SBE_Subcontracting_Plan.pdf

GOVERNMENT OF THE DISTRICT OF COLUMBIA

DEPARTMENT OF GENERAL SERVICES

Attachment

SBE SUBCONTRACTING PLAN

[ATTACHMENT WILL APPEAR ON THE FOLLOWING PAGE]

SECTION 1.BENEFICIARY AND SOLICITATION/CONTRACT/SPORTS WAGERING

APPLICANTINFORMATION

Section 1A. BENEFICIARY INFORMATION

Company: ______________ Contact #: __________ Email address: ________________

Street Address: ____________________________ City/ State/ Zip Code: ____________________________

Company’s point of contact for agency contract, private project, or Sports Wagering Licensee:

Point of Contact: ________________ Title: ________________

Contact #: _____________ Email address: _________________

Street Address: ____________________________________

Section 1B. SOLICITATION/CONTRACT/SPORTS WAGERING APPLICANT INFORMATION

Solicitation /Contract/ApplicantNo.: ________________ Solicitation Due Date: ________________

Agency: _____________ Total Dollar Amount of Contract: _________________

Please select all the applicable subcontracting requirements for this solicitation:

35% Subcontracting Requirement 50% Subcontracting Requirement DSLBD approved an adjusted subcontracting requirement:

Adjusted Subcontracting Requirement: ____%

Total Value of ALL CBE Subcontracts: _________________ (Include all lower tiers)

I affirm that the value of all my CBE Subcontracts meets or exceeds the subcontracting requirement required under this solicitation or contract. Further, I understand that DSLBD will only provide credit towards my SBE Subcontracting Requirement for work whereby a CBE provided a commercially useful function with its own organization and resources.

I AGREE

I DISAGREE

Section 1C. CBE BENEFICIARY (ONLY COMPLETE IF THE BENEFICIARY IS A CERTIFIED BUSINESS ENTERPRISE)

If the Beneficiary is a Certified Business Enterprise, select all that apply and provide the following information:

I am a CBE that WILL perform 100% of the contracting effort with my own organization and resources and will not subcontract any portion of the contract. Therefore, I am NOT required to submit an SBE Subcontracting Plan that demonstrates subcontracting.

I am a CBE that WILL NOT perform 100% of the contracting effort with my own organization and resources and will subcontract a portion of the contract. Therefore, I understand I am required to submit an SBE Subcontracting Plan (located in Section on 2) that demonstrates that the required subcontracting amount, as indicated above, will go to qualified CBEs.

Please include the percentage of the contract the CBE Prime will perform under the contract or project.

The CBE Prime will self-perform ____% of the contract’s total dollar volume of the contract or project.

Please provide the current CBE Certification Number of the CBE Prime.

CBE Certification No. ______________

BENEFICIARY ATTESTATION

I declare, certify, verify, attest, and state under penalty of perjury that the information provided above is true and correct to the best of my knowledge and belief. Pursuant to D.C. Official Code § 22-2402, I understand that a person convicted of perjury shall be fined not more than $5,000 or imprisoned for not more than 10 years, or both. I understand that any false or fraudulent statement that I provide or assert may be grounds for revocation of my CBE registration pursuant to D.C. Official Code § 2-218.63. Further, a Prime Contractor, Developer, CBE, Certified Joint Venture, or Sports Wagering Licensee that fails to comply with the requirements of the Small and Certified Business Enterprise Development and Assistance Amendment Act of 2005, as amended, (D.C. Law 20-108) (the “Act”), shall be subject to penalties as outlined in the Act.

PRINT NAME: ____________________________ SIGNATURE: ____________________________

JOB TITLE: ____________________________ DATE: ____________________________

Section 2. SBE/CBE SUBCONTRACTORS (FOR EACH TIER):

CBE Subcontractor Company Name Address Certification

No.

Price to be paid to the

CBE Subcontractor

Description of subcontract scope of work to be performed that shall be for a commercially useful function by the CBE

SBE/CBE Point of Contact:

CBE Subcontractor Self-Performance Indicator:

Name: _________

Title: _______

Telephone Number: ________

Email Address: ________

This CBE will perform the ENTIRE subcontract with its own organization and resources.

This CBE will subcontract a portion of the subcontract and will perform ____% of the subcontract’s total dollar volume.

NOTE: If the CBE will not self-perform 100% of the subcontract, it must list each lower-tier CBE subcontractor below.

LOWER TIER

Name Address Certification No. Price to be paid to the

CBE Subcontractor

Description of subcontract scope of work to be performed that shall be for a commercially useful function by the CBE

Tier (e.g., 1st, 2nd, 3rd, 4th, etc.)

No.

Price to be paid to the

CBE Subcontractor

Description of subcontract scope of work to be performed that shall be for a commercially useful

This CBE will subcontract a portion of the subcontract and will perform ____% of the subcontract’s total dollar volume.

NOTE: If the CBE will not self-perform 100% of the

Name Address Certification No. Price to be paid to the

CBE Subcontractor

Description of subcontract scope of work to be performed that shall be for a commercially useful function by the CBE

Tier (e.g., 1st, 2nd, 3rd, 4th, etc.)

No.

Price to be paid to the

CBE Subcontractor

Description of subcontract scope of work to be performed that shall be for a commercially useful

This CBE will subcontract a portion of the subcontract and will perform ____% of the subcontract’s total dollar volume.

NOTE: If the CBE will not self-perform 100% of the

Name Address Certification No. Price to be paid to the

CBE Subcontractor

Description of subcontract scope of work to be performed that shall be for a commercially useful

Tier (e.g., 1st, 2nd, 3rd, 4th, etc.)

No.

Price to be paid to the

CBE Subcontractor

Description of subcontract scope of work to be performed that shall be for a commercially useful

This CBE will subcontract a portion of the subcontract and will perform ____% of the subcontract’s total dollar volume.

NOTE: If the CBE will not self-perform 100% of the

Name Address Certification No. Price to be paid to the

CBE Subcontractor

Description of subcontract scope of work to be performed that shall be for a commercially useful function by the CBE

Tier (e.g., 1st, 2nd, 3rd, 4th, etc.)

AGENCY CONTRACT AWARD

Agency: ________ Prime Contractor: ________ Contract Number: ________ Date SBE Subcontracting Plan Accepted: ________ Date agency contract signed: ________

Anticipated Start Date of Contract: ________ Anticipated End Date of Contract: ________

Total Dollar Amount of Contract: $________

*Design-Build must include total contract amount for both design and build phase of the project.

35% of the Total Contract Amount: $________

35% of the Applicable Performance Period: $________

50% of Total Dollar Amount of Contract: $______________ (pursuant to D.C. Law 24-39)

Total Amount of All SBE/CBE Subcontracts: $________ (include every tier)

( if applies)

Base Period Contract – Option/Extension Period: ________ Multi-year Contract

First Year (Period) of Contract: ________ Current Year (Period) of Contract: ________

Design-Build – Date of Guaranteed Contract: ________

Check if prime contractor is a CBE and will perform the ENTIRE government-assisted project (agency contract) with its own organization and resources and NOT subcontract any portion of the services or goods.

PRIVATE PROJECT SUBSIDY AWARD

Agency Providing Subsidy: ________ District Subsidy: ________ Developer: ________ Amount of District Subsidy: ________ Date District Subsidy Provided/ contract signed: ________

Anticipated Start Date of Project: ________ Anticipated End Date of Project: ________

Project Name: ________ Project Address: ________

Total Development Project Budget: $________ (include pre-construction and construction costs)

35% of the Total Development Project Budget: $________

50% of Total Dollar Amount of Contract: $______________ (pursuant to D.C. Law 24-39)

Total Amount of All SBE/CBE Subcontracts: $________ (include every lower tier)

Check if developer is a CBE and will perform the ENTIRE government-assisted project (private project) with its own organization and resources and NOT subcontract any portion of services or goods.

AGENCY CONTRACTING OFFICER’S AFFIRMATION OR AGENCY PROJECT MANAGER’S AFFIRMATION

( which applies)

The below Agency Contracting Officer or Agency Project Manager affirms the following ( to affirm):

If the Beneficiary is a CBE, DSLBD was contacted to confirm Beneficiary’s CBE certification.

The fully executed Contract (Base or Option or Extension or Multi-Year) or subsidy document, between the Beneficiary and Agency, was emailed to DSLBD at Compliance.Enforcement@dc.gov within five (5) days of signing:

FOR AGENCY CONTRACT the SBE Subcontracting Plan, submitted by Beneficiary, was emailed to DSLBD at Compliance.Enforcement@dc.gov within five (5) days of signing the contract between the Beneficiary and Agency.

Name of Agency Contracting Officer or Agency Project Manager

Title of Agency Contracting Officer or Agency Project Manager

Signature

Date