FORM 2 - DBE AFFIDAVIT.pdf
PDF 117 KB Posted
- Solicitation number
- PS136749
- 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 compliance with LACMTA's established DBE participation goals. Contractors must complete either Part A, indicating they have met or exceeded the DBE goal with a specified percentage, or Part B, indicating they have not achieved the goal but made good faith efforts to do so. Part C requires the authorized representative of the business to execute the affidavit with their signature, printed name, title, contact information, and the date, city, and state where the document was executed.
Contractors who do not meet the DBE participation goal established by LACMTA must submit Good Faith Efforts (GFE) documentation by the bid due date to remain responsive; failure to provide this documentation will result in the bid being deemed non-responsive. The affidavit serves as a compliance verification mechanism to ensure that prime contractors are actively working toward or achieving DBE participation targets, which are federal requirements designed to promote opportunities for disadvantaged business enterprises in public transportation contracts.
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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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