MPA MBE Participation Acknowledgment.pdf
PDF 259 KB Posted
- Attached to
- MPA 613 OE Vaccine Administration Services
- Solicitation number
- OEV26006424
- Issued by
- Providence County, Rhode Island
About this file
This document is an MBE Participation Acknowledgment form issued by the State of Rhode Island Division of Equity, Diversity and Inclusion Minority Business Enterprise Compliance Office for use in the MPA 613 Open Enrollment vaccine administration services procurement. The form requires prime contractors to acknowledge and confirm compliance with Rhode Island General Laws 37-14.1, which mandates the inclusion of Minority Business Enterprises (MBE), Women Business Enterprises (WBE), and Veteran-Owned Business Enterprises (VBE) in all state-funded and state-directed public construction programs, projects, and service purchases. Contractors must certify their understanding that MBE/WBE/VBE businesses shall be awarded a minimum of 15 percent of the dollar value of the entire procurement or project. The form requires submission of executed agreements with subcontractors, monthly reporting and payment verification to the MBE Compliance Office, immediate notification of all vendor, subcontractor, or supplier changes including change orders, and acknowledgment that non-compliance may result in sanctions under state law.
By initialing and signing the acknowledgment, the prime contractor's authorized representative affirms five key conditions: acknowledgment of state MBE/WBE inclusion requirements; submission of all executed subcontractor agreements to the MBE Compliance Office upon contract award; monthly submission of required reports and documents verifying MBE subcontractor payments; immediate notification to the MBE Compliance Office of all changes in vendors, subcontractors, suppliers, or change orders; and understanding that failure to comply with these conditions may result in a determination of non-compliance and sanctions. The form requires the contractor to provide their MPA number and title, company name, authorized contact information, phone number, and email address, and to indicate their certification status as an MBE, WBE, VBE, or N/A.
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Text version
Division of Equity, Diversity and Inclusion Minority Business Enterprise Compliance Office
One Capitol Hill, Providence, R.I. 02908-5850
(401) 574-8670 - mbe.compliance@doa.ri.gov - RI Relay 711
MPA PRE-AUTHORIZATION MBE PARTICIPATION ACKNOWLEDGMENT
MPA # and Title: ________________________________________________________________________________
Prime Contractor: _________________________ Authorized Contact Person: _______________________________
Contractor Phone Number: ________________________ Contractor Email: _________________________________
Which of the following describes your business’ status in terms of Minority and/or Woman, and/or Veteran-Owned
Business Enterprise certification with the State of Rhode Island? MBE ____ WBE ____ VBE ____ or N/A _____
Rhode Island General Laws § 37-14.1 et al., requires Minority and Women Business Enterprises be included in all state funded and state directed public construction programs and projects and in state purchases of goods and services and shall be awarded a minimum of 15% of the dollar value of an entire procurement or project. By initialing the following sections and signing the bottom of this document in my capacity as the contractor or an authorized representative of the contractor, I hereby confirm that:
• I acknowledge the State’s requirements of including MBE/WBE certified businesses in all state funded and state directed public construction programs, projects and purchases.
Initials: _____
• I acknowledge that, if awarded the contract, the company must submit to the MBE Compliance Office (MBECO), copies of all executed agreements with the subcontractor(s) being utilized to achieve the participation goals.
Initials: _____
• I acknowledge that, if awarded the contract, the company must submit required reports and documents to the MBECO on a monthly basis verifying payments to the MBE subcontractors.
Initials: _____
• I acknowledge that, if awarded the contract, the company is required to immediately notify the MBECO of
ALL changes in the use of vendors, subcontractors, or suppliers used under this contract including ALL Change Orders.
Initials: _____
• I acknowledge that, if awarded the contract, any failure to comply with the conditions acknowledged above may result in a determination of Non-Compliance and may result in sanctions pursuant to R.I. Gen. Laws § 37-14.1 et al.
Initials: _____
I, as an authorized signatory for the prime contractor, do solemnly declare and affirm under the penalty of perjury that the contents of the foregoing Acknowledgment are true and correct to the best of my knowledge, information and belief.
Printed Name Signature Date mailto:mbe.compliance@doa.ri.gov
| MPA PRE-AUTHORIZATION MBE PARTICIPATION ACKNOWLEDGMENT |
| MPA # and Title: ________________________________________________________________________________ |
| MPA and Title: |
| Prime Contractor: |
| Authorized Contact Person: |
| Contractor Phone Number: |
| Contractor Email: |
| Business Enterprise certification with the State of Rhode Island MBE: |
| WBE: |
| VBE: |
| or NA: |
| Initials: |
| Initials_2: |
| Initials_3: |
| Initials_4: |
| Initials_5: |
| Printed Name: |
| Date: |
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