SDP plan form 3 - reporting~45.xlsx

XLSX spreadsheet 27 KB Posted

Attached to
DRM 2024-57 #7 Emergency Notification System at MCI-Shirley and SBCC
Solicitation number
BD-25-1025-DOCFS-9843-111147
Issued by
Worcester County, Massachusetts

About this file

This is a Supplier Diversity Program (SDP) Spending Report Form (Form #3) for Commonwealth contracts that must be submitted within 45 days of each quarter's end to the Commonwealth Contract Manager. The form requires contractors to report their quarterly spending with SDP partners across four fiscal quarters: Q1 (July 1-September 30), Q2 (October 1-December 31), Q3 (January 1-March 31), and Q4 (April 1-June 30).

The form requires contractors to document their total contract sales and their committed SDP spending percentage, along with detailed information about their SDP partners, including company names, email addresses, and certification types (MBE, WBE, MWBE, MNPO/WNPO/MWNPO, or SDVOBE). The form includes automatic calculations to track compliance with annual spending commitments and requires explanation if compliance targets are not met. The document must be certified under penalty of perjury by an authorized representative of the contractor.

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SDP Spending Report

Supplier Diversity Program (SDP) Spending Report
SDP Plan Form #3
Document Number/Name:
Instructions: This form must include information on your company's spending with your Supplier Diversity Program (SDP) Partner(s) and must be completed and submitted
within 45 days of the end of each quarter to Commonwealth Contract Manager.

Part I Contractor Information (Required)

Contractor CompanyContact NameTotal Supplier DiversityQuarterly Contract SalesFiscal Year
NameSpending Commitment %*Quarter 1 (7/1-9/30)Quarter 2 (10/1-12/31)Quarter 3 (1/1-3/31)Quarter 4 (4/1-6/30)Total (calculates automatically)
$ - 0

Part II SDP Partner Information (Required) (Insert additional lines as needed)

SDP Partner(s) CompanyEmail Address**Certification Type***Quarterly Spending with Supplier Diversity Partner(s)Fiscal Year
Name(Choose One)Quarter 1 (7/1-9/30)Quarter 2 (10/1-12/31)Quarter 3 (1/1-3/31)Quarter 4 (4/1-6/30)Total (calculates automatically)
$ - 0
$ - 0
$ - 0
$ - 0
$ - 0
$ - 0
Year-To-Date Compliance Check (Do not change this line)$ - 0

If not in compliance, please explain why and what actions will be taken to bring your company to compliance with the annual spending commitment:

Part III Under 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
EmailMWBE - Minority and Woman Business Enterprise
Authorized SignatureMNPO/WNPO/MWNPO - Minority or Woman Non-Profit Organization
(May be left blank if submitted electronically)SDVOBE - Service-Disabled Veteran-Owned Business Enterprise
Date
*This is your company's SDP Plan commitment percentage submitted in your Bid Response or established through negotiation.
**The Supplier Diversity Office and contracting department reserves the right to contact SDP Partners at any time to request that they attest to the amounts reported to have been
paid to them by the Contractor.
***Certification Status for SDP Partner(s) can be checked at www.mass.gov/sdo
Revised: November 13, 2013

&"-,Bold"&10Last Edit: &"-,Regular"&D

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