1: Off |
| FIRM NAME: |
| Text50: |
| ADDRESS: |
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| FIRM NAME_2: |
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| ADDRESS_2: |
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| FIRM NAME_3: |
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| ADDRESS_3: |
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| Text72: |
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| FIRM NAME_4: |
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| ADDRESS_4: |
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| FIRM NAME_5: |
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| ADDRESS_5: |
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| FIRM NAME_6: |
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| ADDRESS_6: |
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