MPA MBE Participation Acknowledgment.pdf
PDF 259 KB Posted
- Attached to
- MPA 213 Videographer Services
- Solicitation number
- OEV27006925
- Issued by
- Rhode Island
About this file
This is a Minority Business Enterprise (MBE) Participation Acknowledgment Form issued by the State of Rhode Island's Division of Equity, Diversity and Inclusion in support of Master Price Agreement (MPA) 213 for Videographer Services. The form requires prime contractors to acknowledge their understanding of 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 purchases. Contractors must certify their business enterprise status and acknowledge that if awarded the contract, they must submit executed agreements with subcontractors to the MBE Compliance Office, provide monthly reports verifying payments to MBE subcontractors, immediately notify the office of all changes in vendors or subcontractors including change orders, and understand that non-compliance may result in sanctions under Rhode Island law.
The form serves as a pre-authorization document that contractors must complete and sign under penalty of perjury, confirming their acceptance of MBE participation requirements. Failure to comply with the acknowledged conditions may result in a determination of non-compliance and sanctions. The form requires the prime contractor to provide basic information including company name, authorized contact person, phone number, email address, and certification status with the State of Rhode Island. All acknowledgments must be initialed by an authorized signatory, and the completed form must be submitted as part of the proposal package for MPA 213, with a 15% minimum dollar value allocation to certified MBE/WBE businesses being a mandatory requirement for contract performance.
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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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