FORM 2 - DBE AFFIDAVIT.pdf
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- Attached to
- APS COOLING AND PROPULSION FANS (OEM)
- Solicitation number
- DR141705
- 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 submitting bids on contract opportunities. The form serves as an official declaration of DBE participation levels achieved by the offeror and must be completed by the prime contractor only.
The affidavit requires offerors to declare whether they have met or exceeded the DBE participation goal established by LACMTA, or alternatively, acknowledge that they did not meet the goal while documenting good faith efforts to do so. Offerors must complete either Part A (if the DBE goal was achieved or exceeded) or Part B (if the goal was not achieved), along with Part C containing signature and business information. If an offeror did not achieve the established DBE percentage goal, submission of Good Faith Efforts (GFE) documentation is mandatory by the bid due date, with failure to submit resulting in the bid being deemed non-responsive. The form requires the authorized representative to provide execution date, business name, complete business address, printed name, title, phone number, and email address, with space provided to document the specific DBE percentage achieved.
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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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