commbuys.sdp.pln.report.frm3.6.8.18.xlsx
XLSX spreadsheet 15 KB Posted
- Attached to
- DEP-BWR-FY2019-PFAS ANALYTICAL LAB SERVICES
- Solicitation number
- BD-20-1045-BWR00-BWR01-45234
- Issued by
- Suffolk County, Massachusetts
About this file
This document is the Supplier Diversity Program (SDP) Spending Report Form #3 for the Commonwealth of Massachusetts. It requires contractors to report their quarterly spending with certified Supplier Diversity Program (SDP) partners, including Minority Business Enterprises (MBEs), Woman Business Enterprises (WBEs), and other certified diversity suppliers. The form must be completed and submitted within 45 days of the end of each fiscal quarter. It includes fields for the contractor's annual SDP spending commitment percentage, quarterly spending amounts with each SDP partner, and a year-to-date compliance check.
The related state and local contract opportunity is for PFAS analytical laboratory services to assist the Massachusetts Department of Environmental Protection (MassDEP) in testing for per- and polyfluoroalkyl substances, an emerging contaminant, in public and private water supplies across the Commonwealth. MassDEP intends to solicit bids from qualified analytical laboratories to perform this PFAS testing work.
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Text version
SDP Spending Report
| Supplier Diversity Program (SDP) Spending Report |
| SDP Plan Form #3 |
| Document Number/Name: |
| Instructions: This form must include information on your company's spending with your Supplier Diversity Program (SDP) Partner(s) and must be completed and submitted |
| within 45 days of the end of each quarter to Commonwealth Contract Manager. |
Part I Contractor Information (Required)
| Contractor Company | Contact Name | Annual Supplier Diversity | Quarterly Contract Sales | Fiscal Year | |||
| Name | Spending Commitment %* | Quarter 1 (7/1-9/30) | Quarter 2 (10/1-12/31) | Quarter 3 (1/1-3/31) | Quarter 4 (4/1-6/30) | Total (calculates automatically) | |
| $ - 0 |
Part II SDP Partner Information (Required) (Insert additional lines as needed)
| SDP Partner(s) Company | Email Address** | Certification Type*** | Quarterly Spending with Supplier Diversity Partner(s) | Fiscal Year | |||
| Name (as it appears on a list at www.mass.gov/sdo) | (Choose One) | Quarter 1 (7/1-9/30) | Quarter 2 (10/1-12/31) | Quarter 3 (1/1-3/31) | Quarter 4 (4/1-6/30) | Total (calculates automatically) | |
| $ - 0 | |||||||
| $ - 0 | |||||||
| $ - 0 | |||||||
| $ - 0 | |||||||
| $ - 0 | |||||||
| $ - 0 | |||||||
| Year-To-Date Compliance Check (Do not change this line) | $ - 0 |
If not in compliance, please explain why and what actions will be taken to bring your company to compliance with the annual spending commitment:
Part III Under the pains and penalties of perjury I certify that the information provided in this report is accurate.
| Name | Supplier Diversity Certification Acronyms: | |
| Title | MBE - Minority Business Enterprise | |
| Phone | WBE - Woman Business Enterprise | |
| M/WBE - Minority and Woman Business Enterprise | ||
| Authorized Signature | SDVOBE - Service-Disabled Veteran-Owned Business Enterprise | |
| (May be left blank if submitted electronically) | VBE - Veteran-Owned Business Enterprise | |
| Date | M/NPO - Minority Non-Profit Organization | |
| W/NPO - Women Non-Profit Organization | ||
| *This is your company's SDP Plan commitment percentage submitted in your Bid Response | M/W/NPO - Minority and Women Non-Profit Organization | |
| or established through negotiation. | DOBE - Disability-Owned Business Enterprise | |
| **The Supplier Diversity Office and contracting department reserves the right to contact | LGBTBE - Lesbian, Gay, Bisexual or Transgender Business Enterprise | |
| SDP Partners at any time to request that they attest to the amounts reported to have been | ||
| paid to them by the Contractor. | ||
| ***Certification Type for SDP Partner(s) can be checked at www.mass.gov/sdo | Revised: March 8, 2016 |
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