FORM 2 - DBE AFFIDAVIT.pdf
PDF 117 KB Posted
- Attached to
- Security Asset Manager (SAM) Key Safe
- Solicitation number
- OP143616
- Issued by
- California
About this file
This is a Disadvantaged Business Enterprise (DBE) Affidavit form required by the Los Angeles County Metropolitan Transportation Authority (LACMTA) for prime contractors bidding on state and local contract opportunities. The form requires prime contractors to declare their level of DBE participation and commitment to the established DBE goal. Contractors must complete either Part A, indicating they have met or exceeded the DBE participation goal, or Part B, indicating they did not meet the goal but made good faith efforts to do so. Both sections require contractors to specify the actual DBE participation percentage achieved. Part C requires execution by an authorized representative and includes fields for business name, address, authorized signature, printed name, title, phone number, and email address.
Contractors who did not achieve the DBE goal must submit Good Faith Efforts (GFE) documentation by the bid due date or face rejection as non-responsive. The affidavit must be completed and signed by the prime contractor only, establishing accountability for DBE participation compliance. This form serves as a certification mechanism to ensure contractors are actively working toward LACMTA's DBE participation objectives and demonstrates commitment to inclusive contracting practices for disadvantaged business enterprises.
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Text version
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: _______________________________________
| HAS ACHIEVED THE DBE PARTICIPATION FOR THIS CONTRACT: Off |
| The Offeror declares it achieved the following DBE percentage: |
| Percent: |
| HAS NOT ACHIEVED THE DBE PARTICIPATION FOR THIS CONTRACT: Off |
| The Offeror achieved the following DBE percentage: |
| Percent_2: |
| Executed on: |
| at: |
| undefined_2: |
| Business Name: |
| Business Address: |
| Printed Name: |
| Title: |
| Phone: |
| Email: |
| Text4: |
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