SBE_JOC-Contractor's_Statement_of_Utilization_Form.pdf

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: