FORM 2 - DBE AFFIDAVIT.pdf
PDF 117 KB Posted
- Attached to
- UPS Battery Replacement Location 64
- Solicitation number
- PS132603(2)
- 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 requires prime contractors to declare their level of DBE participation and commitment to meeting LACMTA's established DBE goals. Contractors must complete either Part A (if they have met or exceeded the DBE goal) or Part B (if they have not met the goal), along with mandatory Part C signature requirements. The form requests documentation of the achieved DBE percentage, execution date, business information, and authorized representative details.
Contractors who do not meet the DBE participation goal must submit Good Faith Efforts (GFE) documentation by the bid due date or face deemed non-responsive status. The affidavit serves as a binding declaration by the offeror regarding its DBE participation efforts and achievements relative to LACMTA's established targets. Completion of this form is a mandatory requirement for bid submission, with the contractor's signature attesting to the accuracy of the stated DBE percentage and participation level.
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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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