MPA MBE Participation Acknowledgment.pdf
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- Solicitation number
- OEV27006965
- Issued by
- Rhode Island
About this file
This is a Minority Business Enterprise (MBE) Participation Acknowledgment form issued by the Division of Equity, Diversity and Inclusion's Minority Business Enterprise Compliance Office under the State of Rhode Island, Department of Administration. The form serves as a pre-authorization document for procurement and project participation requirements. Prime contractors must complete the form by providing their business name, authorized contact information, phone number, and email address, and by identifying their certification status with the State of Rhode Island as a Minority Business Enterprise (MBE), Woman Business Enterprise (WBE), Veteran Business Enterprise (VBE), or indicate if none of these designations apply. The form does not specify particular products, services, project timelines, quantities, response deadlines, or contract terms; instead, it functions as a compliance acknowledgment instrument applicable to all state-funded and state-directed public construction programs and purchases.
Rhode Island General Laws 37-14.1 requires that MBE and WBE certified businesses receive a minimum of 15 percent of the dollar value of all state-funded procurements and projects. By signing the acknowledgment, contractors confirm their understanding of compliance obligations, including the requirement to submit executed subcontractor agreements to the MBE Compliance Office, provide monthly verification reports of payments to MBE subcontractors, and immediately notify the office of any changes to vendors, subcontractors, suppliers, or change orders. Failure to comply with these conditions may result in a determination of non-compliance and sanctions under Rhode Island law. The form requires the authorized signatory to declare under penalty of perjury that all information provided is accurate.
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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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