FORM 2 - DBE AFFIDAVIT.pdf
PDF 117 KB Posted
- Solicitation number
- MA130013
- Issued by
- California
About this file
This is a DBE (Disadvantaged Business Enterprise) Affidavit form designed for use by bidders and contractors participating in state and local contract opportunities, particularly those involving federal funding or compliance with transportation programs. The form serves as a sworn statement certifying the ownership, control, and operations status of a business entity regarding its eligibility as a disadvantaged business enterprise under federal definitions and state guidelines.
The affidavit requires detailed information regarding the principal owner(s), including personal financial statements, business structure, years in operation, and documentation of ownership percentages and operational control. Signatories must attest under penalty of perjury to the accuracy of provided information concerning the business's disadvantaged status, which typically involves documentation of social and economic disadvantage. The form requires certification that the applicant business meets all eligibility criteria for DBE classification and has not falsified information to obtain such status. Completion and notarization of this affidavit is a standard requirement for contractors seeking to qualify for DBE set-asides, participate in DBE utilization goals on larger contracts, or claim DBE certification benefits in competitive bidding processes. The affidavit becomes part of the official bid submission and contract documentation, with false statements subject to legal penalties.
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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: |
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