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Identification of MWBE Participation
Submission of Affidavits which include statements of “To Be Determined” or failure to submit
the required information as outlined in the Specifications shall cause the Bid be deemed non-
responsive and subject to rejection.
I,
,
(Name of Bidder)
do hereby certify that on this project, we will use the following minority business enterprises as
construction subcontractors, vendors, suppliers or providers of professional services.
Firm Name, Address and Phone #
Work type
*MWBE
Category
*Minority categories: Black, African American (B), Hispanic (H), Asian American (A) American Indian (I),
Female (F) Socially and Economically Disadvantaged (D)
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The total value of minority business contracting will be ($)
.
AFFIDAVIT A
This Affidavit and ALL THREE (3) SECTIONS Herein Must Be Completed By ALL BIDDERS and Submitted with
Bid.
Section I - Listing of the Good Faith Effort
Bidder must earn at least 50 points from the Good Faith Efforts list for their Bid to be
considered responsive and must submit documentation supporting all items checked within the
timeframes set forth in Section III below.
I have made Good Faith Effort to comply under the following areas checked:
1 - Contacted minority businesses that reasonably could have been expected to submit a quote and that were
known to the contractor, or available on State or local government maintained lists, at least 10 days before
the bid date and notified them of the nature and scope of the work to be performed. “Contact” means contact
by letter, fax, e-mail or other means to a viable and active address. CONTRACTOR MUST ATTACH
EVIDENCE OF CONTACT TO THIS AFFIDAVIT AND SUBMIT WITH BID. Value = 10 points.
2.-Made the construction plans, specifications and requirements available for review by prospective MWBE
businesses, or providing these documents to them at least 10 days before the bids are due. Value = 10
points.
3 - Broken down or combined elements of work into economically feasible units to facilitate minority
participation. Value = 15 points.
4 - Worked with MWBE trade, community, or contractor organizations identified by the Office of Historically
Underutilized Businesses and included in the bid documents that provide assistance in recruitment of
MWBE’S. Value = 10 points.
5 - Attended prebid meetings scheduled by the public owner. Value = 10 points.
6 - Provided assistance in getting required bonding or insurance or provided alternatives to bonding or
insurance for subcontractors. Value = 20 points.
7 - Negotiated in good faith with interested MWBE’S and did not reject them as unqualified without discussing
with MWBE’S sound reasons based on their capabilities. CONTRACTOR MUST ATTACH TO THIS
AFFIDAVIT AND SUBMIT WITH BID COPIES OF QUOTES OR RESPONSES FROM ALL FIRMS
SUBMITTING QUOTES OR RESOPNSES, AND, IF APPLICABLE, WRITTEN JUSTIFICATION FOR ANY
REJECTION OF A MWBE BASED ON LACK OF QUALIFICATION. Value = 15 points.
8 - Provided assistance to an otherwise qualified MWBE in need of equipment, loan capital, lines of credit, or
joint pay agreements to secure loans, supplies, or letters of credit, including waiving credit that is ordinarily
required. Assisted minority businesses in obtaining the same unit pricing with the bidder's suppliers in order
to help MWBE businesses in establishing credit. Value = 25 points.
9 - Negotiated joint venture and partnership arrangements with MWBE businesses in order to increase
opportunities for MWBE business participation on the construction or repair project when possible. Value = 20
points.
10 - Provided quick pay agreements and policies to enable MWBE contractors and suppliers to meet cash-
flow demands. Value = 20 points.
The undersigned hereby certifies that he or she has read the terms of the MWBE business
commitment, that the bidder has made the Good Faith Efforts in the areas checked above, and that he
or she is authorized to bind the bidder to the commitment herein set forth.
Date:
Name of Authorized Officer:
Signature:
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Section II - Portion of the Work to be Performed by Minority Firms
I will expend a minimum of
% of the total dollar amount of the contract with MWBE. MWBE
will be employed as construction subcontractors, vendors, suppliers or providers of professional
services. Such work will be subcontracted to the following firms listed below.
(Attach additional sheets if necessary)
Name and Phone Number
*MWBE Work description
Category
Dollar Value
*MWBE categories: Black, African American (B), Hispanic (H), Asian American (A) American Indian (I),
Female (F) Socially and Economically Disadvantaged (D)
Pursuant to GS143-128.2(d), the undersigned will enter into a formal agreement with MWBE for work
listed in this schedule conditional upon execution of a contract with the Owner. Failure to fulfill this
commitment may constitute a breach of the contract.
The undersigned hereby certifies that he or she has read the terms of this commitment and is
authorized to bind the bidder to the commitment herein set forth.
Date:
Name of Authorized Officer:
Signature:
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Section III – Documentation of Good Faith Efforts
ALL BIDDERS, regardless of percentage of MWBE participation, MUST provide documentation of all
Good Faith Efforts checked in Section I within the timeframes set forth in Parts A and B below.
Failure to submit these documents / information shall be grounds for deduction of Good Faith Points. In
the event such a deduction results in a failure to achieve the required number of Good Faith Points, the
Bid shall be rejected unless the bidder has otherwise demonstrated Good Faith Efforts.
PART A (Documentation Required to be Submitted With Bid)
Documentation MUST be provided WITH THE BID in order for the bidder to receive credit for certain
items checked. If the bidder checked Items 1 or 7 in Section I, the bidder MUST provide documentation
supporting those Good Faith Efforts WITH THE BID.
Examples of such documentation include, but are not limited to, the following:
ITEM 1
● Copies of solicitations for quotes to at least three (3) MWBE’s from the source list provided by
the State for each subcontract to be let under this contract (if 3 or more firms are shown on the
source list). Each solicitation shall contain a specific description of the work to be
subcontracted, location where bid documents can be reviewed, representative of the Prime
Bidder to contact, and location, date and time when quotes must be received.
● Copies of quotes and responses received from each firm responding to the solicitation.
● A telephone log of follow-up calls to each firm sent a solicitation.
ITEM 7
● Copies of quotes or responses received from all firms submitting quotes or responses for each
subcontract, and, if applicable a letter detailing the reason(s) for any rejection of minority
business(es) due to lack of qualification.
I do certify the attached documentation as true and accurate representation of my good faith efforts.
Date:
Name of Authorized Officer:
Signature:
Title:
State of North Carolina, County of
SEAL
Subscribed and sworn to before me this
day of
20
Notary Public
My commission expires
PART B (Documentation Required to be Submitted Within 72 Hours of Notification)
Certain documentation MUST be provided within 72 hours of notification of being the apparent lowest
responsible, responsive bidder in order to receive credit for certain additional Items checked. If the
bidder checked Items 2, 3, 4, 5, 6, 8, 9 or 10, the bidder MUST provide documentation supporting those
Good Faith Efforts within 72 hours of notification of being the apparent lowest responsible, responsive
bidder.
Examples of such documentation include, but are not limited to the following:
ITEM 2
• Invitation to view construction plans, specifications and requirements.
• Cover letter enclosing construction plans, specifications and requirements.
ITEM 3
• Copies of all bid solicitations or request for proposals broken down by scope of work.
• Letter detailing contractor’s efforts to break down or combine elements of work into economically feasible
units to facilitate minority participation.
ITEM 4
• Documentation of any contacts or correspondence to MWBE, community, or contractor organizations in
an attempt to meet the goal.
ITEM 5
• Copy of pre-bid roster.
ITEM 6
• Letter documenting efforts to provide assistance in obtaining required bonding or insurance for MWBE.
ITEM 8
• Letter documenting proposed assistance offered to minority business in need of equipment, loan capital,
lines of credit, or joint pay agreements to secure loans, supplies, or letter of credit, including waiving
credit that is ordinarily required.
ITEM 9
• Letter documenting negotiations with MWBE businesses to create joint venture or partnership
arrangement for the construction or repair project.
ITEM 10
• Copy of quick pay agreements.
• Copy of quick pay policies.
I do certify the attached documentation as true and accurate representation of my good faith efforts.
Date:
Name of Authorized Officer:
Signature:
Title:
State of North Carolina, County of
SEAL
Subscribed and sworn to before me this
day of
20
Notary Public
My commission expires
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