sdp-form-for-pos07-2016 (1).xls

XLS spreadsheet 52 KB Posted

Attached to
MRCADET 3-17
Solicitation number
BD-17-1071-AO-CON01-15897
Issued by
Suffolk County, Massachusetts

About this file

This document is a Supplier Diversity Program (SDP) Form for Purchase of Service (POS) contracts required to be filed annually by Commonwealth of Massachusetts providers that hold POS contracts. The form requires the provider to report their total POS state expenditures for the fiscal year, as well as to list any current or planned SDP partners, including the partner company name, certification type, description of business arrangement, committed amount for the current fiscal year, and expended amount in the prior fiscal year. The form must be completed and submitted along with the provider's Uniform Financial Report (UFR) and when responding to POS contract opportunities.

The related state and local contract opportunity is for a request for response to solicit providers of driver evaluations, consultations, and driver training for individuals with disabilities who require vehicle modifications or adaptive driver education services. This is a rolling enrollment contract issued by the Commonwealth of Massachusetts.

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SDP Spending Report

Supplier Diversity Program (SDP) Form for Purchase of Service (POS)
Completing all parts of this form is required in order for a provider to be qualified to contract with Commonwealth Agencies for POS services.
This form is due annually with a provider's UFR Report and a copy of the completed form is to be submitted when responding to POS contract opportunities with an Executive Department.
Submission for Fiscal Year
Part IContractor Information (Required)
Business NameContact NameContact EmailContact PhoneFiscal Year Total POS State Expenditures
$ - 0
Part IISDP Partner Information (Required) (Insert additional lines as needed)
Providers that are currently SDO Certified may not list themselves as a Partner in this section.
Planned and Current SDP Partner(s) Company Name (as it appears on a list at www.mass.gov/sdo)Certification Type (Choose One)Description of Business ArrangementCommitted Amount in Current Fiscal YearExpended Amount in Prior Fiscal Year
$ - 0$ - 0
$ - 0$ - 0
$ - 0$ - 0
$ - 0$ - 0
$ - 0$ - 0
$ - 0$ - 0
TOTAL$ - 0$ - 0
PERCENT (%) OF POS SPEND0%
Part IIIUnder the pains and penalties of perjury I certify that the information provided in this report is accurate.
NameSupplier Diversity Certification Acronyms:
TitleMBE - Minority Business Enterprise
PhoneWBE - Woman Business Enterprise
EmailM/WBE - Minority and Woman Business Enterprise
Authorized SignatureSDVOBE - Service-Disabled Veteran-Owned Business Enterprise
(May be left blank if submitted electronically)VBE - Veteran-Owned Business Enterprise
DateM/NPO - Minority Non-Profit Organization
W/NPO - Women Non-Profit Organization
Form revised: July 1, 2016M/W/NPO - Minority and Women Non-Profit Organization
DOBE - Disability-Owned Business Enterprise
LGBTBE - Lesbian, Gay, Bisexual or Transgender Business Enterprise

FORM INSTRUCTIONS

Overall Providers that hold POS contracts with Commonwealth departments are required to file a "Supplier Diversity Program (SDP) Form for Purchase of Service (POS)" each year and upload it with their Uniform Financial Report (UFR). This requirement includes Providers who have already been certified by the Supplier Diversity Office (SDO) as a Minority- and/or Women Business/Organization. Providers that are exempt from UFR filing requirements must submit the SDP form when they upload their exemption request. Providers responding to POS bids posted on COMMBUYS will be directed to submit the most recent completed copy of this form with their proposals/quotes.

Part I - Contractor Information Bidder/Contractor Information: Business name, contact name, phone number and email.

Fiscal Year Total POS State Expenditures can be found on the "POS Expenditure and Federal Funds Listing" posted by OSD on the provider’s UFR eFiling site.

Part II - Contractor's SDP Partner Information Planned or Current SDP Partner(s) must belong to any one or more of the following groups:

- MBE - Minority Business Enterprise, WBE - Woman Business Enterprise , or M/WBE - Minority and Woman Business Enterprise;

- M/NPO - Minority Non-Profit Organization, W/NPO - Women Non-Profit Organization, M/W/NPO - Minority and Women Non-Profit;

- SDVOBE - Service-Disabled Veteran-Owned Business Enterprise; and/or

- VBE - Veteran-Owned Business Enterprise Organization

Only partners listed on one of the "Directory of Certified Businesses" lists on www.mass.gov/sdo can be listed as partners on this form.

Providers certified by SDO may not list their own organization as an SDP partner.

Although currently not covered by SDP spending commitments, Providers may also inform the Commonwealth of their spending with partners certified as DOBE - Disability-Owned Business Enterprise, and LGBTBE - Lesbian, Gay, Bisexual or Transgender Business Enterprise.

Certification Type: Select the partner's certification type from the menu. For partners with multiple certification types, please select the one that is highest on the dropdown list.

Description of Business Relationship: Describe the business relationship/arrangement with the SDO Certified Partner (e.g. "providing transportation services").

Committed Amount in Current Fiscal Year : Enter the amount (as an exact dollar figure) your organization is committed to spend with SDP partner(s) during the current Fiscal Year. If you are filing a UFR for Fiscal Year 2016, the commitment would be for Fiscal Year 2017.

Expended Amount in Prior Fiscal Year: Enter the amount (as an exact dollar figure) that your organization expended with SDP partner(s) during the past fiscal year (UFR reporting year). If you are filing a UFR for Fiscal Year 2016, the commitment would be for Fiscal Year 2017.

Additional Resources

· More information about the Supplier Diversity Program (SDP) is available at www.mass.gov/sdp

· For a complete list of certified vendors refer to www.mass.gov/sdo

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