SCMTD February 2004 Board of Directors Agendas - Santa Cruz ...

CONTRACTOR DBE INFORMATION
CONTRACTOR’S NAME CONTRACTOR’S ADDRESS
DBE GOAL FROM CONTRACT %
FED. NO.
COUNTY PROPOSAL AMOUNT $
AGENCY PROPOSAL OPENING DATE
CONTRACT NO. DATE OF DBE CERTIFICATON
SOURCE **
This information must be submitted during the initial negotiations with the District. By submitting a proposal, offeror certifies that he/she is in compliance with the District’s policy. Failure to submit
the required DBE information by the time specified will be grounds for finding the proposal non-responsive.
CONTRACT
ITEM NO.
ITEM OF WORK AND DESCRIPTION OF
WORK OR SERVICES TO BE SUBCONTRACTED
OR MATERIALS TO BE PROVIDED *
CERTIFICATION
FILE NUMBER
NAME OF DBE
DOLLAR
AMOUNT
DBE ***
PERCENT
DBE
TOTAL CLAIMED DBE
PARTICIPATION $ %
SIGNATURE OF CONTRACTOR DATE
AREA CODE/TELEPHONE (Detach from proposal if DBE information is not submitted with proposal.)
* If 100% of item is not to be performed or furnished by DBE, describe exact portion, including plan location of work to be performed, of item to be performed or furnished by DBE.
** DBE’s must be certified on the date proposals are opened.
*** Credit for a DBE supplier who is not a manufacturer is limited to 60% of the amount paid to the supplier.
NOTE: Disadvantaged business must renew their certification annually by submitting certification questionnaires in advance of expiration of current certification. Those not on a current list cannot
be considered as certified.