ISBE Form - RFP Appendix B - 12.01.2025.pdf
PDF 90 KB Posted
- Solicitation number
- RFP27006941
- 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 in conjunction with a Department of Corrections solicitation for onsite vision and optometry services to the incarcerated population. The form is designed to document commitments between prime contractors and certified subcontractors or suppliers, including detailed descriptions of work to be performed and corresponding percentages of contract value. All MBE/WBE subcontractors and suppliers must be certified by the Division of Equity, Diversity & Inclusion MBE Compliance Office at the time of bid submission, while Disability Business Enterprise subcontractors must be certified by the Governor's Commission on Disabilities. Separate forms must be completed for each subcontractor or supplier utilized on the solicitation, and vendors who fail to provide detailed descriptions of work at bid submission will receive zero percent MBE participation credit.
MBE/WBE and Disability Business Enterprise subcontractors must self-perform 100 percent of contracted work or subcontract exclusively to other Rhode Island-certified MBEs to receive participation credit. Vendors may count 60 percent of material and supply expenditures obtained from MBE-certified regular dealers or suppliers, and 100 percent of expenditures from MBE-certified manufacturers. The form requires completion of all fields including vendor name and contact information, solicitation number, project name, total contract value, subcontract value, and anticipated performance dates. Both the prime contractor/vendor and subcontractor/supplier must provide signatures certifying under penalty of perjury that all statements are true and correct.
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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 |
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