FORM 2 - DBE AFFIDAVIT.pdf

FORM 2 – DBE AFFIDAVIT

TO BE COMPLETED BY PRIME ONLY

Complete Parts A and C or Parts B and C Part A: Met or Exceeded Goal

HAS ACHIEVED THE DBE PARTICIPATION FOR THIS CONTRACT

The Offeror 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 DBE goal established by LACMTA for DBE participation.

The Offeror declares it achieved the following DBE percentage:

_____________________________________________________________ Percent ( ____ %)

Part B: Did Not Meet Goal

HAS NOT ACHIEVED THE DBE PARTICIPATION FOR THIS CONTRACT

The Offeror declares to the best of its knowledge, information and belief that while it made efforts to achieve the DBE goal, it DID NOT ACHIEVE the DBE goal established by LACMTA. Offeror must submit Good Faith Efforts (GFE) documentation by bid due date or Offeror will be deemed non-responsive for failure to submit GFE documents with bid.

The Offeror achieved the following DBE percentage:

_____________________________________________________________ Percent ( ____ %)

Part C: SIGNATURE

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

Business Name: ____________________________________________________________________

Business Address: __________________________________________________________________ (Street) (City) (State)

Authorized Signature: ________________________________________________________________

Printed Name: ___________________________________ Title: ______________________________

Phone: ______________________________ Email: _______________________________________