FORM 2 - AFFIDAVIT.pdf

PDF 122 KB Posted

Attached to
Neurodiversity Accessibility Training and Transit Orientation Program
Solicitation number
PS144500
Issued by
California

About this file

This is an affidavit form required by Metro (a California public transportation agency) to be completed by prime bidders or proposers in response to contract solicitations. The form addresses Small Business Enterprise (SBE) and Disadvantaged Veteran Business Enterprise (DVBE) participation requirements, as well as Local Small Business Enterprise (LSBE) preference eligibility for the Neurodiversity Accessibility Training and Transit Orientation Program.

The affidavit requires prime contractors to declare either that they have met or exceeded Metro's established SBE and DVBE participation goals (Part A) or acknowledge failure to meet those goals (Part B), with the latter resulting in ineligibility for award. Part C addresses LSBE preference eligibility, allowing bidders/proposers to claim status as Metro-certified LSBE firms or to demonstrate subcontracting at least 30 percent of contract value with eligible LSBE firms. The form requires completion of either Parts A and C or Parts B and C, along with executed signatures, business identification, and relevant solicitation details including IFB/RFP/RFIQ number and project name.

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Text version

FORM 2 - AFFIDAVIT

TO BE COMPLETED BY PRIME ONLY

Complete Parts A and C or Parts B and C

PART A: SBE and DVBE – MET OR EXCEEDED GOAL

HAS LISTED SBE and DVBE PARTICIPATION FOR THIS CONTRACT

The Bidder/Proposer declares to the best of its knowledge, information and belief that by its efforts, it ACHIEVED a level of participation greater than or equal to the SBE/DVBE goal established by Metro for SBE/DVBE participation.

The Bidder/Proposer declares it achieved the following SBE percentage:

_____________________________________________________________ Percent ( ____ %)

The Bidder/Proposer declares it achieved the following DVBE percentage:

_____________________________________________________________ Percent ( ____ %)

PART B: SBE and DVBE – DID NOT MEET GOAL

HAS NOT LISTED SBE and DVBE PARTICIPATION FOR THIS CONTRACT The Bidder/Proposer declares to the best of its knowledge, information and belief that while it made efforts to achieve the SBE and DVBE goal, it DID NOT ACHIEVE the SBE and DVBE goal established by Metro. Good Faith Efforts (GFE) is no longer accepted if the SBE and DVBE goals are not met. Bidder/Proposers that do not meet the SBE and DVBE goals will not be eligible for award.

The Bidder/Proposer achieved the following SBE percentage:

_____________________________________________________________ Percent ( ____ %)

The Of Bidder/Proposer achieved the following DVBE percentage:

_____________________________________________________________ Percent ( ____ %)

PART C: LOCAL SMALL BUSINESS ENTERPRISE (LSBE) PREFERENCE

The Proposer declares to the best of its knowledge, information and belief meets the eligibility criteria for a LSBE preference, as defined by Metro program guidelines, as stated in the Letter of Invitation Supplement, Section B, “Local Small Business Enterprise (LSBE) Preference. (Check which applies)

Bidder/Proposer itself is a Metro certified LSBE firm

Bidder/Proposer is not a Metro certified LSBE but subcontracts at least 30% of the contract value with eligible LSBE firms.

PART D: SIGNATURE

Executed on: _____________________, 20 ___, at, _____________________________, _________ (Date) (City) (State)

Business Name: ____________________________________________________________________ (Street) (City) (State)

Authorized Signature: ________________________________________________________________

Printed Name: ___________________________________ Title: ______________________________

IFB/RFP/RFIQ Number: _________________ Project Name: _________________________________

PART A SBE and DVBE MET OR EXCEEDED GOAL:
HAS LISTED SBE and DVBE PARTICIPATION FOR THIS CONTRACT: Off
The BidderProposer declares it achieved the following SBE percentage:
Percent:
The BidderProposer declares it achieved the following DVBE percentage:
Percent_2:
HAS NOT LISTED SBE and DVBE PARTICIPATION FOR THIS CONTRACT: Off
The BidderProposer achieved the following SBE percentage:
Percent_3:
The Of BidderProposer achieved the following DVBE percentage:
Percent_4:
BidderProposer itself is a Metro certified LSBE firm: Off
BidderProposer is not a Metro certified LSBE but subcontracts at least 30 of the contract value: Off
Executed on:
at:
undefined_4:
Business Name_2:
Printed Name:
Title:
IFBRFPRFIQ Number_3:
Project Name:
Text8:

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