EXHIBIT D - Business Development Form.pdf

ATTACHMENT D

Business Development Form

The Travis County Healthcare District’s policy is to include Minority Business Enterprise (MBE), Women Business Enterprises (WBE), and Veteran Owned Small Business (VOSB) in its procurement process and to provide equal opportunities for Minority, Women, & Veteran owned businesses to participation in the provision of supplies, services, equipment and construction projects required by the District. As such, the District seeks to ensure that a “good faith effort” is made to assist certified HUB vendors and contractors in its award of contracts and subcontracts.

To be considered as a “Certified Contractor/Vendor”, the contractor/vendor must have been certified by and hold a current and valid certification from any of the following certifying agencies recognized by the District: the Texas Building and Procurement Commission (State of Texas); City of Austin; the Texas Unified Certification Program (TUCP), which includes six (6) certifying agencies; and San Antonio; South Central Texas Regional Certification Agency (SCTRCA).

Suggested directories to assist proposers in identifying potential Minority, Women, & Veteran owned businesses to meet the District’s “good faith effort” requirement include: State: https://comptroller.texas.gov/purchasing/vendor/hub/ City: https://www.austintexas.gov/department/small-and-minority-business-resources-0 TUCP: https://www.txdot.gov/business/disadvantaged-small-business-enterprise/additional-details-on-dbe-interim-final-ruling.html SCTRCA: https://sctrca.org/

**Please complete page 2 - Disclosure of Certified Subcontractors**

Estimated percentage of the bid (proposal) that is to be subcontracted with Certified sources: %

Proposer Declaration Is your company certified as an MBE/WBE/VOSB source? Yes No. If yes,

1. Attach your certification to this form and return it in the proposal;

2. Identify the certification agency by checking all that apply;

State of Texas Comptroller HUB Program

City of Austin; SCTRCA; or TUCP

3. Identify Certified Status (Gender & Ethnicity):

______________________________: Use this space to state the certifying agency, if not listed https://comptroller.texas.gov/purchasing/vendor/hub/ https://www.austintexas.gov/department/small-and-minority-business-resources-0 https://www.txdot.gov/business/disadvantaged-small-business-enterprise/additional-details-on-dbe-interim-final-ruling.html https://www.txdot.gov/business/disadvantaged-small-business-enterprise/additional-details-on-dbe-interim-final-ruling.html https://sctrca.org/

ATTACHMENT D

Business Development Form

Disclosure of Subcontractors

Sub Company Name: EIN/VID #:

Address: City: State: Zip Code:

Contact: Phone No.: Fax No.: E-mail:

Subcontract Amount: Percentage: Description of Work:

Is the company certified?

□ Yes ☐ No Indicate Certification:

Certifying Agency (Check all applicable). If another Agency, list below:

State of Texas https://comptroller.te xas.gov/purchasing/v endor/hub/

(HUB) ☐

City of Austin https://www.austinte xas.gov/department/ certification-division

(M/WBE) ☐

South Central Texas Regional Certification Agency https://sctrca.org/ ☐

Sub Company Name: EIN/VID #:

Address: City: State: Zip Code:

Contact: Phone No.: Fax No.: E-mail:

Subcontract Amount: Percentage: Description of Work:

Is the company certified?

□ Yes ☐ No

Indicate Certification:

Certifying Agency (Check all applicable). If another Agency, list below:

State of Texas https://comptroller.te xas.gov/purchasing/v endor/hub/

(HUB) ☐

City of Austin https://www.austinte xas.gov/department/ certification-division

(M/WBE) ☐

South Central Texas Regional Certification Agency https://sctrca.org/ ☐

Sub Company Name: EIN/VID #:

Address: City: State: Zip Code:

Contact: Phone No.: Fax No.: E-mail:

Subcontract Amount: Percentage: Description of Work:

Is the company certified?

□ Yes ☐ No Indicate Certification:

Certifying Agency (Check all applicable). If another Agency, list below:

State of Texas https://comptroller.te xas.gov/purchasing/v endor/hub/

(HUB) ☐

City of Austin https://www.austinte xas.gov/department/ certification-division

(M/WBE) ☐

South Central Texas Regional Certification Agency https://sctrca.org/ ☐ https://comptroller.texas.gov/purchasing/vendor/hub/ https://comptroller.texas.gov/purchasing/vendor/hub/ https://comptroller.texas.gov/purchasing/vendor/hub/ https://www.austintexas.gov/department/certification-division https://www.austintexas.gov/department/certification-division https://www.austintexas.gov/department/certification-division https://sctrca.org/ https://comptroller.texas.gov/purchasing/vendor/hub/ https://comptroller.texas.gov/purchasing/vendor/hub/ https://comptroller.texas.gov/purchasing/vendor/hub/ https://www.austintexas.gov/department/certification-division https://www.austintexas.gov/department/certification-division https://www.austintexas.gov/department/certification-division https://sctrca.org/ https://comptroller.texas.gov/purchasing/vendor/hub/ https://comptroller.texas.gov/purchasing/vendor/hub/ https://comptroller.texas.gov/purchasing/vendor/hub/ https://www.austintexas.gov/department/certification-division https://www.austintexas.gov/department/certification-division https://www.austintexas.gov/department/certification-division https://sctrca.org/

**Please complete page 2 - Disclosure of Certified Subcontractors**