FORM 5 - SBE BIDDERS LIST.pdf

SBE FORM 5 – BIDDERS LIST FORM

The Los Angeles County Metropolitan Transportation Authority (LACMTA) is required per 49 CFR 26.11(c) to create and maintain a comprehensive Bidders List. The purpose of this bidders list information is to compile as accurate data as possible about the universe of SBE and non-SBE contractors and subcontractors who seek to work on LACMTA’s federally assisted contracts. The Bidder's List is a compilation of all bidders, proposers, quoters, subcontractors, manufacturers, and suppliers of materials and services who bid or propose as a prime contractor or subcontractor for this solicitation, inclusive of unsuccessful bids or quotes. Bidders and Proposers are required to submit Form 5 with their bid or proposal. Please provide the following data:

Bidder 1: Business data

Business Name:

Business Address:

Street City State Zip

Is the firm an DBE:

Name of Contact Person:

Yes No

Rac and Gender of Firm’s Majority Owner:

Phone: Email Address: NAICS code applicable to the scope of work to be performed by firm:

Age of Business: Years Months

Annual Gross Receipts:

a. Less than $500,000 b. $500,000 to $1,000,000 c. $1,000,000 to $2,000,000

d. $2,000,000 to $5,000,000 e. Over $5,000,000

Bidder 2: Business data

Business Name:

Business Address:

Street City State Zip

Is the firm an DBE:

Name of Contact Person:

Yes No

Race and Gender of Firm’s Majority Owner:

Phone: Email Address: NAICS code applicable to the scope of work to be performed by firm:

Age of Business: Years Months

Annual Gross Receipts:

a. Less than $500,000 b. $500,000 to $1,000,000 c. $1,000,000 to $2,000,000

d. $2,000,000 to $5,000,000 e. Over $5,000,000 If necessary, this “Bidders List” form can be duplicated to include all firms (SBE and non-SBE) that have submitted a bid or quote on this DOT-assisted project.