commbuys.sdp.pln.report.frm3.6.8.18.xlsx

XLSX spreadsheet 15 KB Posted

Attached to
DEP-BAW-RFR-EEA-PIL-2019-001
Solicitation number
BD-19-1045-BAW00-BAW01-32831
Issued by
Plymouth County, Massachusetts

About this file

This document is a Supplier Diversity Program (SDP) Spending Report Form required to be submitted quarterly by a contractor to the Commonwealth of Massachusetts. The form collects information on the contractor's spending commitments and actual spending with certified SDP partners during each quarter of the fiscal year. The contractor must report their annual SDP spending commitment percentage, as well as the quarterly and year-to-date SDP partner spending for the contract. The contractor must certify under pains and penalties of perjury that the information provided is accurate.

The related state and local contract opportunity is for the Department of Environmental Protection (DEP) within the Executive Office of Energy and Environmental Affairs (EEA) of the Commonwealth of Massachusetts. EEA is seeking the services of a qualified contractor/consulting firm with expertise in all aspects of Nuclear Power Generation Facility Decommissioning. No additional details about the contract opportunity are provided in the information given.

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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 CompanyContact NameAnnual Supplier DiversityQuarterly Contract SalesFiscal Year
NameSpending 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) CompanyEmail 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.

NameSupplier Diversity Certification Acronyms:
TitleMBE - Minority Business Enterprise
PhoneWBE - Woman Business Enterprise
EmailM/WBE - Minority and Woman Business Enterprise
Authorized SignatureSDVOBE - Service-Disabled Veteran-Owned Business Enterprise
(May be left blank if submitted electronically)VBE - Veteran-Owned Business Enterprise
DateM/NPO - Minority Non-Profit Organization
W/NPO - Women Non-Profit Organization
*This is your company's SDP Plan commitment percentage submitted in your Bid ResponseM/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 contactLGBTBE - 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/sdoRevised: March 8, 2016

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