MPA MBE Participation Acknowledgment.pdf
PDF 259 KB Posted
- Attached to
- MPA 611 OE COVID-19 Test Kits
- Solicitation number
- OEV24004199
- Issued by
- Providence County, Rhode Island
About this file
This is an MBE Participation Acknowledgment form used by the State of Rhode Island's Division of Equity, Diversity and Inclusion for the COVID-19 Test Kits Master Price Agreement (MPA 611). The acknowledgment is required for prime contractors bidding on this open enrollment solicitation (OEV24004199) to provide FDA-authorized rapid antigen test kits and laboratory-based PCR tests. The MPA has an initial four-year term with options to renew for up to three additional 12-month periods, running from May 1, 2024, through June 30, 2026, with vendors able to submit proposals at any time during the open enrollment period. When agencies issue mini-bids for specific testing needs, vendors must submit detailed pricing quotes and comply with all state contracting requirements.
The acknowledgment requires prime contractors to confirm their understanding of Rhode Island General Laws 37-14.1 et al., which mandates that Minority Business Enterprises, Women Business Enterprises, and Veteran-Owned Business Enterprises be included in all state-funded and state-directed public construction programs, projects, and purchases, with a minimum of 15% of the dollar value awarded to certified MBE/WBE/VBE vendors. Contractors must initial five separate acknowledgments confirming they understand their obligations to submit executed subcontractor agreements, provide monthly compliance reports to the MBE Compliance Office, immediately notify the office of any changes in vendors or subcontractors, and accept that non-compliance may result in sanctions. The form requires the authorized signatory to declare under penalty of perjury that all information provided is accurate and complete.
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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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