Part A: PRIME CONTRACTOR PROJECT SUMMARY FORM Name of Bidder (Offeror): Fed. ID: Address: Telephone: Cell: Email: Fax: Contracting Agency BALTIMORE CITY PUBLIC SCHOOLS Contract (Project) Title Contract Number: Bid Due : Overall MBE/WBE Goal MBE GOAL: WBE GOAL: THIS PACKAGE OF MBE AND WBE PARTICIPATION FORMS IS DUE WITH THE BID. FOR MORE INFORMATION OR ASSISTANCE WITH THESE FORMS, CONTACT: Minority and Women Business Enterprise Department City Schools 200 East North Avenue Room 208 Baltimore, Maryland 21202 Phone: 443-642-4364 or 443-642-4365 Email: MBE@bcps.k12.md.us 14
PART B: MBE/WBE PARTICIPATION DISCLOSURE FORM Use this form to list MINORITY Business Enterprises that you will use to meet the MBE/WBE Participation Goal. Please be reminded that: The same subcontractor may not be used to meet both the MBE and WBE goals. If Bidder is an MBE/WBE, Bidder may not use itself to meet either of the contract goals. Only 25% of each contract goal may be attained by expenditures to MBE/WBEs or WBEs that are non-manufacturing suppliers. (i.e. If bid amount is $100,000 and MBE/WBE goal is 15% or $15,000; then participation limit for MBE/WBE suppliers that are non-manufacturers is $3,750 or 25% of the 15% MBE/WBE goal.) If MBE/WBE sub-goals apply to this contract, each pre-determined sub-goal must be achieved and their total must equal or exceed the overall MBE/WBE contract goal. Prime Contractor s Name: Prime Contractor s Address: Contract Number & Title: MBE/WBE SUBCONTRACTORS Name Certification Number Expiration $ Amount of Subcontract % of Total Contract TOTAL DOLLAR AMOUNT OF CONTRACT TOTAL DOLLAR AMOUNT OF MBE/WBE SUBCONTRACTS TOTAL MBE/WBE PERCENTAGE OF ENTIRE CONTRACT $ $ % Form Prepared by: Name and Title Phone # 15
(If necessary, make additional copies of this page. Each additional page must be signed and dated.) (If necessary, make additional copies of this page. Each additional page must be signed and dated.) PART B: WBE PARTICIPATION DISCLOSURE FORM Use this form to list WOMEN S Business Enterprises that you will use to meet the WBE Participation Goal. Please be reminded that: The same subcontractor may not be used to meet both the MBE and WBE goals. If Bidder is MBE or WBE, Bidder may not use itself to meet either of the contract goals. Only 25% of each contract goal may be attained by expenditures to s or WBEs that are non-manufacturing suppliers. (i.e. If bid amount is $100,000 and WBE goal is 6% or $6,000; then participation limit for WBE suppliers that are non-manufacturers is $1,500 or 25% of the 6% WBE goal.) Prime Contractor s Name: Prime Contractor s Address: Contract Number & Title: WBE SUBCONTRACTORS Name Certification Number Expiration $ Amount of Subcontract % of Total Contract TOTAL DOLLAR AMOUNT OF CONTRACT TOTAL DOLLAR AMOUNT OF WBE SUBCONTRACTS $ $ TOTAL WBE PERCENTAGE OF ENTIRE CONTRACT % Form Prepared by: Name and Title Phone # (If necessary, make additional copies of this page. Each additional page must be signed and dated.) 16
PART C: MBE/WBE AND PRIME CONTRACTOR S STATEMENT OF INTENT COMPLETE A SEPARATE FORM FOR EACH AND EVERY MBE AND WBE NAMED IN PART B OR BID WILL BE CONSIDERED NON-RESPONSIVE. Contract Name and Number: Name of Prime Contractor: Name of MBE or WBE: MBE or WBE Certification Number: Work/Service to be performed by MBE or WBE: Materials/Supplies to be furnished by MBE or WBE: Subcontract Amount: $ (If this is a requirements contract, the subcontract dollar amount may be omitted.) Subcontract percentage of total contract: % The undersigned Prime Contractor and subcontractor agree to enter into a contract for the work/service indicated above for the dollar amount or percentage indicated, subject to the prime contractor s execution of a contract with the Baltimore City Public Schools for the above referenced contract number. The undersigned subcontractor is currently certified as MBE or WBE with the City of Baltimore Minority and Women s Business Opportunity Department. Signature of Prime Contractor (REQUIRED) Signature of MBE or WBE (REQUIRED) 17
PART D: MBE/WBE PARTICIPATION AFFIDAVIT The Undersigned authorized representative of Contractor does hereby make the following Affidavit: Contractor acknowledges the overall goal %WBE sub goal of %, and the WBE sub goal of % for Contract No. /Title with City Schools. My firm will make good faith efforts to achieve the MBE and WBE participation goals for this contract. I understand that, if awarded the contract, my firm must submit to City Schools copies of all executed agreements with the MBE and WBE firms being utilized to achieve the participation goals and other requirements. I understand that these documents must be submitted prior to the issuance of a notice to proceed. I understand that, if awarded the contract, my firm must submit to City Schools canceled checks and any other documentation and reports required by City Schools on a monthly basis, verifying payments to the MBE and WBE firms utilized on the contract. This information must be submitted electronically via City Schools compliance tracking software system. I understand that, if I am awarded this contract and I find that I am unable to utilize the MBEs or WBEs identified in my Statements of Intent, I must substitute other certified MBE and WBE firms to meet the participation goals. I understand that I may not make a substitution or additions until I have obtained the written approval of the M/WBE representative. I understand that, if awarded this contract, authorized representatives of the City Schools may examine, the books, records and files of my firm to the extent that such material is relevant to a determination of whether my firm is complying with the MBE and WBE participation requirements of this contract. I do solemnly declare and affirm under the penalty of perjury that the contents of the foregoing Affidavit are true and correct to the best of my knowledge, information and belief. Contractor Company Name Address Sworn and subscribed before me this day of, in the year. Signature Print Name and Title Notary Public 18
PART E: MBE/WBE PARTICIPATION WAIVER REQUEST FORM Name of Bidder (Offeror) Address Contracting Agency Contract (Project) Title Contract Number: Bid Due : Goals on this contract: % MBE % WBE I have achieved % MBE % WBE I am requesting a waiver of % MBE % WBE I have contacted MWBOO for assistance Yes No Number of MBE firms contacted: (Attach a list of names and dates contacted) Number of WBE firms contacted: (Attach a list of names and dates contacted) To support this request for a waiver, I include the following information as attachments which I certify to be true to the best of my knowledge. 1. A detailed statement of the efforts made by the contractor to identify and select portions of the work proposed to be performed by subcontractors in order to increase the likelihood of achieving the stated goal; 2. A detailed statement of the efforts made by the contractor prior to and up to 10 days before the bid opening to solicit minority business enterprises through written notices that describe the categories of work for which subcontracting is being solicited, the type of work to be performed, and specific instructions on how to submit a bid; 3. A detailed statement of the contractor s efforts to make personal contact with MBE/WBE firms identified for Item 2. above; 4. A record of the name, address, telephone number, and dates contacted for each M/WBE identified under items 2. and 3. above; 5. A description of the information provided to MBE/WBE s regarding the plans, specifications and the anticipated time schedule for portions of the work to be performed; 6. Information on activities to assist minority business enterprises to fulfill bonding requirements, or to obtain a waiver of these requirements; 19
7. Information on activities to publicize contracting opportunities to minority business enterprises, attendance at pre-bid meetings, or other meetings scheduled by the M/WBE Department or designated representative; 8. As to each MBE/WBE that placed a subcontract quotation or offer which the apparent low bidder or successful offeror considers not to be acceptable, a detailed statement of reasons for this conclusion; and 9. A list of minority subcontractors found to be unavailable. Signature (Company Representative Name) Sworn and subscribed before me this day of in the year Notary Public ------------------------------------------------------------------------------------------------------------------------------ Reviewed and accepted by the City Schools M/WBE Department or Representative. Signature (City Schools Representative Name) 20
PART F: MBE/WBE SUBCONTRACTOR UTILIZATION FORM Prime Contractor s Name: Contract Title: Contract Number: Total Contract Dollar Amount: Provide the following information for EACH AND EVERY subcontractor, both MBE/WBE and NON-MBE/WBE used on this contract. (Duplicate form if necessary.) Name of Subcontractor Goods or services provided on subcontract Race/ethnicity AND sex of subcontractor s owner Dollar amount of subcontract Dollar amount paid to date If amount paid to date is less than subcontract dollar amount, explain why. Name of Subcontractor Goods or services provided on subcontract Race/ethnicity AND sex of subcontractor s owner Dollar amount of subcontract Dollar amount paid to date If amount paid to date is less than subcontract dollar amount, explain why Name of Subcontractor Goods or services provided on subcontract Race/ethnicity AND sex of subcontractor s owner Dollar amount of subcontract Dollar amount paid to date If amount paid to date is less than subcontract dollar amount, explain why Prime Contractor s Signature 21