MPA MBE Participation Acknowledgment.pdf
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- Solicitation number
- OET27007038
- 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, applicable to MPA 603 Literacy and Dyslexia Endorsement Providers solicitation administered by the Rhode Island Department of Education (RIDE). The form serves as a pre-authorization compliance document for prime contractors bidding on state-funded procurement opportunities. Contractors must acknowledge and initial their understanding of Rhode Island's MBE/WBE/VBE participation requirements, which mandate that minority and women-owned business enterprises receive a minimum of 15% of the dollar value on all state-funded public construction programs, projects, and purchases of goods and services. The form requires contractors to identify their business certification status (MBE, WBE, VBE, or N/A) and provide prime contractor information, authorized contact details, and phone and email contact information for official correspondence.
Upon contract award, prime contractors are required to submit executed agreements with all subcontractors to the MBE Compliance Office (MBECO), provide monthly reports verifying payments to MBE subcontractors, and immediately notify MBECO of any changes in vendors, subcontractors, suppliers, or Change Orders. Failure to comply with these acknowledgments and conditions may result in a determination of non-compliance and sanctions pursuant to Rhode Island General Laws 37-14.1 et al. The authorized signatory for the prime contractor must sign and date the form under penalty of perjury, affirming the accuracy and completeness of all information provided. This documentation is mandatory for all contractors seeking to participate in state-directed procurement activities in Rhode Island.
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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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