ISBE Form - RFP Appendix B - 12.01.2025.pdf

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