FORM 4 - PROPOSED LOWER TIER SUBCONTRACTORS & SUPPLIERS.pdf
PDF 41 KB Posted
- Solicitation number
- AE141998
- Issued by
- California
About this file
This is a Form 4 submission template for proposed lower-tier subcontractors and suppliers required by the California Department of Transportation (Metro) for state and local contract opportunities. The form must be completed by all subcontractors listed on Form 1 and requires documentation of all lower-tier businesses, including Small Business Enterprises (SBEs), Disabled Veteran Business Enterprises (DVBEs), and Local Small Business Enterprises (LSBEs), as well as non-SBE/DVBE entities to be utilized on the project. This submission fulfills requirements under the California Subletting and Subcontracting Fair Practices Act and is submitted concurrently with Form 3, the Business Data Sheet. The form accommodates up to ten subcontractors and requires identification of the IFB/RFP/RFIQ number, project name, total proposal or bid price, and proposal or bid due date.
The form requires bidders to identify each subcontractor's certification status (SBE, DVBE, and LSBE designations), classify whether the entity is a supplier or broker, and provide detailed price breakdowns with corresponding SBE and DVBE credits. Special credit provisions apply: suppliers providing only materials or supplies receive 60 percent credit toward SBE/DVBE goals, while brokers receive credit only for their fees. Non-LSBE proposers demonstrating at least 30 percent LSBE participation qualify for a preference in evaluation. The total of all SBE and DVBE commitments must be clearly calculated and reconciled against the total proposal or bid price.
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Text version
FORM 4 - PROPOSED LOWER TIER SUBCONTRACTORS & SUPPLIERS
TO BE COMPLETED BY ALL SUBCONTRACTORS LISTED ON FORM 1
All subcontractors listed on Form 1 that are subcontracting work are requested to list ALL lower-tier businesses, which include SBE/DVBEs & Non SBE/DVBEs to be utilized on this project. Completion of this form and Form 3, Business Data Sheet fulfills the requirements of the California Subletting and Subcontracting Fair Practices Act.
IFB/RFP/RFIQ Number: Project Name:
Total Proposal/Bid Price: Proposal/Bid Due Date:
Printed Name and Title: Authorized Signature/Date:
A B C D E F G H I
NAME OF BUSINESS
(Subcontractors)
SBE?
(Y/N)
DVBE?
(Y/N)
LSBE?
(Y/N)
Supplier?1 (Y/N)
Broker?2 (Y/N)
Proposal/Bid Price Breakdown $ SBE Credit $ DVBE Credit $
Prime
Su bc on tra ct or s
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Total:
(Should match Total Prop/Bid Price on top of pg.) (Total SBE Commitment) (Total DVBE Commitment)
*NOTE: Non-LSBE Proposers that identify at least thirty percent (30%) LSBE participation are eligible for a preference
1If an SBE/DVBE business is a supplier providing materials/supplies, only sixty-percent (60%) of the cost will be credited toward the SBE/DVBE goal. Metro will take 60% of the cost for materials/supplies listed in Column E to credit for SBE/DVBE participation. If an SBE/DVBE supplier, please list 60% of the Proposal Price in Column G/H.
2If an SBE/DVBE business is providing brokering services, only the broker’s fee cost will be credited toward the SBE/DVBE goal. If a broker, please only list broker’s fees in Column G/H.
Appropriate credit will be reviewed by Metro.
| SBE/DVBE INSTRUCTIONS TO BIDDERS/PROPOSERS (IFB/RFP) |
| FORM 4 - PROPOSED LOWER TIER SUBCONTRACTORS & SUPPLIERS |
| IFBRFPRFIQ Number: |
| undefined: |
| Total ProposalBid Price: |
| ProposalBid Due Date: |
| Printed Name and Title: |
| NAME OF BUSINESS SubcontractorsPrime: |
| SBE YNPrime: |
| DVBE YNPrime: |
| LSBE YNPrime: |
| Supplier1 YNPrime: |
| Broker2 YNPrime: |
| ProposalBid Price Breakdown Prime: |
| SBE Credit Prime: |
| DVBE Credit Prime: |
| NAME OF BUSINESS Subcontractors1: |
| SBE YN1: |
| DVBE YN1: |
| LSBE YN1: |
| Supplier1 YN1: |
| Broker2 YN1: |
| ProposalBid Price Breakdown 1: |
| SBE Credit 1: |
| DVBE Credit 1: |
| NAME OF BUSINESS Subcontractors2: |
| SBE YN2: |
| DVBE YN2: |
| LSBE YN2: |
| Supplier1 YN2: |
| Broker2 YN2: |
| ProposalBid Price Breakdown 2: |
| SBE Credit 2: |
| DVBE Credit 2: |
| NAME OF BUSINESS Subcontractors3: |
| SBE YN3: |
| DVBE YN3: |
| LSBE YN3: |
| Supplier1 YN3: |
| Broker2 YN3: |
| ProposalBid Price Breakdown 3: |
| SBE Credit 3: |
| DVBE Credit 3: |
| NAME OF BUSINESS Subcontractors4: |
| SBE YN4: |
| DVBE YN4: |
| LSBE YN4: |
| Supplier1 YN4: |
| Broker2 YN4: |
| ProposalBid Price Breakdown 4: |
| SBE Credit 4: |
| DVBE Credit 4: |
| NAME OF BUSINESS Subcontractors5: |
| SBE YN5: |
| DVBE YN5: |
| LSBE YN5: |
| Supplier1 YN5: |
| Broker2 YN5: |
| ProposalBid Price Breakdown 5: |
| SBE Credit 5: |
| DVBE Credit 5: |
| NAME OF BUSINESS Subcontractors6: |
| SBE YN6: |
| DVBE YN6: |
| LSBE YN6: |
| Supplier1 YN6: |
| Broker2 YN6: |
| ProposalBid Price Breakdown 6: |
| SBE Credit 6: |
| DVBE Credit 6: |
| NAME OF BUSINESS Subcontractors7: |
| SBE YN7: |
| DVBE YN7: |
| LSBE YN7: |
| Supplier1 YN7: |
| Broker2 YN7: |
| ProposalBid Price Breakdown 7: |
| SBE Credit 7: |
| DVBE Credit 7: |
| NAME OF BUSINESS Subcontractors8: |
| SBE YN8: |
| DVBE YN8: |
| LSBE YN8: |
| Supplier1 YN8: |
| Broker2 YN8: |
| ProposalBid Price Breakdown 8: |
| SBE Credit 8: |
| DVBE Credit 8: |
| NAME OF BUSINESS Subcontractors9: |
| SBE YN9: |
| DVBE YN9: |
| LSBE YN9: |
| Supplier1 YN9: |
| Broker2 YN9: |
| ProposalBid Price Breakdown 9: |
| SBE Credit 9: |
| DVBE Credit 9: |
| NAME OF BUSINESS Subcontractors10: |
| SBE YN10: |
| DVBE YN10: |
| LSBE YN10: |
| Supplier1 YN10: |
| Broker2 YN10: |
| ProposalBid Price Breakdown 10: |
| SBE Credit 10: |
| DVBE Credit 10: |
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