FORM 2 - AFFIDAVIT.pdf

PDF 122 KB Posted

Attached to
FSP Light Duty Tow Service - General Purpose Lanes and ExpressLanes
Solicitation number
FS135771
Issued by
California

About this file

This is an affidavit form for prime contractors/proposers to complete when submitting bids or proposals to Metro. 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. Bidders must complete either Part A or Part B along with Part C. Part A applies when a bidder has met or exceeded Metro's established SBE and DVBE participation goals and must declare the achieved percentages for each category. Part B applies when a bidder has not met the SBE and DVBE goals; notably, the form specifies that Good Faith Efforts are no longer accepted if goals are not met, and bidders failing to meet these goals are ineligible for contract award. The form requires bidders to specify their SBE and DVBE participation percentages in corresponding blank fields.

Part C addresses LSBE preference eligibility and requires bidders to declare whether they meet Metro's LSBE eligibility criteria under the Letter of Invitation Supplement guidelines. Bidders must indicate one of two options: either the bidder itself is a Metro-certified LSBE firm, or the bidder is not Metro-certified but will subcontract at least 30 percent of the contract value to eligible LSBE firms. Part D requires signature, date, location, business name and address, authorized signature, printed name, title, IFB/RFP/RFIQ number, and project name. This affidavit form is mandatory for prime bidders and serves as documentation of compliance with Metro's small business and disadvantaged veteran business participation goals and preferences.

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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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