Attachment E - Form C-49 PSC DBE Good Faith Efforts Documentation.docx
DOCX document 32 KB Posted
- Attached to
- 27-0013 Courtland Drive Corridor Study
- Solicitation number
- RFP-125590
- Issued by
- Buena Vista City, Virginia
About this file
This is a Good Faith Efforts Documentation Form (Form C-49 PSC) issued by the Virginia Department of Transportation for Disadvantaged Business Enterprise (DBE) and Small, Women-owned, and Minority-owned Business (SWaM) requirements applicable to Professional Services Contracts. The form is designed for use with the City of Fredericksburg's Courtland Drive Corridor Study, a transportation engineering services contract that requires assessment of impacts and development of planning-level concepts and cost estimates for a multi-modal east-west connection linking Courtland Drive and Learning Lane.
The form establishes procedures for documenting good faith efforts to meet DBE and SWaM participation goals established in the contract. Submission is required at the Expression of Interest stage if an offeror cannot meet the stated goals, at contract renewal for Limited Services Term contracts, upon request for supplement agreements on Project Specific Contracts, and with each Annual Work Plan for Program Support Services contracts. The documentation must include detailed records of solicitation efforts, including names and identification numbers of DBE/SWaM firms contacted, dates and methods of solicitation and follow-up communications, telephone logs with contact information and dates called, advertisements or proofs of publication in relevant media, and any pending work assignments to DBE/SWaM vendors with associated costs and timelines. The consultant must certify the accuracy of all submitted documentation through authorized signature.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Form Instructions: If, at the time of submitting the Expression of Interest, the Offeror knowingly cannot meet or demonstrate good faith efforts in meeting the required DBE and/or SWaM contract goal(s), form C-49 PSC shall be submitted.
After contract award, for Limited Services Term contracts, consultants must submit this form at renewal to document DBE / SWaM utilization to date. If goals are being met for current term, submission of page 1 is sufficient. If goals are not being met at the time of renewal, the full form must be submitted.
After contract award, for Project Specific Contracts, consultant must submit this form if or when supplement agreements are requested. For Program Support Services (PSS) contracts, this form shall be submitted with each Annual Work plan (AWP). If goals on PSS Contract are being met, submission of page 1 is sufficient. If goals are not being met at the time of AWP review & approval, the full form must be submitted.
CONTRACT ID:
Contract Date(s):
Firm Name:
Renewal Term:
If applicable.
Type of Contract:
UPC # (if Project Specific Contract)
DBE Goal (As per contract)
SWaM Goal (As per contract)
DBE Expenses to Date:
SWaM Expenses to Date:
Submission Date:
Purpose of Submittal*:
*(Inability to Meet Goal at EOI Submission; Term Renewal; Annual Work Plan; or Supplement Agreement)
If the DBE and/or SWaM goals established for this contract have not been met at the time of renewal or VDOT requests the submittal thereof, the bidder is required to submit good faith efforts as outlined in the contract.
Explanation / Details To Support Demonstration Of Good Faith Effort: (See Page 6 for Add’l Space)
The consultant acknowledges and certifies that this form accurately represents the action taken to secure participation by DBE / SWaM subconsultants.
Firm Name Signature
Title Date
CONTRACT ID DATE SUBMITTED
PENDING WORK FOR DBE / SWAM VENDORS
If consultant has ordered work as part of a project based on contract schedule, executed task orders, or assignment in an Annual Work Plan that includes work to be conducted by DBE / SWaM subconsultants but prosecution of work has not yet occurred, please provide details:
The consultant acknowledges and certifies that this form accurately represents the action taken to secure participation by DBE / SWaM subconsultants.
Firm Name Signature
Title Date
Task Order / Assignment Details (ID #s, Description of Work to be Performed)
| Amount of Work Assigned VS Amount of Work Paid to Date |
| Approx Date |
of Work to Occur
NOTE: ATTACH ADDITIONAL PAGES IF NECESSARY, INCLUDING ANY DOCUMENTATION
CONTRACT ID NO. DATE SUBMITTED
WORK SOLICITED / REQUESTED BUT DECLINED BY DBE / SWAM SUBCONSULTANT
Provide information on certified DBE / SWaM subconsultants and the dates on which work was solicited / request was made to participate on this proposal / contract. Include the items of work offered and the dates and methods used for following up initial solicitations to determine whether or not DBEs/SWaM subconsultants were Interested.
The consultant acknowledges and certifies that this form accurately represents the action taken to secure participation by DBE / SWaM subconsultants.
Firm Name Signature
Title Date
NAMES and ID#s of DBEs and/or SWaM FIRMS SOLICITED
| DATE OF INITIAL SOLICITATION |
| NAICS (if DBE) |
and NIGP Codes (if SWAM)
FOLLOW-UP METHODS AND DATES
CONTRACT ID NO. DATE SUBMITTED
TELEPHONE LOG FOR DBE/SWAM SOLICTATION / REQUEST TO PARTICIPATE
If the DBE / SWaM goal(s) established has not or cannot be met or VDOT requests the submittal thereof, the bidder is required to submit good faith efforts as outlined in this document. Provide names, addresses, and telephone numbers for the firms listed.
The consultant acknowledges and certifies that this form accurately represents the action taken to secure participation by DBE / SWaM subconsultants.
Firm Name Signature
Title Date
| DBE / SWaM FIRMS CALLED |
| TELEPHONE |
NUMBER
DATE
CALLED
TIME
CALLED
CONTACT PERSON OR
VOICE MAIL STATUS
COMM0NWEALTH OF VIRGINIA Form C-49 PSC Updated 6/15/2023
DEPARTMENT OF TRANSPORTATION
DBE & SWAM REQUIREMENTS FOR PROFESSIONAL SERVICES CONTRACTS
GOOD FAITH EFFORT DOCUMENTATION
CONTRACT ID NO. DATE SUBMITTED
ADVERTISEMENTS OR PROOFS OF PUBLICATION
If the DBE / SWaM goal(s) established for this contract has not been met or VDOT requests the submittal thereof, the consultant is required to submit good faith efforts as outlined in this document.
Names and dates of each publication / website in which a request for DBE / SWaM subconsultants participation for the project was placed by the consultant. Attach copies of published advertisements or proofs of publication.
The consultant acknowledges and certifies that this form accurately represents the action taken to secure participation by DBE / SWaM subconsultants.
Firm Name Signature
Title Date
| PUBLICATIONS |
| DATES OF ADVERTISEMENT |
CONTRACT ID NO. DATE SUBMITTED
ADDITIONAL DATA TO SUPPORT DEMONSTRATION OF GOOD FAITH EFFORT
If the DBE / SWaM goal(s) established for this contract has not been met or VDOT requests the submittal thereof, the consultant is required to submit good faith efforts as outlined in this document.
The consultant acknowledges and certifies that this form accurately represents the action taken to secure participation by DBE / SWaM subconsultants.
Firm Name Signature
Title Date
ADDITIONAL JUSTIFICATION TO SUPPORT DEMONSTRATION OF GOOD FAITH EFFORT
Including Details on Future DBE / SWaM Utilization Plan
File details come from the government source that posted it. Updated .