DBE Documents.pdf

DBE-1

Bid Specification

The requirements of 49 CFR part 26 apply to this contract. It is the policy of the Sponsor to practice nondiscrimination based on race, color, sex, or national origin in the award or performance of this contract. The Sponsor encourages participation by all firms qualifying under this solicitation regardless of business size or ownership.

Bidders List: The Sponsor is required to obtain the following bidder information about all DBE and non-DBEs who bid as prime contractors and subcontractors on each DOT-assisted contract. The Bidder must submit the following information within five (5) days of bid opening on the forms provided herein (Bidders List Collection Form):

• Firm’s name;

• Firm’s address including zip code;

• Firm’s status as a DBE or non-DBE;

• Race and gender information for the firm’s majority owner;

• NAICS code applicable to each scope of work the firm sought to perform in its bid;

• Age of the firm; and

• Annual gross receipts of the firm.

Good Faith Efforts: A DBE contract goal of 10.07 percent has been established for this contract. The Sponsor’s award of this contract is conditioned upon Bidder satisfying the good faith effort requirements of 49 CFR §26.53.

As a condition of responsiveness, the Bidder must submit the following information within five (5) days of bid opening on the forms provided herein (Demonstration of Good Faiths Efforts – Form 1, 2, & 3 and Schedule of DBE Unavailability):

1) The names and addresses of Disadvantaged Business Enterprise (DBE) firms that will participate in the contract;

2) A description of the work that each DBE firm will perform. To count toward meeting a goal, each DBE firm must be certified in a NAICS code applicable to the kind of work the firm would perform on the contract;

3) The dollar amount of the participation of each DBE firm participating;

4) Written documentation of the bidder’s commitment to use a DBE subcontractor whose participation it submits to meet a contract goal; and

5) Written confirmation from each listed DBE firm that it is participating in the contract in the kind and amount of work provided in the prime contractor's commitment.

6) If the contract goal is not met, evidence of good faith efforts (as elaborated in Appendix A of Part 26). The documentation of good faith efforts must include copies of each DBE and non-DBE subcontractor quote submitted to the bidder when a non- DBE subcontractor was selected over a DBE for work on the contract

Small Business Participation: The Sponsor has established a Small Business Element in accordance with 49 CFR Part 26 to facilitate competition by small business concerns, taking all reasonable steps to eliminate obstacles to their participation and to create a level playing field on which small businesses can compete fairly. While there is no specific numerical goal assigned to small business participation the prime contractor should make every effort to solicit small business concerns (as defined in 13 CFR Part 121) to participate as subcontractors, service providers, suppliers, etc.

The Sponsor has identified work categories conducive to small business participation on the form entitled Fostering Small Business Participation – List Defining Work Categories Conducive to Small Business Participation. Prime contractors are encouraged to solicit small business participation for the work items referenced.

The Bidder must submit the Small Business Participation information on the forms provided herein (Fostering Small Business Participation & Non-Certified Small Business Verification Form) when requested by the Sponsor.

DBE-2

Socially/Economically Disadvantaged Financial Institutions: The Sponsor encourages Contractors and Subcontractors to utilize the services of financial institutions owned and controlled by socially and economically disadvantaged individuals in the community. You can find a link to Minority-Owned Financial Institutions and their branches on the FDIC website:

https://www.fdic.gov/regulations/resources/minority/mdi.html or the U. S. Department of Treasury – Bureau of the Fiscal Service https://fiscal.treasury.gov/mbdp/.

Required Forms

The following forms will be included in the Bid Specification when Contract Goals are established:

• Bidders List Collection Form

• Demonstration of Good Faith Efforts Form 1, 2, & 3

• Schedule of DBE Unavailability

• Fostering Small Business Participation – List Defining Work Categories Conducive to Small Business Participation

• Fostering Small Business Participation

• Non-Certified Small Business Verification Form https://www.fdic.gov/regulations/resources/minority/mdi.html https://fiscal.treasury.gov/mbdp/

Bidders List Collection Form DBE-3

BIDDERS LIST COLLECTION FORM

Firm Name: Certified DBE:

Firm Address: City: State: Zip Code:

Contact Name: Email Address: Phone:

Annual Gross Receipts

Firm Name: Certified DBE:

Firm Address: City: State: Zip Code:

Contact Name: Email Address: Phone:

Annual Gross Receipts

Firm Name: Certified DBE:

Firm Address: City: State: Zip Code:

Contact Name: Email Address: Phone:

Annual Gross Receipts

Prime Contractor

NAICS Code(s) associated with Bid Project Race of Majority Owner Age of Firm

NAICS Code(s) associated with Bid Project Race of Majority Owner Age of Firm

Sex of Majority Owner

Sub Contractor

Sex of Majority Owner

Sub Contractor

NAICS Code(s) associated with Bid Project Race of Majority Owner Age of Firm

Sex of Majority Owner

Yes No

Black American

Hispanic American

Asian-Pacific American

Subcontinent Asian American

Native American

Non-minority

Other

Less than 1 year

1 - 3 years

4 - 7 years 8 - 10 years

More than 10 years

Less than $1 million

$1 - $3 million

$3 - $6 million $6 - $10 million

Over $10 million

Yes No

Black American

Hispanic American

Asian-Pacific American

Subcontinent Asian American

Native American

Non-minority

Other

Less than 1 year

1 - 3 years

4 - 7 years 8 - 10 years More than 10 years

Less than $1 million

$1 - $3 million

$3 - $6 million $6 - $10 million Over $10 million

Yes No

Black American

Hispanic American

Asian-Pacific American

Subcontinent Asian American

Native American

Non-minority

Other

Less than 1 year

1 - 3 years

4 - 7 years 8 - 10 years More than 10 years

Less than $1 million

$1 - $3 million

$3 - $6 million $6 - $10 million Over $10 million

Male Female Other

Male Female Other

Bidders List Collection Form DBE-4

Firm Name: Certified DBE:

Firm Address: City: State: Zip Code:

Contact Name: Email Address: Phone:

Annual Gross Receipts

Firm Name: Certified DBE:

Firm Address: City: State: Zip Code:

Contact Name: Email Address: Phone:

Annual Gross Receipts

Firm Name: Certified DBE:

Firm Address: City: State: Zip Code:

Contact Name: Email Address: Phone:

Annual Gross Receipts

NAICS Code(s) associated with Bid Project Race of Majority Owner Age of Firm

Sub Contractor

Sex of Majority Owner

Sub Contractor

NAICS Code(s) associated with Bid Project Race of Majority Owner Age of Firm

NAICS Code(s) associated with Bid Project Race of Majority Owner Age of Firm

Sex of Majority Owner

Sub Contractor

Sex of Majority Owner

Yes No

Black American

Hispanic American

Asian-Pacific American

Subcontinent Asian American

Native American

Non-minority

Other

Less than 1 year

1 - 3 years

4 - 7 years 8 - 10 years More than 10 years

Less than $1 million

$1 - $3 million

$3 - $6 million $6 - $10 million Over $10 million

Yes No

Black American

Hispanic American

Asian-Pacific American

Subcontinent Asian American

Native American

Non-minority

Other

Less than 1 year

1 - 3 years

4 - 7 years 8 - 10 years More than 10 years

Less than $1 million

$1 - $3 million

$3 - $6 million $6 - $10 million Over $10 million

Yes No

Black American

Hispanic American

Asian-Pacific American

Subcontinent Asian American

Native American

Non-minority

Other

Less than 1 year

1 - 3 years

4 - 7 years 8 - 10 years More than 10 years

Less than $1 million

$1 - $3 million

$3 - $6 million $6 - $10 million Over $10 million

Please copy page if you need to add more subcontractors.

Male Female Other

Good Faith Efforts DBE-5

FORM 1: DISADVANTAGED BUSINESS ENTERPRISE (DBE) UTILIZATION FORM

The undersigned bidder/offeror has satisfied the requirements of the bid specification in the following manner:

The bidder/offeror has met the DBE contract goal.

The bidder/offeror is committed to a minimum of 10.07 % DBE utilization on this contract.

The bidder/offeror has not met the DBE contract goal.

The bidder/offeror is committed to a minimum of ______% DBE utilization on this contract and has submitted documentation demonstrating good faith efforts.

Legal name of bidder/offeror’s firm

Bidder/Offeror Representative:

Name & Title

Signature Date

Good Faith Efforts DBE-6

FORM 2: LETTER OF INTENT FORM

The authorized representative (AR) named below must be an individual vested with the authority to make contracting decisions on behalf of the firm. If the bidder/offeror does not receive the award of the prime contract, any and all representations in this Letter of Intent shall be null and void. Submit this form for each DBE subcontractor.

Name of Bidder/Offeror’s Firm

Name & Title of Firm’s AR

Phone Email

Name of DBE Firm

Name & Title of DBE Firm’s AR

Phone Email

Address City State/ Zip

Work to be performed by DBE firm:

Description of Work NAICS Dollar Amount / % 1 Manufacturer/Regular Dealer/Distributor/Broker 2

1 Percentage is to be used only in negotiated procurements

2 For DBE suppliers only, state how the DBE will perform. For dealer/distributor/broker, Form 3 must be included.

The undersigned bidder/offeror is committed to utilizing the DBE firm named above for the work described above.

The total expected dollar value of this work is $ __________________________. The bidder/offeror understands that if it is awarded the contract/agreement resulting from this procurement, it must enter into a subcontract with the DBE firm identified above that is representative of the type and amount of work listed. The bidder/offeror understands that upon submitting this form with its bid/offer, it may not substitute or terminate the DBE listed above without following the procedures of 49 CFR Part 26, §26.53.

Signature of Bidder/Offeror’s Authorized Representative Date

The undersigned DBE affirms that it is ready, willing, and able to perform the amount and type of work described above and is properly certified to be counted for DBE participation.

Signature of DBE’s Authorized Representative Date

Good Faith Efforts DBE-7

FORM 3: DBE REGULAR DEALER/DISTRIBUTOR AFFIRMATION FORM

Link to Form: https://www.transportation.gov/sites/dot.gov/files/2024-04/DBE%20Regular%20Dealer- Distributor%20Affirmation%20Form-Pending%20OMB%20approval%2004-17-2024.pdf https://www.transportation.gov/sites/dot.gov/files/2024-04/DBE%20Regular%20Dealer-Distributor%20Affirmation%20Form-Pending%20OMB%20approval%2004-17-2024.pdf https://www.transportation.gov/sites/dot.gov/files/2024-04/DBE%20Regular%20Dealer-Distributor%20Affirmation%20Form-Pending%20OMB%20approval%2004-17-2024.pdf

Good Faith Efforts DBE-8

SCHEDULE OF DBE UNAVAILABILITY

Submit this form only if the DBE goal is NOT met

The undersigned certifies that the below DBEs were contacted, in good faith, and said DBEs were unable to submit an acceptable bid. This form should be completed and submitted within five days after bid opening. When a non-DBE subcontractor is selected over a DBE subcontractor, copies of each DBE and non-DBE subcontractor quote submitted to the bidder must be attached to the completed form. The making of a material misrepresentation of fact is grounds disqualification.

Project Information

Project No/Description _________________________________________________________________________________________________________________________________________________

Prime Contractor

Firm Name _________________________________________________________________________ Contact Name __________________________________________________________________

Email Address ______________________________________________________________________ Phone __________________________________________________________________________

DBE Firms Contacted

DBE Firm & Address NAICS/Type of Work Reason Unavailable Method of Contact

Prime Contractor Signature

Signature _________________________________________________________________________ Title _________________________________________________________________________

Print Name _______________________________________________________________________ Date _________________________________________________________________________

Please copy page if you need to add more subcontractors.

DBE-9

FOSTERING SMALL BUSINESS PARTICIPATION – LIST DEFINING WORK CATEGORIES CONDUCIVE TO

SMALL BUSINESS PARTICIPATION

Background 49 CFR §26.39

The Sponsor has established a Small Business Element in accordance with 49 CFR Part 26 to facilitate competition by small business concerns, taking all reasonable steps to eliminate obstacles to their participation and to create a level playing field on which small businesses can compete fairly. While there is no specific numerical goal assigned to small business participation the prime contractor should make every effort to solicit small business concerns (as defined in 13 CFR Part 121).

The Sponsor has identified the below work categories that are conducive to small business participation for the referenced project. As per the agreement, prime contractors are encouraged to solicit small business participation for the work items referenced below.

Project Information

Project No/Description SHV West Cargo Apron Pavement Rehabilitation Phase II & Airfield Markings

Identified Work Categories Conducive to Small Business

Work Category/Bid Line Item NAICS Code Estimated Total Cost of Work

Highway, Street, and Bridge Construction 237310

DBE-10

Fostering Small Business Participation

The Sponsor has established a Small Business Element in accordance with 49 CFR Part 26 to facilitate competition by small business concerns, taking all reasonable steps to eliminate obstacles to their participation and to create a level playing field on which small businesses can compete fairly. While there is no specific numerical goal assigned to small business participation the prime contractor should make every effort to solicit small business concerns (as defined in 13 CFR Part 121) to participate as sub-contractors, service providers, suppliers, etc.

The Sponsor encourages small business participation, including DBE certified firms and SBA certified Small Disadvantaged Business (SBD), Women-Owned Small Business/Economically Disadvantaged Women-Owned Small Businesses (ED/WOSB), Veteran-Owned Small Business/Service-Disabled Veteran-Owned Small Business (SD/VOSB), 8(a) Small Business Development Program (8(a)), SBA Mentor-Protégé Program (SBA MP), and HUBZone Program (HUBZone).

DBE certified firms can be located through the State's UCP website and SBA certified firms can be located through the Small Business Search Tool (https://beta-search.certify.sba.gov/advanced and https://dsbs.sba.gov/search/dsp_dsbs.cfm).

Prime Contractor

Firm Name ________________________________________________ Contact Name ____________________________________________

Email Address ________________________________________________________ Phone _________________________________________

Small Business Firms to be Utilized

Firm Name ________________________________________________ Contact Name ____________________________________________

Email Address ________________________________________________________ Phone _________________________________________

Address __________________________________________________ City __________________________ State _______ Zip ____________

Is the firm currently certified? If yes, check the appropriate box(es) and provide proof of certification. If no, complete the non-certified small business verification form.

☐ DBE ☐ SBD ☐ ED/WOSB ☐ SD/VOSB ☐ 8(a) ☐ SBA MP ☐ HUBZone ☐ No, Verification Form Attached

NAICS Code Description of Work to be Performed Estimated Total Cost

DBE-11

Firm Name ________________________________________________ Contact Name ____________________________________________

Email Address ________________________________________________________ Phone _________________________________________

Address __________________________________________________ City __________________________ State _______ Zip ____________

Is the firm currently certified? If yes, check the appropriate box(es) and provide proof of certification. If no, complete

☐ DBE ☐ SBD ☐ ED/WOSB ☐ SD/VOSB ☐ 8(a) ☐ SBA MP ☐ HUBZone ☐ No, Verification Form Attached

Firm Name ________________________________________________ Contact Name ____________________________________________

Email Address ________________________________________________________ Phone _________________________________________

Address __________________________________________________ City __________________________ State _______ Zip ____________

Is the firm currently certified? If yes, check the appropriate box(es) and provide proof of certification. If no, complete

☐ DBE ☐ SBD ☐ ED/WOSB ☐ SD/VOSB ☐ 8(a) ☐ SBA MP ☐ HUBZone ☐ No, Verification Form Attached

Prime Signature

Signature ____________________________________________________________ Date ________________________________________

Print Name __________________________________________________________ Title _________________________________________

Firm Name ____________________________________________________________________________________________________________

DBE-12

NON-CERTIFIED SMALL Business VERIFICATION

Firms seeking to participate under the Sponsor's Small Business Element who are not certified under one of the pre-qualified certifications listed on the Fostering Small Business Participation Form but believe their firm meets the small business requirements per 13 CFR Part 121 should complete the attached form and provide the requested documentation. Firms meeting the requirements as verified by the Sponsor are eligible to participate in the Small Business Participation Plan.

Business Information Firm Name ________________________________________________ Contact Name ____________________________________________

Email Address ________________________________________________________ Phone _________________________________________

Address __________________________________________________ City __________________________ State _______ Zip ____________

Business Profile

Primary Activities of your Firm Associated NAICS Codes

Number of Employees

Full Time ____________________ Part-time ____________________ Total ____________________

Gross Receipts of Firm (Attach Tax Returns for the last five years)

Gross Receipts of Firm for last 5 years Year _______________ Total Receipts ________________________________ Year _______________ Total Receipts ________________________________ Year _______________ Total Receipts ________________________________ Year _______________ Total Receipts ________________________________

Average Total Receipts ________________________________

Gross Receipts of Affiliate Firms (Attach Tax Returns for the last five years)

Gross Receipts of Affiliate Firms for last 5 years Year ________________ Total Receipts ________________________________

Affiliates are defined in accordance with Year _______________ Total Receipts ________________________________ the Small Business Administration (SBA) Year _______________ Total Receipts ________________________________ definition. Year _______________ Total Receipts ________________________________ Average Total Receipts ________________________________

Prime Signature

Signature ____________________________________________________________ Date ________________________________________

Print Name __________________________________________________________ Title _________________________________________

DBE-13

Firm Name ____________________________________________________________________________________________________________

Reviewer Certification (For use by Sponsor Only)

The Reviewer has determined that the above presented business:

☐ Meets the requirements of a Small Business and is eligible to participate under the Small Business Element ☐ Does not meet requirements of a Small Business and is not eligible to participate under the Small Business Element

Signature __________________________________________________________

Print Name _________________________________________________________ Date _________________________________________

Firm Name __________________________________________________________ Title _________________________________________