ATTACHMENT FORM D - S-SDV Business Subcontracting Plan.docx
DOCX document 22 KB Posted
- Solicitation number
- IFB-125001
- Issued by
- Portsmouth City, Virginia
About this file
This is a Subcontractor/Subconsultant Letter of Intent form (Form D) for the Virginia Department of Minority Business Enterprise, related to IFB 04-27-SKL for Grounds Maintenance Services at Fire Stations in Virginia. The form is used by certified minority, women, and service-disabled business enterprises to express their intent to perform work as subcontractors or subconsultants on the project. The document requires submission on the vendor's official letterhead and must be signed by an authorized company officer. It requests detailed specification of work items, materials, or services to be provided and requires documentation of M/WBE certification status with the Commonwealth of Virginia's Department of Minority Business Enterprise (DMBE), including the SWAM certification number.
The form includes a pay application section that must accompany each pay request and final payment submission, requiring documentation of payments to all contractors, suppliers, and service providers with identification of M/WBE category classifications. M/WBE categories recognized are African American (B), Asian American (A), Hispanic (H), Native American (N), and Woman (W). The form requires tracking of current requested payment amounts, total payments to date, and total committed amounts, with approval and certification signatures from authorized project representatives. This document serves as a compliance and documentation tool for subcontracting plans under Virginia's minority and women business enterprise program requirements.
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Text version
FORM D
LETTER OF INTENT TO PERFORM AS A SUBCONTRACTOR OR SUBCONSULTANT OR TO PROVIDE SERVICES/SUPPLIES Note: This form must be submitted on the Subcontractor/Subconsultant Company Official Stationery or Letterhead and signed by an authorized officer of the company or business Project Name: # Name of Prime Offeror:
| Address: | Street | City | State | Zip Code | |
| Telephone: | Email: |
Name of Certified Vendor The undersigned intends to perform work in connection with the above project as
| Minority Business Enterprise | Women's Business Enterprise |
| Service-disabled Enterprise |
The M/WBE status of the undersigned is/is not certified by the Commonwealth of Virginia’s Department of Minority Business Enterprise (DMBE) Our SWAM certification number is The undersigned is prepared to perform the following described work or provide materials or services in connection with the above project (specify in detail particular work items, materials or services to be performed or provided):
Note: This description is to be inserted in the submitted letter.
Date:
Name of Business:
Address: Street City State Zip Code
(Name & Title of Authorized Officer)
(Signature)
Prime Contractor/Architect: _ Address & Phone:
Project Name:
Pay Application #: Period:
Current Requested Payment Amount:
The following is a list of payments to be made to all contractors/suppliers & other providers on this project for the above-mentioned period.
| Firm Name and Address |
| *M/WBE Category |
| Amount to be Paid form this pay Request |
| Total Payments to date |
| Total Amount Committed |
*M/W/SBE categories: African American (B), Asian American (A), Hispanic (H), Native American (N), Woman (W)
Date: _ Approved/Certified By:
Name Title:
Signature:
**THIS DOCUMENT MUST BE SUBMITTED WITH EACH PAY REQUEST & FINAL PAYMENT**
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