SBE_JOC-Contractor's_Statement_of_Utilization_Form.docx

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Attached to
SANITARY SEWER REHABILITATION PROGRAM JOB ORDER CONTRACT
Solicitation number
JOC261
Issued by
Maricopa County, Phoenix City, Arizona

About this file

This is a Contractor's Statement of Proposed Small Business Enterprise (SBE) Utilization Form for Job Order Contracts (JOC) issued by the City of Phoenix, Arizona. The form is used to document proposed SBE firm participation for individual job orders within a larger sanitary sewer rehabilitation program. Contractors must list all SBE firms to be utilized, including their scope of work, subcontract amounts, and certifications with the City of Phoenix as of the proposal date. The form requires identification of a required annual SBE goal percentage and allows contractors to designate whether each SBE firm is a supplier, with a maximum of 25 percent of the goal satisfiable by supplier classifications.

The form requires contractors to calculate the total SBE dollars committed and express it as a percentage of the overall contract value. Only SBE firms certified with the City of Phoenix at the time of proposal submission will have their subcontract amounts counted toward meeting required goals. Contractors may indicate "none" for job orders in which no SBE firms will be used. The form must be signed by an authorized company representative and includes fields for company name, contact information, and signatory details.

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Text version

Small Business Enterprise Program

CONTRACTOR’S STATEMENT OF PROPOSED SBE UTILIZATION - JOB ORDER CONTRACTS (JOC)

Project #: __________________ Contract #: ________________ JOA #: ________________

Project Description: __________________________________________________________

Job Order Proposal Amount: $__________________________________________________

Required Annual SBE Goal

Please list the SBE firms that will be utilized on the Job Order Agreement to meet the required goals.

Use a separate form for each JOA that is part of the overall contract. For JOA’s in which no SBE firms are to be used, list “none” in the spaces below. The SBE firms listed below must be certified with the City of Phoenix as of the proposal date or their subcontract amount will not be counted towards meeting the required goals.

COMPANY NAME
Scope of Work to be Performed
Supplier

(may not satisfy more than 25% of goal) Sub-Contract $ Amount

|_| YES |_| NO

|_| YES |_| NO

|_| YES |_| NO

|_| YES |_| NO

|_| YES |_| NO

|_| YES |_| NO

|_| YES |_| NO

% of Contract = %
Total SBE $
$

COMPANY NAME: EMAIL: PHONE:

NAME & TITLE: ____________________________________________________________________________________________

SIGNATURE: DATE:

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