Exhibit M DBE Compliance Form.docx

Exhibit “M”

DBE COMPLIANCE FORM

ALL INFORMATION OUTLINED ON THIS FORM IS REQUIRED FOR DBE COMPLIANCE REVIEW. THE PROPOSED PRIME CONTRACTOR (DESIGN-BUILDER) AND OWNER SHOULD ENSURE THAT THIS INFORMATION IS COMPLETE PRIOR TO SUBMITTAL.

Loan Recipient _________________________ SRF Loan Number____________________ PRIME CONTRACTOR’S AND OWNER‘S CERTIFICATIONS: I certify that the information submitted on and with this form is true and accurate and that this firm has met and will continue to meet the conditions of this construction contract regarding DBE solicitation and utilization. I further certify that criteria used in selecting subcontractors and suppliers were applied equally to all potential participants and that EPA Forms 6100-2 and 6100-3 were distributed to all DBE subcontractors.

________________________________________ Date ________________________ (Prime Contractor signature) (Printed name and title) I certify that I have reviewed the information submitted on and with this form and that it meets the requirements of the Owner's State Revolving Fund loan contract.

________________________________________ Date ________________________ (Signature of Owner or Owner's representative) (Printed name and title)

CONTACT INFORMATION

Owner contact __________________________________________________________________ Owner phone number and email ____________________________________________________ Designer (Engineer) contact _______________________________________________________ Designer (Engineer) phone number and email__________________________________________ Proposed Prime Contractor (Design-Builder)___________________________________________ Prime Contractor contact __________________________________________________________ Prime Contractor phone number and email ____________________________________________ Proposed total contract amount $ ___________________________________________________ Proposed total MBE participation $ ________________ Percentage _________ Goal: 4.0 percent Proposed total WBE participation $ ________________ Percentage _________ Goal: 4.0 percent

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Please submit the following with the DBE Compliance Form:

a. List of all committed and uncommitted subcontractors by trade, including company name, address, telephone number, contact person, dollar amount of subcontract, and DBE/MBE/WBE status.

b. Indicate in writing if no solicitations were made because the Prime Contractor intends to use only its own forces to accomplish the work.

c. Proof of certification by EPA, SBA, DOT (or by state, local, tribal, or private entities whose certification criteria match EPA criteria) for each subcontractor listed as a DBE, MBE, or WBE.

d. Documentation of solicitation efforts for prospective DBE firms, such as fax confirmation sheets, copies of solicitation letters and emails, printout of online solicitations, printouts of online search results, and copies and affidavits of publication in newspapers or other publications. (see also, “Six Good Faith Efforts”, page GEFA-7).

i. The Prime Contractor shall use the necessary resources to identify and directly solicit no less than three certified MBE firms and three certified WBE firms to bid in each expected subcontract trade or area. If a diligent and documented search of the recommended directories does not identify three potential certified MBE firms and three potential certified WBE firms, then the Prime Contractor shall post an advertisement in the Owner’s local legal organ, the Owner’s official website, a regional newspaper in a larger community in the proximity, the Prime Contractor’s website, or some other appropriate resource.

ii. The Prime Contractor is encouraged to follow-up each written, fax, or email solicitation with at least one logged phone call.

iii. Whenever possible, post solicitations for bids or proposals for a minimum of 30 calendar days before the bid or proposal closing date.

e. Written justification for not selecting a certified DBE subcontractor that submitted a low bid for any subcontract area.

f. Certification By Proposed Prime Contractor or Subcontractor Regarding Equal Employment Opportunity (GEFA-9)

g. Certification By Proposed Prime or Subcontractor Regarding Debarment, Suspension, and Other Responsible Matters. (GEFA-10)

END OF DBE COMPLIANCE FORM