LPA RFP Forms for LOI Submittals

Description

(Rev. 03-29-10) Request for Proposals Bulletin Project AFFIRMATIVE ACTION CERTIFICATION FOR DBE I hereby certify that my company intends to affirmatively seek out and consider Disadvantaged Business Enterprises (DBEs) certified in the State of Indiana to participate as part of this proposal. I acknowledge that this certification is to be made an integral part of this proposal. I understand and agree that the submission of a blank certification may cause the proposal to be rejected. I certify that I have consulted the following DBE website to confirm that the firms listed below are currently certified DBEs: https://financial.gmis.in.gov/psc/guest/EMPLOYEE/ERP/c/SOI_APPS_MWBE.SOI_DBE_CERT.GBL?& I certify that I have contacted the certified DBEs listed below, and if my company becomes the CONSULTANT, these DBEs have tentatively agreed to perform the services as indicated. I understand that neither my company nor I will be penalized for DBE utilization that exceeds the goal. After contract award, any change to the firms listed in this Affirmative Action Certification to be applied toward the DBE goal must have prior approval by INDOT’s Economic Opportunity Division. SUBCONSULTANTS DBE SUBCONSULTANTS TO BE APPLIED TOWARD GOAL Certified DBE Name Service Planned Estimated percentage to be paid to DBE* % % % % DBE SUBCONSULTANTS TO BE USED BEYOND GOAL Certified DBE Name Service Planned Estimated percentage to be paid to DBE* % % % % Estimated Total Percentage Credited toward DBE Goal: Estimated Percentage of Voluntary DBE Work Anticipated over DBE Goal: Name of Company: By: Date: *It is understood that these individual firm percentages and dollar amounts are estimates only and that amounts paid may be greater or less as a result of negotiation of the contract scope of work. My firm will use good faith efforts to meet the overall DBE goal through the use of these or other certified and approved DBE firms.