SEALED BID DISADVANTAGED BUSINESS ENTERPRISE (DBE) PARTICIPATION SCHEDULE As specified in the DBE Participation Section included in the Bidding Documents, the Bidder shall furnish to SEPTA’s satisfaction the details of disadvantaged business enterprise participation. NOTE: Firms must be Pennsylvania Unified Certification Program (PA UCP)-certified prior to being listed on a DBE Participation Schedule. PROJECT NAME: SEALED BID NO.: TABLE I. ALL WORK/SERVICES TO BE PERFORMED BY THE DBE FIRM 1 2 3 NAME OF DBE FIRM DESCRIPTION OF WORK TOTAL DBE AGREED TO BE PERFORMED1 PRICE TO BE CREDITED CONTACT PERSON, BUSINESS ADDRESS, TELEPHONE NUMBER TO DBE GOAL2 Firm Name: Contact: Address: Tele. No.: (Type or Print all information) TABLE II. MATERIAL/SUPPLIES TO BE PURCHASED FROM “REGULAR DEALERS” 1 2 3 NAME OF DBE FIRM DESCRIPTION OF MATERIAL TO BE TOTAL DBE AGREED PRICE SUPPLIED1 TO BE CREDITED CONTACT PERSON, BUSINESS ADDRESS, TELEPHONE NUMBER TO DBE GOAL2 (Total Price x .6) Total Price: Firm Name: X .6 Contact: Address: Amount Credited to Tele. No.: DBE Goal: (Type or Print all information) Name of Bidder: Tele. No.: ( ) (type or print) Email: Contact: Title: (type or print) Signature: Date: A FULLY COMPLETED DBE PARTICIPATION SCHEDULE, FOR EACH DBE FIRM DESIGNATED TO PARTICIPATE, IS REQUIRED TO BE SUBMITTED. FAILURE OF THE BIDDER TO SUBMIT FULLY COMPLETED DBE PARTICIPATION SCHEDULE(S) TO SEPTA’S SATISFACTION MAY RESULT IN THE REJECTION OF THE BID. BIDDER MUST SIGN AND DATE ABOVE. BIDDER WILL BE REQUIRED TO PROVIDE A COMMITMENT/CONFIRMATION DOCUMENT FOR EACH DESIGNATED DBE FIRM UPON REQUEST FROM SEPTA. Bidders are hereby notified that the information contained herein will be verified with the designated DBE firm. Additionally, if and when the award of a contract is made, the DBE firm listed herein will be simultaneously notified of the award. SEPTA reserves the right to waive informalities herein in its sole reasonable discretion. 1 See Section D. “Determination of Percentage of DBE Participation” for discussion of types of participation and credit given toward achieving the DBE Goal. 2 This may be expressed in dollars or as a percentage of the Bidder’s total maximum price to SEPTA.
SEALED BID DISADVANTAGED BUSINESS ENTERPRISE (DBE) PARTICIPATION SCHEDULE As specified in the DBE Participation Section included in the Bidding Documents, the Bidder shall furnish to SEPTA’s satisfaction the details of disadvantaged business enterprise participation. NOTE: Firms must be Pennsylvania Unified Certification Program (PA UCP)-certified prior to being listed on a DBE Participation Schedule. PROJECT NAME: SEALED BID NO.: TABLE I. ALL WORK/SERVICES TO BE PERFORMED BY THE DBE FIRM 1 NAME OF DBE FIRM CONTACT PERSON, BUSINESS ADDRESS, TELEPHONE NUMBER 2 DESCRIPTION OF WORK TO BE PERFORMED1 3 TOTAL DBE AGREED PRICE TO BE CREDITED TO DBE GOAL2 Firm Name: Contact: Address: Tele. No.: (Type or Print all information) TABLE II. MATERIAL/SUPPLIES TO BE PURCHASED FROM “REGULAR DEALERS” 1 NAME OF DBE FIRM CONTACT PERSON, BUSINESS ADDRESS, TELEPHONE NUMBER 2 DESCRIPTION OF MATERIAL TO BE SUPPLIED1 3 TOTAL DBE AGREED PRICE TO BE CREDITED TO DBE GOAL2 (Total Price x .6) Firm Name: Total Price: Contact: X .6 Address: Amount Credited to DBE Goal: Tele. No.: (Type or Print all information) Name of Bidder: Tele. No.: ( ) Contact: (type or print) Email: Title: Signature: (type or print) Date: A FULLY COMPLETED DBE PARTICIPATION SCHEDULE, FOR EACH DBE FIRM DESIGNATED TO PARTICIPATE, IS REQUIRED TO BE SUBMITTED. FAILURE OF THE BIDDER TO SUBMIT FULLY COMPLETED DBE PARTICIPATION SCHEDULE(S) TO SEPTA’S SATISFACTION MAY RESULT IN THE REJECTION OF THE BID. BIDDER MUST SIGN AND DATE ABOVE. BIDDER WILL BE REQUIRED TO PROVIDE A COMMITMENT/CONFIRMATION DOCUMENT FOR EACH DESIGNATED DBE FIRM UPON REQUEST FROM SEPTA. Bidders are hereby notified that the information contained herein will be verified with the designated DBE firm. Additionally, if and when the award of a contract is made, the DBE firm listed herein will be simultaneously notified of the award. SEPTA reserves the right to waive informalities herein in its sole reasonable discretion. 1 See Section D. “Determination of Percentage of DBE Participation” for discussion of types of participation and credit given toward achieving the DBE Goal. 2 This may be expressed in dollars or as a percentage of the Bidder’s total maximum price to SEPTA.
03-2016-stateconstructionrev-16-00043-ARIB.docx