Exhibit D.pdf

actions necessary to earn good faith efforts points must occur prior to bid opening. In determining whether a

Bidder has made good faith efforts, the City will evaluate the efforts made by the Bidder and will determine compliance with regard to quantity, intensity, and results of these efforts prior to recommendation of award.

Post-Award

Payment

For purposes of this section the word "Contractor'' means both the prime contractor and the CMAR for CMAR projects. The Contractor must submit a completed Payment Affidavit - Subcontractor/ Supplier Utilization Form with each payment application, including periodic payments and final payment. Payment applications will not be processed by the City until a completed Payment Affidavit - Subcontractor/ Supplier Utilization Form is submitted. Within seven (7) days of receipt by the Contractor of a periodic or final payment from the City, the

Contractor must pay each first-tier Subcontractor based on work completed or services provided under each subcontract. If the Contractor has made a quick pay commitment with any MWBE Subcontractor, they must comply with the provisions of their quick pay commitment.

Changing a Certified MWBE Subcontractor

If the situation arises that it becomes necessary to terminate, replace, or reduce the work of a MWBE

Subcontractor counted toward a committed MWBE subcontracting goal, the Contractor must submit a completed Request to Change MWBE Subcontractor form to the applicable department project manager and the City's MWBE Program Manager. Any change in the work of a MWBE Subcontractor, including its termination and/or replacement, must first be approved by the City based upon good cause shown. Any further explanation or detail to the City in addition to what is identified in the Request to Change MWBE Subcontractor form must be on company letterhead. Good faith efforts shall apply to the selection of any substitute Subcontractor.

Updated 6.02.2025

ACKNOWLEDGMENT OF MWBE POLICY

[PURSUANT TO N.C.G.S. § 143-128.2]

The City’s policy is to encourage bidders in the participation of MWBE businesses. A presentation of that policy has been made at the pre-bid or pre-proposal conference. By submission of a bid or proposal in response to this solicitation, the Bidder consents to all the terms and conditions of the City of Raleigh Minority and Women-Owned Business Enterprise (MWBE) Policy. A copy of the policy may be provided upon request by the Business Engagement & Opportunities Division, or online at www.raleighnc.gov.

Bidder recognizes that the City of Raleigh encourages and provides equal opportunity for MWBE businesses to participate in all aspects of the City’s contracting and procurement. The City’s MWBE participation aspirational goal is at least fifteen percent (15%) of the total contract amount to MWBEs on construction projects of $300,000 or more and building related contracts of $100,000 or more that include any State funding. The Bidder on the subject Contract/Proposal must document good faith efforts to provide meaningful participation by MWBEs in the performance of the Contract. Bidder agrees that the City may reject a bid for MWBE Policy violations, including but not limited to, providing inaccurate information or for failure to provide required MWBE documentation.

The Prime Contractor will be required to identify participation of MWBE businesses and how that participation will be achieved. Bidder must identify anticipated subcontractors, including any Minority & Women-Owned Businesses, intended to be used. Bidder further agrees, if awarded a Contract, it will, upon request, submit to the City, the proper affidavit identifying the workforce actually utilized on the Contract. All MWBE related bid documents have been provided to the Bidder. MWBE information provided by the Bidder is subject to the NC Public Records Act. Bidder acknowledges that the City must be notified of any change of subcontractors, suppliers, or subconsultants.

To the extent permitted by North Carolina law, the Bidder for themselves, their agents, officials, directors, officers, members, representatives, employees, and contractors agree not to discriminate in any manner or in any form based on actual or perceived age, mental or physical disability, sex, religion, creed, race, color, sexual orientation, gender identity or expression, familial or marital status, economic status, veteran status or national origin in connection with this Contract/Proposal or its performance. The Bidder agrees to conform with the provisions and intent of Raleigh City Code §4-1004 in all matters related to this Contract/Proposal. This provision is incorporated herein for the benefit of the City of Raleigh and its residents and may be enforced by an action for specific performance, injunctive relief, or any other remedy available at law or equity. This section shall be binding on the successors and assigns of all parties with reference to the subject matter of the Contract/Proposal.

I have read and understand the City of Raleigh’s MWBE policy.

Signature

Printed Name and Title

Company

Date http://www.raleighnc.gov/

Updated 11.23.21

MWBE SUBCONTRACTORS

IDENTIFICATION OF MWBE PARTICIPATION

Formal Contracts & Construction Contracts Equal or Exceeding $300,000

This Identification of MWBE Participation Form is for the purpose of capturing information regarding the utilization of MWBEs and other subcontractors and suppliers on Formally Bid City Contracts and Construction Contracts equal or exceeding $300,000. MWBE participation is encouraged for all City of Raleigh contracting opportunities. Please refer to the City’s MWBE Policy for any contract specific requirements.

Copy this Form as needed.

BIDDER NAME

PROJECT NAME

PROJECT NUMBER CITY DEPARTMENT

CONTRACT TYPE Construction Services Other ____________________________* PRIME IS MWBE Classification: ________

Certified with NCHUB Certified with NCDOT-DBE

BID SUBMITTAL DATE

MWBE Classifications: American Indian (AI), Asian American (AA), Black/African-American (B), Hispanic (H), Non-Minority Female (NMF), Socially/Economic Disadvantaged (D) *For Professional Services Contracts, please use the Identification of MWBE Participation for Professional Services Form

WORK TO BE SELF-PERFORMED

Check this box only if you intend to perform 100% of the work on this Project/Contract with your own current work forces, and you normally perform and have the capability to perform all elements of this work on this Project/Contract with your own current work forces.

Complete the chart below for all MWBE subcontractors that you intend to use on this Project/Contract regardless of dollar amount.

Company Name

MWBE

Classification Description of

Services Percentage of

Total Contract* Total Projected Utilization ($)*

MWBE Classifications: American Indian (AI), Asian American (AA), Black/African-American (B), Hispanic (H), Non-Minority Female (NMF), Socially/Economic Disadvantaged (D) *If the proposal is subject to an RFQ process, you may enter “N/A”.

*If the proposal is subject to an RFQ process, you may enter “N/A”.

Total Estimated MWBE Utilization* $

Total Proposal Amount* $

Percent Estimated MWBE Utilization*

(Total Estimated MWBE Utilization divided by Total Bid Amount)

AFFIDAVIT A

Listing of Good Faith Efforts (GFE)

Affidavit of___________________________________________________________________________ (Name of Bidder)

Total Available GFE Points: 155 Minimum Number GFE Points Required: 50

POINTS GOOD FAITH EFFORT (GFE)

10 Contacted MWBE businesses that reasonably could have been expected to submit a quote and that were known to the contractor or available on State or local government-maintained lists, at least 10 days before the bid date and notified them of the nature and scope of the work to be performed.

10 Made construction plans, specifications and requirements available for review by prospective MWBE businesses or provided these documents at least 10 days before bids are due.

15 Broken down or combined elements of work into economically feasible units to facilitate MWBE business participation.

10 Worked with MWBE businesses trade, community, or contractor organizations identified by the MWBE Office and included in the bid documents that provide assistance in recruitment of MWBE businesses.

10 Attended pre-bid meetings schedule by the public owner.

20 Provided assistance in getting required bonding or insurance or provided alternatives to bonding or insurance for subcontractors.

15 Negotiated in good faith with interested MWBE businesses and did not reject them as unqualified without sound reasons based on their capabilities. Any rejection of a MWBE business based on lack of qualification should have the reasons documented in writing.

25 Provided assistance to MWBE businesses in need of equipment, loan capital, lines of credit, or joint pay agreements to secure loans, supplies, or letters of credit, including waiving credit that is ordinarily required. Assisted MWBE businesses in obtaining the same unit pricing with the bidder’s suppliers in order to help MWBE businesses in establishing credit.

20 Negotiated joint venture and partnership arrangements with MWBE businesses in order to increase opportunities for MWBE businesses participation on a public construction or repair project when possible.

20 Provided quick pay agreements and policies to enable MWBE business contractors and suppliers to meet cash flow demands.

Total GFE Points ________

The undersigned certifies the preceding representation is a true and accurate statement of Good Faith Efforts made toward the participation of MWBE businesses in the performance of this Project/Contract. Failure to provide accurate and truthful information is a violation of the City of Raleigh MWBE Policy and may result in the sanctions prescribed therein.

This the ___ of _________, 20 _____ __________________________ __________________________ Signature Printed Name/Title

Project Name

Project Number

Total Project Bid Bid Submittal Date

AFFIDAVIT B

Intent to Perform Contract with Own Workforce

Affidavit of___________________________________________________________________________ (Name of Bidder)

*MWBE Classifications: American Indian (AI), Asian American (AA), Black/African-American (B), Hispanic (H), Non-Minority Female (NMF), Socially/Economic Disadvantaged (D)

The Bidder hereby certifies having read and understood the City of Raleigh MWBE Policy, and affirms that it is the intent of the Bidder to perform 100% of the work required for the above-named Contract.

In making this certification, the Bidder states that the Bidder does not customarily subcontract elements of this type project, and normally performs and has the capability to perform and will perform all elements of work on this project with the Bidder’s own current work forces; and

The Bidder agrees to provide any additional information or documentation requested by the City of Raleigh in support of the above statement. If additional scopes of work are added after the Bidder has been awarded the Contract, then the Bidder agrees to make a Good Faith Effort to utilize Minority and Women-Owned Business Enterprises (MWBEs), as applicable, where possible.

The undersigned hereby certifies that he or she has read this certification and is authorized to bind the Bidder to the commitments herein contained.

Date: _____________________ Name of Authorized Officer: _____________________________

Signature: _________________________________________

Title: _________________________________________

State of North Carolina, County of _____________________________

Subscribed and sworn to before me this ___________ day of ___________20___

Notary Public __________________ My commission expires _________

SEAL

Project Name

Total Project Bid Bid Submittal Date

Project Number PRIME IS MWBE Classification: ________ Certified with NCHUB

Certified with NCDOT-DBE

Pg. 1 of 2 Updated 3.3.22

SECTION 2. MWBE SUBCONTRACTORS

SECTION 1. PROJECT INFORMATION

AFFIDAVIT C

MWBE SUBCONTRACTOR UTILIZATION COMMITMENT

This affidavit is to be provided by the Prime Contractor within three (3) business days after notification by the City of being the apparent lowest, responsible, responsive bidder (LRRB) if the portion of the work to be performed by MWBE Businesses equals or exceeds fifteen percent (15%) of the total contract price. Copy this Form as needed.

Complete the chart below for all MWBE subcontractors to be used on this Project/Contract regardless of dollar amount.

Company Name Contact

Information (Name, Email, Phone)

MWBE

Classification

Description of Services

Percentage of Total Contract

Total Projected Utilization ($)

*MWBE Classifications: American Indian (AI), Asian American (AA), Black/African-American (B), Hispanic (H), Non-Minority Female (NMF), Socially/Economic Disadvantaged (D)

Project Name

Project Number City Department

Project Manager

Phone Number Email Address

Bidder Contact Name

Phone Number Email Address PRIME IS MWBE Classification: ________

Certified with NCHUB Certified with NCDOT-DBE

Bid Submittal Date

Prime to Perform $___________________________ Prime to Perform ___________________ %

Total Base Bid Amount $

Total Contract Amount (including Contingency) $

Total MWBE Subcontractor / Supplier Utilization $

Percent MWBE Subcontractor Utilization (Total MWBE $ divided by Total Base Bid) %

Pg. 2 of 2 Updated 3.3.22

Letters of Intent Submitted Upon Notice from the City

Within three (3) Business Days after receiving a request from the City (or within such longer time as may be communicated by the City in writing), Bidders must submit a separate Letter of Intent for each MWBE listed on Affidavit C. Each Letter of Intent must be executed by both the MWBE and the Bidder. The City shall not count proposed MWBE utilization for which it has not received a Letter of Intent by this deadline.

Adding Subcontractors or Suppliers After Submitting This Form Nothing in this Affidavit shall be deemed to preclude you from entering into subcontracting arrangements after submission of this form. However, per the City of Raleigh MWBE Policy, you must comply with the following:

• You must maintain the level of MWBE participation proposed on this Affidavit throughout the duration of the Contract, except as may be otherwise specifically allowed by the City.

• If you need to terminate or replace a MWBE, you must complete a Request to Change a MWBE Subcontractor Form.

• If the scope of work on the Contract increases, or if you elect to subcontract any portion of work not identified on this form as subcontracted, then you must comply with City of Raleigh MWBE Policy, including Good Faith Efforts.

• A Letter of Intent must also be submitted for each MWBE you add subsequent to contract award.

Signature Your signature below indicates that the undersigned firm certifies and agrees that:

a. You have complied with all provisions of the City of Raleigh MWBE Policy;

b. The information provided is a true and accurate statement of MWBE businesses intended to be used as subcontractors, subconsultants, or suppliers in the performance of this Project/Contract; and

c. Failure to provide accurate and truthful information or to properly document such compliance in the manner and within the time periods established by the City of Raleigh MWBE Policy shall constitute a violation of the City of Raleigh MWBE Policy and may result in the sanctions prescribed therein, including rejection of your bid.

This the ___ of _________, 20 _____ _____________________________ __________________________________ Signature Printed Name/Title

Pg. 1 of 3 Updated 3.3.2022

SECTION 2. MWBE SUBCONTRACTORS

SECTION 1. PROJECT INFORMATION

AFFIDAVIT D

GOOD FAITH EFFORTS (GFE) AND STATEMENT OF GFE COMPLIANCE

This affidavit is to be provided by the Prime Contractor within three (3) business days after notification by the City of being the apparent lowest, responsible, responsive bidder (LRRB) if the Bidder has not fully met the established MWBE Goal (15%) for this Project. The Bidder must document it has met the GFE requirements by completing this Form. GFE Points will be calculated independently by the City.

Complete the chart below for all MWBE subcontractors to be used on this Project/Contract regardless of dollar amount.

Company Name Contact

Information (Name, Email, Phone)

MWBE

Classification

Description of Services

Percentage of Total Contract

Total Projected Utilization ($)

*MWBE Classifications: American Indian (AI), Asian American (AA), Black/African-American (B), Hispanic (H), Non-Minority Female (NMF), Socially/Economic Disadvantaged (D)

Project Name

Project Number City Department

Project Manager

Phone Number Email Address

Bidder Contact Name

Phone Number Email Address PRIME IS MWBE Classification: ________

Certified with NCHUB Certified with NCDOT-DBE

Bid Submittal Date

Prime to Perform $___________________________ Prime to Perform ___________________ %

Total Base Bid Amount $

Total Contract Amount (including Contingency) $

Total MWBE Subcontractor / Supplier Utilization $

Percent MWBE Subcontractor Utilization (Total MWBE $ divided by Total Base Bid) %

Pg. 2 of 3 Updated 3.3.2022

SECTION 3. GOOD FAITH EFFORTS

Below is a list of Good Faith Efforts as defined in the City’s MWBE Policy. To the left of each item is the number of points assigned to that item. Please place an “X” in the first column for each item you are claiming credit. Please provide any documentation, if available.

Failure to achieve the minimum number of GFE points stated in the box below may constitute grounds for rejection of your bid.

NOTE: All actions necessary to earn GFE Points must be undertaken prior to Bid Opening.

Total Available GFE Points: 155 Minimum Number GFE Points Required: 50

POINTS GOOD FAITH EFFORT (GFE)

10 Contacted MWBE businesses that reasonably could have been expected to submit a quote and that were known to the contractor or available on State or local government-maintained lists, at least 10 days before the bid date and notified them of the nature and scope of the work to be performed.

10 Made the construction plans, specifications and requirements available for review by prospective MWBE businesses or providing these documents to them at least 10 days before the bids are due.

15 Broken down or combined elements of work into economically feasible units to facilitate MWBE business participation.

10 Worked with MWBE businesses trade, community, or contractor organizations identified by the MWBE Office and included in the bid documents that provide assistance in recruitment of MWBE businesses.

10 Attended pre-bid meetings schedule by the public owner.

20 Provided assistance in getting required bonding or insurance or provided alternatives to bonding or insurance for subcontractors.

15 Negotiated in good faith with interested MWBE businesses and did not reject them as unqualified without sound reasons based on their capabilities. Any rejection of a MWBE business based on lack of qualification should have the reasons documented in writing.

25 Provided assistance to MWBE businesses in need of equipment, loan capital, lines of credit, or joint pay agreements to secure loans, supplies, or letters of credit, including waiving credit that is ordinarily required. Assisted MWBE businesses in obtaining the same unit pricing with the bidder’s suppliers in order to help MWBE businesses in establishing credit.

20 Negotiated joint venture and partnership arrangements with MWBE businesses in order to increase opportunities for MWBE businesses participation on a public construction or repair project when possible.

20 Provided quick pay agreements and policies to enable MWBE business contractors and suppliers to meet cash flow demands.

Total GFE Points (Claimed by Bidder) ________ Total GFE Points (Assessed by City) ________

Pg. 3 of 3 Updated 3.3.2022

Letters of Intent Submitted Upon Notice from the City Within three (3) Business Days after receiving a request from the City (or within such longer time as may be communicated by the City in writing), Bidders must submit a separate Letter of Intent for each MWBE listed on this Affidavit D. Each Letter of Intent must be executed by both the MWBE and the Bidder. The City shall not count proposed MWBE utilization for which it has not received a Letter of Intent by this deadline.

Adding Subcontractors or Suppliers After Submitting This Form Nothing in this Affidavit shall be deemed to preclude you from entering into subcontracting arrangements after submission of this form. However, per the City of Raleigh MWBE Policy, you must comply with the following:

• You must maintain the minimum level of MWBE participation proposed on this Affidavit throughout the duration of the Contract, except as may be otherwise specifically allowed by the City.

• If you need to terminate or replace a MWBE, you must complete a Request to Change a MWBE Subcontractor Form.

• If the scope of work on the Contract increases, or if you elect to subcontract any portion of work not identified on this form as subcontracted, then you must comply with City of Raleigh MWBE Policy, including Good Faith Efforts.

• A Letter of Intent must also be submitted for each MWBE you add subsequent to contract award.

Signature Your signature below indicates that the undersigned firm certifies and agrees that:

a. You have complied with all provisions of the City of Raleigh MWBE Policy;

b. The information provided is a true and accurate statement of Certified MWBE businesses intended to be used as subcontractors, subconsultants, or suppliers in the performance of this Project/Contract; and

c. Failure to provide accurate and truthful information or to properly document such compliance in the manner and within the time periods established by the City of Raleigh MWBE Policy shall constitute a violation of the City of Raleigh MWBE Policy and may result in the sanctions prescribed therein, including rejection of your bid.

This the ___ of _________, 20 _____ _____________________________ __________________________________ Signature Printed Name/Title

Letter of Intent

In accordance with City of Raleigh MWBE Policy, within three (3) Business Days after receiving a request from the City (or within such longer time as may be communicated by the City in writing), a Bidder must submit a separate Letter of Intent for each MWBE subcontractor listed on Affidavit C or Affidavit D, as may be applicable.

Project Name

Project Number

Section 1: TO BE COMPLETED BY THE BIDDER

Name of Bidder

Address

Contact Person

Telephone E-mail Fax

If the Bidder has entered into a Quick Pay Agreement, in association with this Letter of Intent and as defined in the City’s MWBE Policy, please attach a copy of the executed Agreement with the undersigned MWBE.

Identify in complete detail the scope of work to be performed or item(s) to be supplied by the MWBE.

Cost of Work to be Performed by MWBE $

Section 2: TO BE COMPLETED BY MWBE SUBCONTRACTOR

Name of MWBE

Address

Contact Person

Telephone E-mail Fax

Upon execution of a Prime Contract with the City for the above referenced project, the Bidder certifies that it intends to utilize the MWBE listed above, and that the description, cost and percentage of work to be performed by the MWBE as described above is accurate. The MWBE firm certifies that it has agreed to provide such work/supplies for the amount stated above.

BIDDER Signature

Print Name and Title

Date

MWBE

Signature

Print Name and Title

Date

Updated 3.3.22

ALL CONTRACT SUBCONTRACTORS

CONTRACT SUBCONTRACTOR IDENTIFICATION FORM

Building Project/Construction Contracts

(This form MUST be submitted within 30 days after award of the Contract)

This Final Subcontractor Identification Form is to provide a list of all subcontractors that the Contractor will use in the performance of the Contract with the City, in accordance with NCGS §143-128.2. Copy this Form as needed.

CONTRACTOR NAME

PROJECT NAME

PROJECT NUMBER CITY DEPARTMENT

PRIME IS MWBE Classification: ________

Certified with NCHUB Certified with NCDOT-DBE

CONTRACT AWARD DATE

MWBE Classifications: American Indian (AI), Asian American (AA), Black/African American (B), Hispanic (H), Non-Minority Female (NMF), Socially/Economic Disadvantaged (D)

WORK TO BE SELF-PERFORMED

Check this box only if you intend to perform 100% of the work on this Project/Contract with your own current work forces, and you normally perform and have the capability to perform all elements of this work on this Project/Contract with your own current work forces.

Complete the chart below for all subcontractors that will be used on this Contract regardless of dollar amount.

Company Name Contact Description of Service/Trade Total ($) Name:

Certified MWBE Registered Raleigh SCS E-mail: Address:

Name:

Certified MWBE Registered Raleigh SCS E-mail: Address

Name:

Certified MWBE Registered Raleigh SCS E-mail: Address:

Name:

Certified MWBE Registered Raleigh SCS E-mail: Address:

Name:

Certified MWBE Registered Raleigh SCS E-mail: Address:

Name:

Certified MWBE Registered Raleigh SCS E-mail: Address:

Name:

Certified MWBE Registered Raleigh SCS E-mail: Address:

Certification must be with NCHUB or the NCDOT-DBE. Proof of Certification may be required upon request by the City.

Total Contract Amount $ __________________________

Total MWBE Utilization $ __________________________

Percent MWBE Utilization

(Total MWBE Utilization divided by Total Contract Amount) %

Updated 3.3.22

APPENDIX E - CERTIFIED SUBCONTRACTOR / SUPPLIER PAYMENT APPLICATION FORM

Contractors must submit this form with each request for payment from the City of Raleigh, including any invoice or request for final payment.

Requests for payment are limited to work that has been completed and approved for all subcontractors and suppliers in connection with the Contract.

Copy this form as needed. The Contractor on the Prime Contract (i.e., Prime) is responsible for collecting and submitting this Appendix E from all subsequent lower tier contractors.

Project Name Contractor Name

Total Contract Amount $ Pay App #/Contract ID #

Total MWBE Sub ($/%) $ % Invoice Amount $

Payment Period ___/___/20___ through ___/___/20___ City Department FINAL PAYMENT Check only when submitting Final Pay Request. Project Completion Date

Complete the chart below for all MWBE subcontractors used on the Project/Contract regardless of dollar amount.

Company Name MWBE Classification Work Performed

Percentage of Total Contract

Percent of Subcontract Completed

Payment this Period

Cumulative Payments to Date

*MWBE Classifications: American Indian (AI), Asian American (AA), Black/African-American (B), Hispanic (H), Non-Minority Female (NMF), Socially/Economic Disadvantaged (D)

Section 3: PAYMENTS TO SUPPLIERS All suppliers providing goods under City contracts must be listed on the Sales Tax Statement submitted with each pay request. The City may request, on a case-by-case basis, that the Contractor require certain suppliers to be registered in the Raleigh Supplier Connection System and may withhold payment of any amounts due the Contractor in the event the Contractor fails to comply with such request.

The undersigned certifies the preceding chart is a true and accurate statement of all payments that have been made to subcontractors on this Project/Contract, and that all Suppliers providing goods under this contract have been listed in the Sales Tax Statements submitted to the City in connection with this Payment Appendix E. If no subcontractors or suppliers are listed on the preceding chart or Sales Tax Statements, the undersigned certifies that no subcontractors or suppliers were used in performing the Project/Contract for the payment period indicated. Failure to provide accurate and truthful information is a violation of the City of Raleigh MWBE Policy and may result in the sanctions prescribed therein.

This day of 20

Signature Print Name and Title

To be completed by City for FINAL PAYMENT

Total Paid to Contractor

Prime Contractor MWBE

$ Proposed MWBE Amount $ MWBE Commitment:_____%

Total Paid to Subcontractors $ Total to MWBE Subcontractors $ MWBE Final:_____%

Section 1: PROJECT INFORMATION

Section 2: PAYMENTS TO SUBCONTRACTORS

Page 1 of 2 Updated 11.23.21

Section 3: PROPOSED ACTION (SELECT ONE)

SECTION 1: PREVIOUS REQUESTS FOR CHANGE

Section 2: CURRENT MWBE SUBCONTRACTOR INFORMATION

Section 4: REASON FOR CHANGE (SELECT AT LEAST ONE)

REQUEST TO CHANGE A MWBE SUBCONTRACTOR

Contractors must submit this form for any request to change any MWBE subcontractor or supplier in connection with the Contract. The Contractor on the Prime Contract (i.e. prime) is responsible for collecting and submitting this form from all subsequent lower tier contractors.

PROJECT NAME

PROJECT MANAGER CONTRACT NUMBER

PRIME CONTRACTOR CONTACT NAME

PHONE NUMBER E-MAIL ADDRESS

DATE OF CHANGE CITY DEPARTMENT

NO PREVIOUS REQUEST FOR THIS PROJECT/CONTRACT.

Complete the chart below for all previous Requests to Change a MWBE Subcontractor.

Date of Request Subcontractor’s

Company Name

MWBE

Classification

Request Approved:

Y/N Work Performed

MWBE Classifications: American Indian (AI), Asian American (AA), Black/African-American (B), Hispanic (H), Non-Minority Female (NMF), Socially/Economic Disadvantaged (D)

CURRENT MWBE SUBCONTRACTOR

SERVICE PROVIDED

PERCENT OF TOTAL CONTRACT _______% PERCENT OF SUBCONTRACT COMPLETE _______%

TOTAL AMOUNT OF SUBCONTRACT $ TOTAL AMOUNT PAID TO DATE $

WORK TO BE SELF-PERFORMED

Check this box only if the work previously performed by the above MWBE subcontractor will be performed with your own current work forces, and you normally perform and have the capability to perform all elements of this work on this Project/Contract with your own current work forces.

REPLACE MWBE SUBCONTRACTOR

The listed MWBE, after having had a reasonable opportunity to do so, fails or refuses to execute a written contract.

The listed MWBE is bankrupt or insolvent.

The listed MWBE fails or refuses to perform the subcontract or furnish the listed materials.

Page 2 of 2 Updated 11.23.21

Section 5: NEW SUBCONTRACTOR INFORMATION (IF APPLICABLE)

The work performed by the listed subcontractor is unsatisfactory according to industry standards and is not in accordance with the plans and specifications.

The subcontractor is substantially delaying or disrupting the progress of the work.

Other - explain in detail on company letter head and attach to this Request.

Complete the information below for the new MWBE subcontractor requested to be changed on the Project/Contract.

Company Name Contact Person

MWBE

Classification

Work to be Performed

Amount of Subcontract

Subcontractor’s Percentage of Total Contract

MWBE Classifications: American Indian (AI), Asian American (AA,) Black/African-American (B), Hispanic (H), Non-Minority Female (NMF), Socially/Economic Disadvantaged (D)

If new subcontractor(s) is not MWBE, attach documentation of Good Faith Efforts (Affidavit A).

This the ___ of _________, 20 _____ ___________________________ ____________________________ Signature Printed Name/Title

TO BE COMPLETED BY CITY SIGNATURE:

Original Total Contract Amount: $_________________

Original Total MWBE Participation ____ %

PRINT NAME:

New Total Contract Amount: $_________________

New Total MWBE Participation

DATE:

Contract Amount Impact Increase Decrease No Change

MWBE Participation Change Increase

Decrease

No Change

APPROVED

REJECTED

NOTES:

Version 6.15.2021

Minority and Women-owned Business Enterprise Program (MWBE)

Explanation of Affidavit A A Listing of the Good Faith Effort (GFE)

Company has made a good faith effort to recruit minority businesses in accordance with N.C. Gen. Stat. § 143-

128.2 and represents that it has performed the following (check all that apply; note that a minimum of fifty (50) points must be achieved):

Examples of ways to satisfy requirements are given for each criterion below:

❑ 1. (10 points) Contacted minority businesses that reasonably could have been expected to submit a quote and that were known to the contractor or available on State or local government maintained lists, at least 10 days before the bid date and notified them of the nature and scope of the work to be performed.

• Provide a list of potential bidders with proof of acknowledged responses (i.e. quotes)

• Provide confirmation of notification at least 10 days before bid date

• Newspaper/trade ads do not qualify as GFE notification

❑ 2. (10 points) Made the construction plans, specifications and requirements available for review by prospective minority businesses, or provided these documents to them at least 10 days before the bids are due.

• Provide confirmation of notification at least 10 days before bid date

• Include in the notice that plan specs are available in office/online (location/link) and at no cost to MWBEs

• Newspaper/trade ads do not qualify as GFE notification

❑ 3. (15 points) Broke down or combined elements of work into economically feasible units to facilitate minority participation.

• Provide confirmation of solicitation that include subcontracting opportunities (i.e. itemize or group trades such as flooring/trim or divide one sub does flooring and another sub does trim)

❑ 4. (10 points) Worked with minority trade, community, or contractor organizations identified by the Office of Historically Underutilized Businesses and included in the bid documents that provide assistance in recruitment of minority businesses.

• Obtain letter or other documentation from one of these organizations indicating that you are working with them in the recruitment of minority businesses – NCMWBE Coordinators Network, The Institute, NCIEDI or HCAC.

• A list of organizations can be found at www.raleighnc.gov/mwbe

Version 6.15.2021

❑ 5. (10 points) Attended pre-bid meetings scheduled by the public owner.

• Attendance is recorded (make sure you sign-in)

❑ 6. (20 points) Provided assistance in getting required bonding or insurance or provided alternatives to bonding or insurance for subcontractors.

• Include one of the following statements in solicitation to MWBEs as it applies:

o Bonds are not required for this project o Bidder will assist in procuring bonds or insurance if necessary

❑ 7. (15 points) Negotiated in good faith with interested minority businesses and did not reject them as unqualified without sound reasons based on their capabilities. Any rejection of a minority business based on lack of qualification should have the reasons documented in writing.

• “MWBE Solicitation Form” is attached to the Explanation Affidavit A Form o Provide completed MWBE Solicitation Form to document the following:

o Did not receive low quotes from MWBEs o Bidder accepted other low quotes from MWBEs o Written reasons for rejection of any low quotes from MWBEs

❑ 8. (25 points) Provided assistance to an otherwise qualified minority business in need of equipment, loan capital, lines of credit, or joint pay agreements to secure loans, supplies, or letters of credit, including waiving credit that is ordinarily required. Assisted minority businesses in obtaining the same unit pricing with the bidder’s suppliers in order to help minority businesses in establishing credit.

• Indicate in solicitation the following are available: equipment, loan capital, lines of credit, or joint pay agreements for qualified MWBEs or any other needs.

• Document recent history of doing joint pay agreements such as “in the recent past, we have done joint pay agreements (lines of credit, waiving of credit, etc.) with the following MWBEs (x company, y company, z company) and intend to offer the same on this project for qualified MWBEs”

• Provide letter from vendor/supplier indicating that they will give the same pricing to MWBEs quoting to you as vendor/supplier gives directly to you

❑ 9. (20 points) Negotiated joint venture and partnership arrangements with minority businesses in order to increase opportunities for minority business participation on a public construction or repair project when possible.

• Indicate in solicitation that opportunities to negotiate joint venture and partnership arrangements are available

❑ 10. (20 points) Provided quick pay agreements and policies to enable minority contractors and suppliers to meet cash flow demands.

• Indicate in solicitation that quick pay agreements are available for certified MWBEs to include payment terms (i.e., Net 30).

• Document recent history of doing quick pay agreements such as “in the recent past, we have done quick pay agreements with the following MWBE’s (x company, y company, z company) and intend to offer the same on this project for qualified MWBE’s”

SECTION 1. PROJECT INFORMATION

SECTION 2. SOLICITATION INFORMATION

SOLICITATION FORM

Copy this Form as needed to document MWBE contacts.

The Bidder must make the required contacts no less than ten (10) Days before Bid Opening to receive credit for this Good Faith Effort. All contacts must be verifiable with supporting documentation reflecting the methods and content of the solicitation. All documentation must be submitted with this form.

A Bidder must submit this Solicitation Form within the time specified in the City Solicitation Documents. If no time period is specified in the City Solicitation Documents, the Bidder must submit this form within three (3) Business Days after the City requests it.

If “No” is checked for “Selected” below, the Bidder must document the reasons for rejecting each bid submitted by a MWBE on the Good Faith Negotiation Form.

MWBE FIRM CONTACT PERSON

SCOPE OF WORK

INITIAL CONTACT DATE: ____/____/20___ METHOD (select all used): Email Telephone Fax In-Person Mail

FOLLOW-UP DATE: ____/____/20___ METHOD (select all used): Email Telephone Fax In-Person Mail

RESPONSE No Response Not Bidding Bidding ($___________) Other (Explain)

SELECTED Yes No (Explain)

MWBE FIRM CONTACT PERSON

SCOPE OF WORK

INITIAL CONTACT DATE: ____/____/20___ METHOD (select all used): Email Telephone Fax In-Person Mail

FOLLOW-UP DATE: ____/____/20___ METHOD (select all used): Email Telephone Fax In-Person Mail

RESPONSE No Response Not Bidding Bidding ($___________) Other (Explain)

SELECTED Yes No (Explain)

MWBE FIRM CONTACT PERSON

SCOPE OF WORK

INITIAL CONTACT DATE: ____/____/20___ METHOD (select all used): Email Telephone Fax In-Person Mail

FOLLOW-UP DATE: ____/____/20___ METHOD (select all used): Email Telephone Fax In-Person Mail

RESPONSE No Response Not Bidding Bidding ($___________) Other (Explain)

SELECTED Yes No (Explain)

Project Name

Project Number City Department

Bidder Number MWBEs Contacted