ISBE Form - RFP Appendix B - 12.01.2025.pdf
PDF 90 KB Posted
- Attached to
- DOA Risk Management Insurance Broker Services
- Solicitation number
- RFP26006446
- Issued by
- Providence County, Rhode Island
About this file
This is a Minority Business Enterprise (MBE), Women Business Enterprise (WBE), and Disability Business Enterprise Participation Plan form issued by the State of Rhode Island Department of Administration for use in responding to the Department of Administration's Office of Risk Management solicitation for insurance broker services. The form serves as the primary mechanism for prime contractors and vendors to document commitments with certified MBE/WBE and Disability Business Enterprise subcontractors and suppliers, requiring detailed descriptions of work to be performed and corresponding percentages of contract value. All subcontractors and suppliers must be certified at the time of bid submission by the Division of Equity, Diversity & Inclusion MBE Compliance Office or the Governor's Commission on Disabilities, as applicable. The form must be completed in its entirety and submitted with the bid, with separate forms required for each subcontractor or supplier utilized on the solicitation.
Participation credit calculations allow vendors to count 60 percent of expenditures for materials and supplies obtained from an MBE certified as a regular dealer or supplier, and 100 percent of expenditures from an MBE certified as a manufacturer. MBE/WBE and Disability Business Enterprise subcontractors must self-perform 100 percent of their contracted work or subcontract exclusively to another Rhode Island certified MBE to receive participation credit. Vendors that fail to provide detailed descriptions of work at the time of bid submission will receive zero percent MBE participation credit. The form requires certification under penalty of perjury from both the prime contractor/vendor and subcontractor/supplier, with signature authority from designated representatives of each party.
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Text version
STATE OF RHODE ISLAND
DEPARTMENT OF ADMINISTRATION
ONE CAPITOL HILL
PROVIDENCE, RHODE ISLAND 02908
MBE, WBE, and/or DISABILITY BUSINESS ENTERPRISE PARTICIPATION PLAN
Vendor's Name:
Vendor's Address:
Point of Contact:
Telephone:
Email:
Solicitation No.:
Project Name:
This form is intended to capture commitments between the prime contractor/vendor and MBE/WBE and/or Disability Business
Enterprise subcontractors and suppliers, including a description of the work to be performed and the percentage of the work as submitted to the prime contractor/vendor. Please note that all MBE/WBE subcontractors/suppliers must be certified by the Division of Equity, Diversity & Inclusion MBE Compliance Office and all Disability Business Enterprises must be certified by the Governor's
Commission on Disabilities at time of bid, and that MBE/WBE and Disability Business Enterprise subcontractors must self-perform
100% of the work or subcontract to another RI certified MBE in order to receive participation credit. Vendors may count 60% of expenditures for materials and supplies obtained from an MBE certified as a regular dealer/supplier, and 100% of such expenditures obtained from an MBE certified as a manufacturer. This form must be completed in its entirety and submitted at time of bid. Please complete separate forms for each MBE/WBE or Disability Business Enterprise subcontractor/supplier to be utilized on the solicitation.
Name of Subcontractor/Supplier:
This field must be completed.
Type of RI Certification:
□ Minority Business Enterprise (MBE)
□ Women Business Enterprise (WBE)
□ Disability Business Enterprise
□ None of the above
Address:
Point of Contact:
Telephone:
Email:
Detailed description of work to be performed by Subcontractor or materials to be supplied by Supplier:
This row must be completed. Vendors who do not supply this information at time of bid submission will receive 0%
MBE participation credit.
Total Contract Value ($): Subcontract Value ($):
Anticipated Date of Performance:
I certify under penalty of perjury that the foregoing statements are true and correct.
Prime Contractor/Vendor Signature Title
Subcontractor/Supplier Signature Title
Date of Revision 11/15/2024
| Point of Contact: |
| Telephone: |
| Email: |
| Solicitation No: |
| Project Name: |
| Total Contract Value: |
| Subcontract Value: |
| Detailed Description of Work: |
| Subcontractor/Supplier Address: |
| Name of Subcontractor/Supplier: |
| Subcontractor/Supplier Point of Contact Name: |
| Vendor Name: |
| Vendor Address: |
| Subcontractor/Supplier Telephone: |
| Subcontractor/Supplier Email: |
| Check Box1: Off |
| Anticipated Date of Performance: |
| Prime Contractor/Vendor Title: |
| Subcontractor/Supplier Title: |
| Check Box2: Off |
| Check Box3: Off |
| Check Box4: Off |
File details come from the government source that posted it. Updated .