DBE_Goal_Assurance_Form.pdf
PDF 317 KB Posted
- Attached to
- Street Lighting Projects- FHWA Funded
- Solicitation number
- 230121
- Issued by
- Pima County, Arizona
About this file
This document is a Disadvantaged Business Enterprise (DBE) Goal Assurance form from the Arizona Department of Transportation (ADOT) for a Professional Services Project Specific Contract. The form is designed to certify a proposer's commitment to meeting established DBE goals for a federal aid project, requiring the proposer to either meet the DBE goal or demonstrate good faith efforts to do so. The form must be completed and submitted with the Statement of Qualifications (SOQ) and/or cost proposal, with a clear warning that failure to properly complete the form will result in the proposal being considered non-responsive.
The form is a standardized BECO Form 3212PS (Revised 9-1-16) that requires an authorized officer to sign and certify the proposer's DBE participation arrangements. Specific project details such as the ADOT TRACS Number, Agency Project/Contract Number, Project Name, and Prime Contractor's AZ UTRACS Vendor Number are to be filled in by the proposer. The document emphasizes that the certificate cannot be revised or corrected after the proposal submission, highlighting the critical nature of DBE goal compliance in the procurement process.
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Other files
| File | Type | Posted |
|---|---|---|
| Street_Lighting_Projects-_FHWA_Funded.pdf | ||
| Sample_Contract.pdf | ||
| FHWA_Terms_and_Conditions.pdf | ||
| DBE_Program_Provisions.pdf | ||
| OFFER_AND_ACCEPTANCE.RFQ.pdf |
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Text version
PROFESSIONAL SERVICES
PROJECT SPECIFIC CONTRACT
BECO Form 3212PS (Rev. 9-1-16)
Disadvantaged Business Enterprise (DBE) Goal Assurance
ADOT TRACS No.: Agency Project/Contract No.:
Project Name:
Prime: AZ UTRACS Vendor #:
The undersigned, fully cognizant of the requirements and of the goal established, hereby certifies that in the preparation of the proposal for the above stated federal aid project, THIS CERTIFICATE MAY NOT BE REVISED OR CORRECTED AFTER SUBMISSION OF THE PROPOSAL.
FAILURE TO AFFIRMATIVELY MAKE THIS DECLARATION/CERTIFICATION IN THE MANNER OUTLINED IN THE
REQUEST FOR QUALIFICATIONS (RFQ) FURNISHED BY THE LPA/SUBRECIPIENT WILL CAUSE A PROPOSER’S SOQ
TO BE CONSIDERED NON-RESPONSIVE.
(Name of Authorized Officer) (Title)
(Authorized Officer Signature) (Date)
☐ the Proposer will meet the established DBE goal or will make good faith efforts to meet the goal for the contract and that arrangements with certified DBEs have been made prior to the SOQ and/or cost proposal submission.
| ADOT TRACS No: |
| Agency ProjectContract No: |
| Project Name: |
| Prime: |
| AZ UTRACS Vendor: |
| the Proposer will meet the established DBE goal or will make good faith efforts to meet the goal: Off |
| Name of Authorized Officer: |
| Title: |
| Date: |
| AGENCY NAME: |
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