MBE_Participation_Forms.pdf
PDF 751 KB Posted
- Attached to
- RIDOT: Extra Heavy Duty Truck with Utility Body
- Solicitation number
- RFQ26006234
- Issued by
- Kent County, Rhode Island
About this file
MBE Participation Forms Summary
This document consists of MBE (Minority Business Enterprise) and WBE (Women Business Enterprise) participation forms and submission requirements for the Rhode Island Department of Transportation (RIDOT) contract opportunity for twenty-four extra heavy-duty trucks with utility bodies (RI Contract Number 2025-CM-030). The solicitation mandates a 15% MBE/WBE participation goal. Bidders must submit MBE documentation through one of two methods: uploading forms within the Ocean State Procures (OSP) portal during bid submission, or submitting forms electronically to DOT.Contracts@dot.ri.gov no later than 4:00 P.M. on the third business day following bid opening (January 19, 2026). Failure to submit MBE documentation by this deadline results in the bid being deemed nonresponsive and subject to disqualification. All bidders must submit a completed MBE-001 (Pre-Award Utilization Plan) identifying MBE/WBE firms that will participate in the contract. For each participating MBE/WBE firm, bidders must submit an executed MBE-002 (Letter of Intent) containing a work summary and cost quote. If a bidder cannot meet the 15% MBE goal, they must submit an MBE-006 (Good Faith Efforts documentation) demonstrating reasonable efforts to secure adequate MBE participation.
Post-award MBE documentation requirements are similarly comprehensive and must be submitted to the RIDOT Office of Civil Rights (OCR) at DOT.DBE@dot.ri.gov, with copies to the assigned Construction Manager and Project Manager. Prime contractors must submit an MBE-003 (Participation Statement) for each MBE/WBE firm performing work, or alternative forms MBE-004 or MBE-005 if the firm is performing trucking operations or acting as a regular dealer. All MBE/WBE participation must be evaluated by OCR prior to work commencement to confirm eligibility and the firm's ability to perform a commercially useful function (CUF). If any MBE/WBE commitment is terminated or reduced during contract performance and the prime cannot identify replacement participation to achieve the contract goal, an MBE-006 and supporting documentation must be submitted to OCR for review. Failure to provide required post-award documentation may result in a non-compliance determination.
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Bid Opening MBE Participation Submission Requirements
Bidders are responsible for the collection and submission of all MBE documentation and have a choice between two (2) methods to submit their MBE Participation Forms as described below:
The first method is to upload the forms with the bid submission. The upload portal is located in the Questionnaire Section of the Ocean State Procures (OSP) Solicitation under: “DOT Required Forms [10 Questions] – 10. MBE Participation Requirements (Optional Submission Method).”
The second method is for bidders to submit the forms no later than four o’clock (4:00 P.M.) on the third (3rd) business day after the bid opening. Documents must be sent electronically to DOT.Contracts@dot.ri.gov. The Rhode Island Contract Number (RIC No.) shall be clearly identified within the subject line of the e-mail AND all attachments/documentation must be included.
Submissions must be provided through one of the two methods listed above. Failure to submit by four o’clock (4:00 P.M.) on the third (3rd) business day after the bid opening shall result in the bid being deemed nonresponsive and may result in disqualification.
Form Name
MBE
Signature Required
Submission Requirement
MBE-001
MBE Pre-
Award Utilization
Plan
All bidders shall submit an executed MBE-001 identifying MBE/WBE participation to be utilized by the bidder to achieve the assigned contract goal.
MBE-002
MBE
Letter of Intent
An executed MBE-002 form must be attached for each participating MBE/WBE firm named on the executed MBE-001. Upon OCR’s approval and RIDOT contract award, the bidder agrees to enter into a subcontract agreement with the named MBE/WBE firm for the identified scope of work and dollar amount.
MBE-006
MBE Good
Faith Efforts
(GFE)
In the event a bidder is unable to identify enough MBE/WBE participation to achieve the assigned contract MBE goal pre-award, an executed MBE- 006 and all supporting documentation must be attached to the submitted
MBE-001.
mailto:DOT.Contracts@dot.ri.gov.
RIDOT MBE Forms Submission Requirements
Post-Award MBE Participation Form Submission Requirements
Important: All contract work performed by certified MBE/WBE firms must be reported to and monitored by the RIDOT Office of Civil Rights (OCR) whether contract MBE goal is assigned to the contract or not.
All post-award MBE documentation submissions must be submitted directly to the Office of Civil Rights (OCR) AND assigned RIDOT Construction Manager (CM) and Project Manager (PM).
Post-award MBE documentation shall be submitted electronically to: DOT.DBE@dot.ri.gov. The Rhode Island Contract Number (RIC No.) shall be clearly identified within the subject line of the e-mail AND all attachments/documentation must be included in the e-mail.
Form
No.
Form Name
Completed by
Submission Requirement Prime
Contractor
MBE/WBE
Firm
MBE-
MBE
Participation Statement*
For ALL Contracts: An executed MBE-003 and subcontract agreement or purchase order must be submitted to RIDOT OCR for each MBE/WBE firm. For MBE/WBE firms performing Trucking Operation or acting as a Regular Dealer please utilize appropriate forms named below.
MBE-
MBE Trucking Agreement*
For ALL Contracts: An executed MBE-004 and subcontract agreement or purchase order must be submitted to RIDOT OCR.
Note: MBE-004 should only be used for MBE/WBE firms performing trucking operations.
MBE-
MBE Regular Dealer*
For ALL Contracts: An executed MBE-005 and subcontract agreement or purchase order must be submitted to RIDOT OCR.
Note: MBE-005 should only be used for MBE/WBE firms performing as a Regular Dealer.
MBE-
MBE Good Faith Efforts
(GFE)
Assigned Contract Goal:
Termination/Substitution: In the event a MBE/WBE commitment identified on the OCR approved Pre-Award MBE Utilization Plan (MBE-001) is reduced and/or terminated, and the Prime is unable to identify additional MBE/WBE Participation to the extent needed to achieve the contract goal, executed MBE-006 and supporting documentation must be submitted to OCR for review.
Note: Failure to submit may result in non-compliance determination.
Contract Closeout: In the event a contractor is unable to achieve the approved MBE/ WBE commitment as identified on MBE-001, the prime is expected to submit the executed MBE-006 (or equivalent) and supporting documentation demonstrating the efforts made by the firm to meet commitment.
Note: Failure to submit may result in non-compliance determination.
No Contract Goal: No submission/GFE required.
MBE-
MBE/WBE
Termination or
Substitution Request
Assigned Contract Goal: In the event a MBE/WBE commitment identified on the approved pre- award utilization plan, or an approved substitution(s) is impacted by a reduction and/or termination the Prime Contractor must adhere to Termination/ Substitution requirements. An executed MBE-007 must be submitted to RIDOT OCR for approval.
No Contract Goal: Termination or Substitution requirements not applicable.
*To be utilized in the evaluation of the MBE/WBE firm’s ability to perform a commercially useful function (CUF). A MBE/WBE firm’s certified NAICS codes can be found in the MBE Directory.
Note: Applicable MBE-003, MBE-004, and MBE-005 forms will serve as a cover sheet when submitting a subcontract agreement or purchase order.
https://dedi.ri.gov/divisions-units/minority-business-enterprise-compliance-office/minority-business-enterprise-mbe
RIDOT Pre- Award MBE Utilization Plan RI Contract Number: ________________
Contract Goal: ________________
Form MBE-001 (Eff. 4/24/2024) Page _____ of ______
The contractor agrees to ensure that Minority Business Enterprises (MBE) and Women Business Enterprises (WBE) as defined in R.I.GL 37-14.1 have the maximum opportunity to participate in the performance of federally funded contracts and subcontracts.
The contractor shall not discriminate on the basis of race, color, national origin or sex in the award and the performance of Contracts.
An executed MBE-001 must be submitted to RIDOT Contracts no later than 4:00 pm on the 3rd business day after the bid opening. Documents must be submitted electronically to: DOT.Contracts@dot.ri.gov.
Contract Name:
Bidder: Contract Value:
The MBE and/or WBE firms listed below have been contacted regarding participation on this project. If the contractor is successful and is awarded the contract, it shall assure subcontracts and/or supply agreements are executed with the named MBE and/or WBE(s).
MBE/WBE Commitments (Use additional sheets as needed)
MBE/WBE
Firm Name
Commitment Commitment
Commitment Commitment
Commitment Commitment
Commitment Commitment
I, acting in my capacity as an officer of the undersigned bidder (or bidders in a joint venture), hereby assure the Department that on this contract, my company: (check one)
Met or exceeded the contract MBE goal. Contract MBE participation is as follows:
Total Contract MBE Commitment $ Total Contract MBE Participation %
Did NOT meet contract MBE goal. Good Faith Effort documentation (form MBE-006 or equivalent) is attached.
Contract MBE participation is as follows:
Total Contract MBE Commitment $ Total Contract MBE Participation %
Attached is documentation demonstrating my company’s efforts to achieve the contract MBE goal including but not limited to MBE/WBE Letter(s) of Intent, demonstrating MBE/WBE availability and use of each MBE/WBE indicated above and/or Good Faith Efforts documentation. This contractor understands, once the MBE Utilization Plan has been approved by RIDOT Office of Civil Rights (OCR), a commitment has been made to the above firms, and any changes or reductions to the above MBE/ WBE commitments are subject to termination and substitution guidelines. Final contract MBE/WBE credit to be assessed by RIDOT OCR based upon Commercial Useful Function (CUF) performed by the firm and subcontractor payments during contract closeout.
Bidder’s Signature and Date
Please note ALL MBE/WBE participation must be submitted to and reviewed by OCR PRIOR to the start of work to review for MBE/WBE eligibility only. All Subcontractor Agreements are subject to the Construction Management approval process.
MBE/WBE
Firm Name
MBE/WBE
Firm Name
MBE/WBE
Firm Name
MBE/WBE
Firm Name
MBE/WBE
Firm Name
MBE/WBE
Firm Name
MBE/WBE
Firm Name
MBE/WBE
Firm Name
RIDOT MBE Letter of Intent RI Contract Number: ________________
Contract Goal: ________________
Form MBE-002 (Eff. 4/24/2024) Page _____ of ______
Pre-Award- The Bidder is responsible to attach an executed Letter of Intent and work quote for EACH MBE/WBE firm identified on the MBE-001 (MBE Pre-Award Utilization Plan) for the above-named contract.
Executed MBE-002 must be submitted to RIDOT Contracts no later than by 4:00pm on the 3rd business day after the bid opening. Documents must be submitted electronically to: DOT.Construction@dot.ri.gov.
Contractor Information
Bidder:
Bidder Rep:
Address:
Phone Number:
MBE/WBE Subcontractor:
MBE/WBE Rep:
Address:
Phone Number:
MBE/WBE Performance (to be completed by Prime firm)
In accordance with R.I.G.L. 37-14.1 and 49 CFR 26.55, MBE and WBE Eligibility is dependent upon the firm’s ability to perform a Commercially Useful Function (CUF).
Contract MBE/WBE Participation:
Subcontractor Regular Dealer Broker
Professional Services Manufacturer Joint Venture (JV)
Summary of work and line items to be performed by MBE/WBE Firm:
Applicable NAICS Code:
Estimated Dollar Value of Work: ______________________
Proposed Bidder Contract Value: ______________________
Estimated Percentage of Total Contract Value ________________
If awarded the contract, the bidder intends to enter into a subcontract with the above-named MBE/WBE firm to perform the work described above. The MBE/WBE affirms they have the ability to manage, supervise and perform the intended scope of work.
Bidder Signature Date MBE/WBE Signature Date
Note: If the bidder is not awarded the prime contract, any and all representation outlined in the Letter of Intent shall be null and void.
MBE Good Faith Efforts (GFE) Documentation
RI Contract Number: ________________ Contract Goal: %________________
Form MBE-006 (Eff. 4/24/2024) Page ____ of _____
Instructions:
Pre-Award: In the event a bidder is unable to secure adequate MBE participation to meet contract goal, the firm must demonstrate that it made all reasonable efforts to secure MBE participation in order to achieve the contract MBE goal. An executed MBE-006 must be attached to submitted MBE-001 form and submitted to RIDOT Contracts no later than 4:00 pm on the 3rd business day after the bid opening. Documents must be submitted electronically to: DOT.Contracts@dot.ri.gov.
Post Award: In the event a MBE/WBE commitment outlined on the approved utilization plan is reduced and/or terminated, and the Prime is unable to identify additional MBE/WBE Participation to the extent needed to achieve the contract goal an executed MBE-006 must be submitted to RIDOT OCR to evaluate the additional efforts demonstrated. Documents must be submitted electronically to:
DOT.DBE@dot.ri.gov.
To determine whether the bidder/prime contractor has demonstrated Good Faith Efforts (GFE) to achieve the advertised MBE goal on named contract, OCR will consider AT A MINIMUM, the evidence of GFE as demonstrated on this completed form and required supporting documentation. See RIDOT MBE GFE Guidance for additional information.
Contract Information
Contract Name:
Prime Contractor: Contract Value:
Contract MBE Goal
Type of Request (Check one only)
Pre-Award
Approved MBE Goal _____%
VS
Proposed MBE Commitment _____
Post -Award (Includes Termination and/ or reduction in scope of work)
Project Summary Amounts
Total Prime Bid
Total Dollars committed to Non-MBE/WBE Subcontractors
Total Dollars committed to MBE/WBE Subcontractors (Excluding suppliers)
Total Dollars committed to MBE/WBE Suppliers (DBE credit assessed at 60% of supplier commitment)
Total Dollars Performed by the Prime (Prime bid minus dollars allocated to MBE/WBEs and non-
MBE/WBE firms)
Advertised MBE Goal _____%
VS
MBE Commitment _____% %
RI Contract Number: ________________ Contract Goal: %________________
Form MBE-006 (Eff. 4/24/2024) Page ____ of _____
MBE/WBE’s Quoted but NOT Selected*
*All MBE/WBE quotes received but not selected must be attached.
MBE/WBE Subcontractor & and Contact Information
Quoted Dollars Type of Work Quoted Reason Not Selected
Explanation (use separate sheet as needed) Price Capabilities Other
Price Capabilities Other Price Capabilities Other Price Capabilities Other Price Capabilities Other Price Capabilities Other
Total Number of MBE/WBEs Solicited:
Non-MBE/WBE Subcontractor & Contact Information
Subcontracted Dollars
Date Subcontract or P.O. Executed Type of Work
Total dollars to Non- MBE/ WBE for same type of work
*Please make additional copies of this page as needed
Non- MBE/WBE Subcontract Agreements* *In the event a MBE/WBE and non-MBE/WBE firm submitted quotes for the same type of work and the non-MBE/WBE was selected, the non-MBE/WBE quote must be attached.
RI Contract Number: ________________ Contract Goal: %________________
Form MBE-006 (Eff. 4/24/2024) Page ____ of _____
Methods Used by the Prime to Solicit MBE Participation (Select all that apply)
FAX
Attach copies of sample of fax notice. Transmittal including identifying information as to each MBE/ WBE such as name, fax number, and copy of fax transmission page. All fax dates must be clearly visible.
TELEPHONE Attach copy of telephone log displaying the date and time of contact made with each MBE/WBE firm.
Log should include telephone number, contact name, and brief notes as to the conversation.
E-MAIL Attach copies of e-mails sent/responses received in addition to the distribution list
MAIL Attach copy of Sample Letter, Distribution List, and copies of any returned solicitations
WEBSITE Website Address:
ADVERTISEMENT
(attach copy)
Advertisement placed in:
Advertisement date:
COMMUNITY
EVENT
Date/ location of event attended:
Name of Prime Staff who attended event
OTHER Describe any additional efforts taken. Attach sample copies if applicable
Good Faith Efforts (GFE) Summary
Attach a separate detailed summary, on your firm’s letterhead outlining your efforts to obtain MBE participation that are not apparent from the information provided. This is an opportunity for your organization to “tell its story” of how you demonstrated adequate good faith efforts. Please remember, OCR will utilize GFE guidance as identified in RIDOT DBE Special Provisions and 49 CFR 26, Appendix A to make a GFE determination. Please consider the following questions, when providing summary. The questions posed below are not intended to be a checklist or an exhaustive list of what is considered in evaluating GFE. Information that is not provided at time of submission will NOT be considered by OCR in the GFE determination.
Additional guidance can be found in the RIDOT MBE GFE Guidance Form
Certification
Good Faith Efforts (GFE) summary and supporting documentation attached.
The undersigned certifies that the provided information is true the best of his/her knowledge.
Prime Representative Date
Office of Civil Rights Use Only
Date GFE received by OCR
Date OCR GFE Determination OCR Signature
Approved Denied
Contractor Notification Date
Comments:
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| RI Contract Number: 2025-CM-030 |
| Contract Goal: 15% |
| Bidder: |
| MWBE Subcontractor: |
| Bidder Rep: |
| MWBE Representative: |
| Address: |
| Address_2: |
| Phone Number: |
| Phone Number_2: |
| Summary of work and line items to be performed by MBEWBE Firm: |
| Applicable NAICS Code: |
| Estimated Dollar Value of Work: |
| Proposed Bidder Contract Value: |
| Estimated Percentage of Total Contract Value: |
| Date_2: |
| Page: |
| of: |
| Signature2_es_:signer:signature: |
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| Contract Name: |
| Prime Contractor: |
| Advertised DBE Goal: |
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| DBE Commitment: |
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| Explanation use separate sheet as neededPrice Capabilities Other: |
| DBE Subcontractor and Contact InformationRow2: |
| Quoted DollarsRow2: |
| Type of Work QuotedRow2: |
| Explanation use separate sheet as neededPrice Capabilities Other_2: |
| DBE Subcontractor and Contact InformationRow3: |
| Quoted DollarsRow3: |
| Type of Work QuotedRow3: |
| Explanation use separate sheet as neededPrice Capabilities Other_3: |
| DBE Subcontractor and Contact InformationRow4: |
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| Type of Work QuotedRow4: |
| Explanation use separate sheet as neededPrice Capabilities Other_4: |
| DBE Subcontractor and Contact InformationRow5: |
| Quoted DollarsRow5: |
| Type of Work QuotedRow5: |
| Explanation use separate sheet as neededPrice Capabilities Other_5: |
| DBE Subcontractor and Contact InformationRow6: |
| Quoted DollarsRow6: |
| Type of Work QuotedRow6: |
| Explanation use separate sheet as neededPrice Capabilities Other_6: |
| Type of Work QuotedTotal Number of DBEs Solicited: |
| NonDBE Subcontractor and Contact InformationRow1: |
| Subcontracted DollarsRow1: |
| Date Subcontract or PO ExecutedRow1: |
| Type of WorkRow1: |
| NonDBE Subcontractor and Contact InformationRow2: |
| Subcontracted DollarsRow2: |
| Date Subcontract or PO ExecutedRow2: |
| Type of WorkRow2: |
| NonDBE Subcontractor and Contact InformationRow3: |
| Subcontracted DollarsRow3: |
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| NonDBE Subcontractor and Contact InformationRow4: |
| Subcontracted DollarsRow4: |
| Date Subcontract or PO ExecutedRow4: |
| Type of WorkRow4: |
| NonDBE Subcontractor and Contact InformationRow5: |
| Subcontracted DollarsRow5: |
| Date Subcontract or PO ExecutedRow5: |
| Type of WorkRow5: |
| NonDBE Subcontractor and Contact InformationRow6: |
| Subcontracted DollarsRow6: |
| Date Subcontract or PO ExecutedRow6: |
| Type of WorkRow6: |
| Date Subcontract or PO ExecutedTotal dollars committed to NonDBE Subcontractors: |
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