FORM 2 - DBE AFFIDAVIT.pdf
PDF 117 KB Posted
- Solicitation number
- DR145358
- 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 contracts. The form serves as the official declaration of DBE participation levels achieved by the offeror and must be completed by the prime contractor only. Offerors must complete either Part A or Part B in conjunction with Part C. Part A is used when the offeror has met or exceeded the DBE goal established by LACMTA, requiring documentation of the achieved DBE participation percentage. Part B is used when the offeror has not met the established DBE goal; in such cases, the offeror must submit Good Faith Efforts (GFE) documentation by the bid due date or risk being deemed non-responsive.
Part C requires the authorized representative of the business to execute the affidavit with the business name, address, authorized signature, printed name, title, phone number, and email address, along with the execution date and location. The form explicitly requires that if the offeror selects Part B (did not meet goal), Good Faith Efforts documentation must accompany the bid submission. Failure to provide GFE documentation when the DBE goal is not achieved will result in the bid being classified as non-responsive and subject to rejection.
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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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