MPA MBE Participation Acknowledgment.pdf
PDF 259 KB Posted
- Attached to
- MPA 204 OE Printing Services, Offset and Digital
- Solicitation number
- OEV26005877
- Issued by
- Providence County, 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 204 Open Enrollment Printing Services procurement. The form requires prime contractors to acknowledge their understanding and compliance with Rhode Island's MBE/WBE/VBE participation requirements, which mandate that minority and women-owned business enterprises be awarded a minimum of 15% of the dollar value of all state-funded and state-directed public construction programs, projects, and purchases. Prime contractors must complete the form by identifying their business's certification status (MBE, WBE, VBE, or N/A), providing contact information, and initialing acknowledgments confirming their understanding of state requirements regarding subcontractor participation, monthly reporting to the MBE Compliance Office, notification of vendor changes and change orders, and potential sanctions for non-compliance with these conditions.
The acknowledgment form serves as a pre-authorization document that all bidders on the MPA 204 printing services solicitation must execute and submit as part of their proposal. Contractors must acknowledge their obligation to submit executed subcontractor agreements, provide monthly verification of payments to MBE subcontractors, and immediately report all changes in vendors, subcontractors, or suppliers to the MBE Compliance Office. An authorized signatory for the prime contractor must sign the form under penalty of perjury, confirming the accuracy of all statements. The form emphasizes that failure to comply with these requirements may result in a determination of non-compliance and sanctions pursuant to Rhode Island General Laws 37-14.1 et al. Completed forms should be directed to the MBE Compliance Office at mbe.compliance@doa.ri.gov or by phone at (401) 574-8670.
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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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