MPA MBE Participation Acknowledgment Form.pdf
PDF 259 KB Posted
- Solicitation number
- OEV26006605
- 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 Minority Business Enterprise Compliance Office of the State of Rhode Island, applicable to MPA 445 Open Enrollment Lift Trucks, Inspections, and Maintenance. The form requires prime contractors to acknowledge their understanding of Rhode Island's statutory requirements regarding the inclusion of minority and women-owned business enterprises in state-funded procurement projects and programs. The acknowledgment form serves as pre-authorization documentation for contractors bidding on this open enrollment solicitation, which maintains a qualified vendor list of specialists in the repair, service, inspection, and maintenance of motorized aerial and hoisting equipment including personnel lifts, bucket trucks, construction cranes, forklifts, and stationary hoisting equipment, with reviews conducted every 90 days.
Under Rhode Island General Laws 37-14.1 et al., contractors must acknowledge that minority and women business enterprises shall be awarded a minimum of 15 percent of the dollar value of the entire procurement or project. Prime contractors executing this acknowledgment form must confirm their commitment to submit executed subcontractor agreements to the MBE Compliance Office, provide monthly compliance reports verifying payments to MBE subcontractors, immediately notify the office of any changes to vendors or subcontractors including all change orders, and understand that non-compliance may result in sanctions. The form requires the contractor to identify its business certification status (MBE, WBE, VBE, or N/A) and be signed by an authorized signatory under penalty of perjury.
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Other files
| File | Type | Posted |
|---|---|---|
| OEV26006605_Jun_1_26_solicitation_doc.pdf | ||
| OEV26006605_May_11_26_solicitation_doc.pdf | ||
| OEV - Scope of Work.pdf | ||
| MPA 445 Vendor Assessment Sheet.docx | DOCX document | |
| OEV26006605_May_6_26_solicitation_doc.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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