FORM 1 - DBE SUBS AND SUPPLIERS.pdf

FORM 1 - DBE SUBCONTRACTORS & SUPPLIERS

TO BE COMPLETED BY PRIME ONLY

The Prime (Offeror) is required to list ALL DBE businesses, of any tier, to be utilized on this project for whom Prime is seeking DBE Credit. For a bid to be responsive, the Prime (Offeror) must complete this form and submit the completed form with its bid. The form should be complete in accordance with the instructions on this form and in the solicitation, using care so that the information provided in this form is consistent with the information provided in Forms 2 to 5 and the DBE commitment in the DBE Affidavit. If there is any discrepancy or conflict between the information listed on any of Forms 2 to 5 and the information in this Form 1, LACMTA may issue requests for clarification seeking information or clarification from the Prime (Offeror) in accordance with this solicitation. In all events, Prime shall be required to meet the DBE commitment listed in the DBE Affidavit, which will be enforced by LACMTA under the Contract. Each DBE business listed on Form 1 shall complete Attachment A to this Form.

Solicitation Number: Total Prime Bid Price:

Project Name: Authorized Signature / Date:

Bid Due Date: Printed Name and Title:

A1 B C D E E F G2 H I

NAME OF BUSINESS Manufacturer?

(Y/N)

Supplier?3 (Y/N)

Distributor4

(Y/N) Broker5 (Y/N)

Tier (First/ Second/

Third, etc.)

% work intended to be self-performed

If not first-tier, name of business with whom listed business is contracted

Dollar value of listed business’ contract

DBE Credit $6 (Suppliers take 60% of price;

Distributors take 40% of price;

Brokers, fees & commission only) Your Firm

D

BE

S ub co nt ra ct or s

1.

2.

3.

4.

5.

6.

7.

Total:

1For any DBE firm listed on this Project, the Prime is subject to the Termination/Substitution requirements in the solicitation.

2Prime may be required to list businesses not listed on the Subcontractor Listing Form (e.g., a low dollar value non-DBE subcontractor who contracts with a DBE business).

3If a DBE business is a supplier providing materials/supplies, only sixty-percent (60%) of the cost will be credited toward the DBE goal. LACMTA will take 60% of the cost for materials/supplies listed in Column H to credit for DBE participation. If a DBE supplier, list 60% of the Bid Price breakdown in Column I. Appropriate credit will be reviewed by LACMTA according to 49 CFR Part 26.55.

4If a DBE business is Distributor, only forty percent (40%) of the cost will be credited toward the DBE goal. LACMTA will take 40% of the cost for materials/supplies listed in Column H to credit for DBE participation. If a DBE distributor, list 40% of the Bid Price breakdown in Column I. Appropriate credit will be reviewed by LACMTA according to 49 CFR Part 26.55.

5If a DBE business is providing brokering services, only the broker/commission (mark-up) fees will be credited toward the DBE goal. If a broker, only list broker/commission (mark-up) fees in Column H.

6The Prime is reminded that work that a DBE subcontracts to a non-DBE firm does not count toward the DBE goal. See Section 300 (Commercial Useful Function and Counting DBE Participation) of the DBE Instructions to Proposers (Federal). All lower-tier Subcontractors for each DBE firm listed on this form must be identified on Attachment A.

ATTACHMENT A TO FORM 1: SUPPORTING INFORMATION FROM DBE SUBCONTRACTOR

INSTRUCTIONS FOR PRIME (Offeror):

The purpose of this Attachment A is to validate the DBE credit on Form 1 and the DBE commitment in the DBE Affidavit.

1. Send this Attachment A to each DBE business listed on Form 1 and ask each such DBE business to complete Attachment A and return to the Prime.

2. Obtain all Attachment A forms and verify that the information provided in the Attachments is consistent with the aggregated numbers in Form 1 and the DBE commitment listed in the DBE Affidavit. Verify that the information provided in the Attachment A forms is consistent with the information provided in Forms 2 to 5.

3. The Attachment A forms obtained from the DBE businesses listed on Form 1 may include businesses not listed on the Subcontractor Listing Form (e.g., a low dollar value non-DBE subcontractor who contracts with the DBE business).

4. Attach all Attachment A forms received to Form 1 as Attachment A. For a bid to be responsive, you must submit with your bid a completed Attachment A for each DBE business listed on Form 1.

5. If there is any discrepancy or conflict between the information listed on any of Forms 1 to 5 and the information in the Attachments, LACMTA may issue requests for clarification seeking information or clarification from the Prime (Offeror) and the DBE in accordance with this IFB. In all events, Prime shall be required to meet the DBE commitment listed in the DBE Affidavit, which will be enforced by LACMTA under the Contract.

INSTRUCTIONS FOR EACH DBE SUBCONTRACTOR LISTED ON FORM 1 THAT IS SUBCONTRACTING WORK:

1. Complete this Attachment A to Form 1 to the best of your knowledge and information.

2. Complete the row titled "Your Firm" with name in column A and complete the information in columns B to E and G to I for your contract.

3. List each lower-tier Subcontractor (DBE or non-DBE) that you will be sub-contracting Work to in column A and complete the information in columns B through I for each of the Subcontractors listed in column A.

ATTACHMENT A TO FORM 1: SUPPORTING INFORMATION FROM DBE SUBCONTRACTOR

Project Name:

Your Prime Name:

Your Business Name:

Subcontractor Bid Price:

Printed Name and Title: Authorized Signature1 / Date:

A B C D E F G H I

NAME OF BUSINESS DBE?

(Y/N)

Manufacturer (Y/N)

Supplier2 (Y/N)

Distributor3 (Y/N)

Broker4 (Y/N)

Directly contracting through your firm or at a lower tier?

(Direct/lower)

If not first-tier, name of business with whom listed business is contracted

Dollar value of listed business contract5

DBE Credit $6 (Suppliers take 60% of price;

Distributors take 40% of price;

Brokers, fees & commission only)

Your Firm

Lo w er -T ie r

Su bc on tra ct or s

1.

2.

3.

4.

5.

1To be signed by the authorized signatory of the applicable DBE business listed in Form 1.

2If a DBE business is a Supplier providing materials/equipment/supplies, only sixty percent (60%) of the cost will be credited toward the DBE goal. LACMTA will take 60% of the cost for materials/equipment/supplies listed in Column H to credit for DBE participation. If a DBE supplier, please list 60% of the sub-bid price breakdown in Column I. Appropriate credit will be reviewed by LACMTA according to 49 CFR Part 26.55.

3If a DBE business is Distributor, only forty-percent (40%) of the cost will be credited toward the DBE goal. LACMTA will take 40% of the cost for materials/supplies listed in Column H to credit for DBE participation. If a DBE distributor, list 40% of the Bid Price breakdown in Column I. Appropriate credit will be reviewed by LACMTA according to 49 CFR Part 26.55.

4If a DBE business is providing brokering services, only the broker/commission (mark-up) fees will be credited toward the DBE goal. If a broker, only list broker/commission (mark-up) fees in Column I.

6The Subcontractor is reminded that work that a DBE subcontracts to a non-DBE firm does not count toward the DBE goal. See Section 300 (Commercial Useful Function and Counting DBE Participation) of the DBE Instructions to Proposers (Federal).

For any DBE firm listed on Form 1 for this Project, the Prime is subject to the Termination/Substitution requirements in the DEOD Contract Compliance Manual.

FORM 1B - PROPOSED SUBCONTRACTORS & SUPPLIERS FOR NON-CONSTRUCTION IFBs AND RFPs ONLY

TO BE COMPLETED BY PRIME ONLY

The Prime is requested to list ALL first-tier businesses, which include DBEs & non-DBEs, to be utilized on this project to perform work, labor, and/or render service to the Prime for this professional services and/or non-construction procurement. For a bid (IFB)/proposal (RFP) to be responsive, the Prime (Offeror) must complete this form and submit it with the bid/proposal.

IFB/RFP/RFIQ Number: Total Proposal/Bid Price:

Project Name: Authorized Signature / Date:

Proposal/Bid Due Date: Printed Name and Title:

A B C D E F G H

NAME OF BUSINESS DBE?

(Y/N)

Manufacturer (Y/N)

Supplier1 (Y/N)

Distributor2

(Y/N) Broker3 (Y/N) Proposal/Bid Price Breakdown $

DBE Credit $ (If supplier take 60% of price; if Distributor take 40% of price;

if broker, fees and commission only)

Your Firm

Su bc on tra ct or s

1.

2.

3.

4.

5.

6.

7.

8.

9.

Total:

(Should match Total Proposal/Bid Price listed on top of page) (Total DBE Commitment) 1If a DBE business is a Supplier providing materials/supplies, only sixty percent (60%) of the cost will be credited toward the DBE goal. Metro will take 60% of the cost for materials/supplies listed in Column G to credit for DBE participation. If a DBE supplier, please list 60% of the Proposal/Bid Price in Column H. Appropriate credit will be reviewed by LACMTA according to 49 CFR Part 26.55.

2If a DBE business is Distributor, only forty percent (40%) of the cost will be credited toward the DBE goal. LACMTA will take 40% of the cost for materials/supplies listed in Column G to credit for DBE participation. If a DBE distributor, list 40% of the Bid Price breakdown in Column H. Appropriate credit will be reviewed by LACMTA according to 49 CFR Part 26.55.

3If a DBE business is providing brokering services, only the broker/commission (mark-up) fees will be credited toward the DBE goal. If a broker, please only list broker/commission (mark-up) fees in Column H. Appropriate credit will be reviewed by Metro according to 49 CFR Part 26.55.

ATTACHMENT B TO FORM 1B: SUPPORTING INFORMATION FROM DBE SUBCONTRACTOR

FOR NON-CONSTRUCTION IFBs AND RFPs ONLY INSTRUCTIONS FOR PRIME (Offeror):

The purpose of this Attachment B is to validate the DBE credit on Form 1B and the DBE commitment in the DBE Affidavit.

1. Send this Attachment B to each DBE business listed on Form 1B and ask each such DBE business to complete Attachment B and return to the Prime.

2. Obtain all Attachment B forms and verify that the information provided in the Attachments is consistent with the aggregated numbers in Form 1B and the DBE commitment listed in the DBE Affidavit. Verify that the information provided in the Attachment B forms is consistent with the information provided in Forms 2 to 6.

3. Attach all Attachment B forms received to Form 1B as Attachment B. For a bid/proposal to be responsive, you must submit with your bid/proposal a completed Attachment B for each DBE business listed on Form 1B.

4. If there is any discrepancy or conflict between the information listed on any of Forms 1B to 6 and the information in the Attachments, LACMTA may issue requests for clarification seeking information or clarification from the Prime (Offeror) and the DBE in accordance with this IFB. In all events, Prime shall be required to meet the DBE commitment listed in the DBE Affidavit, which will be enforced by LACMTA under the Contract.

INSTRUCTIONS FOR EACH DBE SUBCONTRACTOR LISTED ON FORM 1 THAT IS SUBCONTRACTING WORK:

1. Complete this Attachment B to Form 1B to the best of your knowledge and information.

2. Complete the row titled "Your Firm" with name in column A and complete the information in columns B to E and G to I for your contract.

3. List each lower-tier Subcontractor (DBE or non-DBE) that you will be sub-contracting Work to in column A and complete the information in columns B through I for each of the Subcontractors listed in column A.

ATTACHMENT B TO FORM 1B - PROPOSED LOWER TIER SUBCONTRACTORS & SUPPLIERS

FOR NON-CONSTRUCTION IFBs AND RFPs ONLY

TO BE COMPLETED BY ALL SUBCONTRACTORS LISTED ON FORM 1

All subcontractors listed on Form 1B that are subcontracting work are requested to list ALL lower-tier businesses, which include DBEs & non-DBEs to be utilized on this project.

Your Business Name: Project Name:

Total Proposal/Bid Price: Your Prime Name:

Printed Name and Title: Authorized Signature / Date:

A B C D E F G H

NAME OF BUSINESS DBE

(Y/N)

Manufacturer (Y/N)

Supplier1 (Y/N)

Distributor2

(Y/N) Broker2 (Y/N) Proposal/Bid Price Breakdown $

DBE Credit $ (If Supplier, take 60% of price; if Distributor, take 40% of price; and if broker, fees and commission only)

Your Firm

Su bc on tra ct or s

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Total: (Should match Total Proposal/Bid Price listed on top of page) (Total DBE Commitment)

1If a DBE business is a supplier providing materials/supplies, only sixty percent (60%) of the cost will be credited toward the DBE goal. Metro will take 60% of the cost for materials/supplies listed in Column G to credit for DBE participation. If a DBE supplier, please list 60% of the Proposal Price in Column H.

2If a DBE business is Distributor, only forty percent (40%) of the cost will be credited toward the DBE goal. LACMTA will take 40% of the cost for materials/supplies listed in Column G to credit for DBE participation. If a DBE distributor, list 40% of the Bid Price breakdown in Column H. Appropriate credit will be reviewed by LACMTA according to 49 CFR Part 26.55.

3If a DBE business is providing brokering services, only the broker/commission (mark-up) fees will be credited toward the DBE goal. If a broker, please only list broker/commission (mark-up) fees in Column H. Appropriate credit will be reviewed by Metro according to 49 CFR Part 26.55