MPA MBE Participation Acknowledgment.pdf
PDF 259 KB Posted
- Attached to
- MPA-403 OE Auto and Truck Towing
- Solicitation number
- OEV27006900
- Issued by
- Rhode Island
About this file
This is a Minority Business Enterprise (MBE) Participation Acknowledgment form issued by the Rhode Island Division of Equity, Diversity and Inclusion for use in the MPA-403 Open Enrollment Auto and Truck Towing procurement. The document serves as a pre-authorization compliance form for prime contractors bidding on state-funded towing services within Rhode Island. The form requires contractors to identify their business certification status as a Minority Business Enterprise (MBE), Woman-Owned Business Enterprise (WBE), Veteran-Owned Business Enterprise (VBE), or confirm non-applicability (N/A). No specific response dates, bid due dates, site visits, bidders' meetings, award dates, or contract terms are provided in this form.
The acknowledgment form establishes binding compliance requirements for contractors awarded contracts under this procurement. Contractors must acknowledge Rhode Island General Laws 37-14.1 requirements mandating that MBE/WBE certified businesses receive a minimum of 15 percent of the dollar value of the entire procurement. Prime contractors must commit to submitting executed agreements with subcontractors to the MBE Compliance Office, providing monthly verification reports of MBE subcontractor payments, immediately notifying the office of all vendor or subcontractor changes and change orders, and accepting potential sanctions for non-compliance. Contractors certify their acknowledgment through initials and signature under penalty of perjury, with the authorized signatory required to provide their printed name, signature, and date.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| OEV27006900_Aug_7_26_solicitation_doc.pdf | ||
| OEV27006900_Aug_10_26_solicitation_doc.pdf | ||
| OEV27006900 Vendor Assessment Form.docx | DOCX document | |
| OEV27006900 Affirmative Action Addendum.pdf | ||
| OEV27006900 Scope of Work.pdf |
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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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