EXHIBIT 5 - BIDDERS LIST FORM.pdf
PDF 64 KB Posted
- Attached to
- Employee Assistance Program
- Solicitation number
- PS141248
- Issued by
- California
About this file
This is a Bidders List Form (PRO FORM 132) required by the Los Angeles County Metropolitan Transportation Authority (LACMTA) in compliance with 49 CFR 26.11(c) for the Employee Assistance Program project (RFIQ/IFB/RFP PS141248). The form serves as a comprehensive compilation of all bidders, proposers, quoters, subcontractors, manufacturers, and suppliers who submitted bids during the advertising period for this DOT-assisted acquisition, regardless of bid success. The document is designed to capture information on up to three bidders, with capacity for duplication to accommodate additional firms as needed.
The Bidders List Form requires mandatory data collection for each bidding firm, including business name and address, contact person information, phone and email details, type of work performed, and Disadvantaged Business Enterprise (DBE) certification status. Additional required information includes the age of the business in years and months, and annual gross receipts categorized into five ranges from less than $500,000 to over $5,000,000. This data collection mechanism enables LACMTA to determine the relative availability of certified DBEs and non-DBEs participating in the procurement process and maintain compliance with federal disadvantaged business enterprise requirements for DOT-assisted projects.
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Text version
Project Name ____________________________ RFIQ, IFB, or RFP # ___________________________
EXHIBIT 5 - BIDDERS LIST FORM
The Los Angeles County Metropolitan Transportation Authority (LACMTA) is required per 49 CFR 26. 11 (c) to create and maintain a comprehensive Bidders List. The Bidders List Form (PRO FORM 132) will be used to determine the relative availability of Disadvantaged Business Enterprises (DBEs) and non-DBEs. The Bidders List is a compilation of bidders, proposers, quoters, subcontractors, manufacturers, and suppliers of materials and services who have submitted bids (to the primary bidder) during the advertising period of a specific acquisition, (whether or not they are successful in their attempt to obtain a contract). Please provide the following mandatory data:
Bidder 1: Business Data
Business Name:
Business Address:
Street City State Zip
Name of Contact Person:
Phone: Email Address: Type of Work:
Is this firm a certified DBE? a. Yes b. No Age of Business: ________ Years ________ Months
Annual Gross Receipts: a. Less than $500,000 b. $500,000 to $1,000,000 c. $1,000,000 to $2,000,000
d. $2,000,000 to $5,000,000 e. Over $5,000,000
Bidder 2: Business Data
Business Name:
Business Address:
Street City State Zip
Name of Contact Person:
Phone: Email Address: Type of Work:
Is this firm a certified DBE? a. Yes b. No Age of Business: ________ Years ________ Months
Annual Gross Receipts: a. Less than $500,000 b. $500,000 to $1,000,000 c. $1,000,000 to $2,000,000
d. $2,000,000 to $5,000,000 e. Over $5,000,000
Bidder 3: Business Data
Business Name:
Business Address:
Street City State Zip
Name of Contact Person:
Phone: Email Address: Type of Work:
Is this firm a certified DBE? a. Yes b. No Age of Business: ________ Years ________ Months
Annual Gross Receipts: a. Less than $500,000 b. $500,000 to $1,000,000 c. $1,000,000 to $2,000,000
d. $2,000,000 to $5,000,000 e. Over $5,000,000
If necessary this “Bidders List” form can be duplicated to include all firms (DBE and non-DBE) that have submitted a bid, proposal or quote on this DOT-assisted project.
BIDDERS LIST FORM
| Project Name: Employee Assistance Program |
| RFIQ IFB or RFP: PS141248 |
| Name of Contact Person: |
| c: Off |
| d: Off |
| e: Off |
| Business Name_2: |
| Street_2: |
| City_2: |
| State_2: |
| Zip_2: |
| Name of Contact Person_2: |
| c_2: Off |
| d_2: Off |
| e_2: Off |
| Business Name_3: |
| Street_3: |
| City_3: |
| State_3: |
| Zip_3: |
| Name of Contact Person_3: |
| c_3: Off |
| d_3: Off |
| e_3: Off |
| Email Address1: |
| Years1: |
| Months1: |
| Type of Work1: |
| Phone Number1: |
| Business Name1: |
| Street1: |
| City1: |
| State1: |
| Zip1: |
| Yes1: Off |
| a: Off |
| Phone Number 2: |
| Type of Work 2: |
| Years 2: |
| Months 2: |
| a 2: Off |
| Phone Number 3: |
| Email Address 2: |
| Email Address 3: |
| Type of Work 3: |
| b: Off |
| no 1: Off |
| no2: Off |
| yes 2: Off |
| b_2: Off |
| no 3: Off |
| yes 3: Off |
| b 3: Off |
| a_3: Off |
| Years 3: |
| Months 3: |
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