FORM 2 - SBE AFFIDAVIT.pdf
PDF 104 KB Posted
- Solicitation number
- PS143950
- Issued by
- California
About this file
This is a Small Business Enterprise (SBE) Affidavit form for the Third Party Administrator (TPA) Conflict Claims contract opportunity with Metro in California. The document requires prime contractors or bidders to affirm their commitment to performing a commercially useful function (CUF) as defined by applicable regulations. Specifically, bidders must declare the percentage of contract work they will perform with their own workforce, with a minimum requirement of 30% of work execution, management, and supervision by the prime contractor. The form requires authorized signatures from a Director, Officer, General Partner, or similarly situated Principal, along with complete business identification information including name, address, contact details, and execution date.
The affidavit serves as part of a comprehensive SBE commitment package that includes multiple supporting forms such as the SBE Subcontractors & Suppliers listing, Business Data Sheet, and SBE Affirmation. The document emphasizes that an SBE cannot limit its role to merely passing funds through to obtain the appearance of participation; rather, it must actively execute, manage, and supervise contracted work. Bidders completing this form attest under penalty of perjury that all information provided is current, complete, and accurate to the best of their knowledge, establishing accountability for compliance with CUF requirements throughout contract performance.
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Text version
FORM 2 - COMMERCIALLY USEFUL FUNCTION AFFIDAVIT
TO BE COMPLETED BY PRIME ONLY
PART A: AFFIDAVIT
An SBE performs a commercially useful function (CUF) when it is responsible for at least execution of the work of the contract and is carrying out its responsibilities by actually performing, managing, and supervising the work involve. An SBE does not perform a CUF if its role is limited to that of an extra participant in a transaction, contract, or project through which funds are passed in order to obtain the appearance of SBE participation.
The Bidder/Proposer acknowledges that it will perform at least 30% of the work for during the performance this contract with its own workforce in compliance with the CUF requirements.
The Bidder/Proposer declares to perform the following percentage of work with its own workforce:
_____________________________________________________________ Percent ( ____ %)
PART B: SIGNATURE
The undersigned Director, Officer, General Partner, or similarly situated Principal of the business declares he/she is informed and believe, and thereon allege, that to the best of their knowledge, information and belief, the information set forth on this page of this document and any attachments, is current, complete and accurate.
Executed on: _____________________, 20 ___, at, _____________________________, _________ (Date) (City) (State)
Business Name: ____________________________________________________________________
Business Address: __________________________________________________________________ (Street) (City) (State)
Authorized Signature: ________________________________________________________________
Printed Name: ___________________________________ Title: ______________________________
Phone: ______________________________ Email: _______________________________________
| TABLE 1 - SBE COMMITMENT FORMS |
| SUBCONTRACTOR LISTING FORM FOR IFB ONLY |
| FORM 1 - SBE SUBCONTRACTORS & SUPPLIERS |
| ATTACHMENT A TO FORM 1: SUPPORTING INFORMATION FROM SBE SUBCONTRACTOR |
| ATTACHMENT A TO FORM 1: SUPPORTING INFORMATION FROM SBE SUBCONTRACTOR |
| FORM 2 - COMMERCIALLY USEFUL FUNCTION AFFIDAVIT |
| FORM 3 - BUSINESS DATA SHEET Page 1 of 2 |
| FORM 4 – SBE AFFIRMATION |
| The BidderProposer declares to perform the following percentage of work with its own workforce: |
| Percent: |
| at: |
| undefined: |
| Business Name: |
| Business Address: |
| Printed Name: |
| Title: |
| Phone: |
| Email: |
| Executed on: |
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