sdp-rplan-form-3-reporting~7.xlsx

XLSX spreadsheet 15 KB Posted

Attached to
Abuse Reporting Hotline Answering and Processing Service
Solicitation number
BD-20-1018-DAC01-DAC01-49658
Issued by
Norfolk County, Boston City, Massachusetts

About this file

This document is the Supplier Diversity Program (SDP) Spending Report that must be completed and submitted quarterly by a contractor to the Commonwealth Contract Manager. It requires the contractor to provide information on their spending with SDP partner companies, including the partner company name, certification type, and the amount spent with each partner for each quarter of the fiscal year. The contractor must also report their annual SDP spending commitment percentage and explain if they are not in compliance with that commitment. This report is related to a state contract opportunity for an Abuse Reporting Hotline Answering and Processing Service in Massachusetts. The contract requires the selected vendor to document all caller information via web-based access to the DPPC database, digitally record all calls, and contact the DPPC on-call staff for emergencies.

The report requires the contractor to provide the contract sales total for each quarter and fiscal year, as well as the year-to-date compliance check. The contractor must certify under pains and penalties of perjury that the information provided is accurate. The state reserves the right to contact the SDP partners to verify the reported amounts. Pricing terms, set-asides, incumbents, funding sources, and other salient information are not included in this document.

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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 NameAnnual 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 (as it appears on a list at www.mass.gov/sdo)(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
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
*This is your company's SDP Plan commitment percentage submitted in your Bid ResponseM/W/NPO - Minority and Women Non-Profit Organization
or established through negotiation.DOBE - Disability-Owned Business Enterprise
**The Supplier Diversity Office and contracting department reserves the right to contactLGBTBE - Lesbian, Gay, Bisexual or Transgender Business Enterprise
SDP Partners at any time to request that they attest to the amounts reported to have been
paid to them by the Contractor.
***Certification Type for SDP Partner(s) can be checked at www.mass.gov/sdoRevised: March 8, 2016

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Sheet3

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