SAMPLE - Miami-Dade Expressway Authority | MDX · N) Include all information for the...

V. 2018.11 Page 1 of 1

Contractor/Consultant:

MDX Procurement/Contract No.:

MDX Work Program No.:

MDX Project/Service Title:

MDX APPROVED CERTIFICATIONS PURSUANT TO MIAMI-DADE COUNTY'S SMALL BUSINESS PROGRAMSBE/AESBE/CONSSBE/GS Yes

MDX APPROVED CERTIFICATIONS PURSUANT TO THE MDX LOCAL BUSINESS PARTICIPATION POLICY Revised: YesLB

FEDERAL/STATE PROGRAM: Ownership/control of firm of 51% or greater of a minority. Revision #:DBEMBEBHW

Authorized Signature:

Print Name:Date:

Title:

Date:

Type of Certification(s) Type of Work Performing

#DIV/0!#DIV/0!

#DIV/0!

#DIV/0!

#DIV/0!

#DIV/0!

#DIV/0!#DIV/0!

#DIV/0!#DIV/0!

ONLY LIST FIRMS THAT ARE BEING UTILIZED TO MEET THE SB REQUIREMENT ON THE CONTRACT

Minimum % of Work to be Performed By Contractor/Consultant:

Women-Owned: Reviewed By:

Small Business Enterprise - Construction:

Print Name:

Small Business Enterprise - Goods and Services:

Small Business Enterprise - Architectural and Engineering:

MDX WILL UTILIZE THIS SPREADSHEET, AMONGST OTHER PURPOSES, TO TRACK THE CONSULTANT/CONTRACTOR ACHIEVEMENT OF THE SB/LB PARTICIPATION REQUIREMENT THROUGHOUT THE TERM OF THE CONTRACT. ANY DEVIATION OF THE SB/LB PARTICIPATION REQUIREMENT AS DETAILED HEREIN SHALL BE ADDRESSED IN WRITING TO MDX. PLEASE BE AWARE THAT PENALTIES SHALL BE APPLIED AND POSSIBLE CONTRACT TERMINATION MAY BE

EXERCISED BY MDX FOR NON-COMPLIANCE OF THE SB/LB PARTICIPATION REQUIREMENT.

Hispanic:

Original (At Contract Execution):

FOR MDX PROCUREMENT USE ONLY

#DIV/0!

#DIV/0!

#DIV/0!

#DIV/0!

Local Business:

Disadvantaged Business Enterprise: Minority Business Enterprise:

Black:

$0.00

#DIV/0!

Type of Work Performing

#DIV/0!

#DIV/0!

#DIV/0!#DIV/0!

#DIV/0!#DIV/0!

#DIV/0!

#DIV/0!#DIV/0!

#DIV/0!

#DIV/0!Dollar Amount

#DIV/0!

#DIV/0!

#DIV/0!

#DIV/0!#DIV/0!

$0.00

#DIV/0!#DIV/0!

#DIV/0!#DIV/0!#DIV/0!

Total Overall %

Total Overall %

#DIV/0!

Local Business Participation (LB)

Type of Work PerformingExpiration Date

#DIV/0!#DIV/0!

Type of Certification(s) Certification #

Total LB Participation

#DIV/0!

Total Overall %

Remainder of Team#DIV/0!

Dollar AmountCertification #COMPLETE FOR ALL REMAINING TEAM MEMBERS INCLUSIVE OF SMALL BUSINESS & LOCAL BUSINESS FIRMS NOT UTILIZED TO MEET SB AND/OR LB REQUIREMENT ABOVE

Type of Certification(s)#DIV/0!

Type of Certification(s)COMPLETE FOR ALL APPLICABLE TEAM MEMBERS, INCLUSIVE OF SMALL BUSINESS AND/OR LOCAL BUSINESS, ALREADY LISTED ABOVE

Expiration Date

#DIV/0!#DIV/0!

#DIV/0!


#DIV/0!

Total Overall %Type of Work Performing

$0.00

Minority Participation (DBE, MBE, B, H, W)

#DIV/0!

#DIV/0!#DIV/0!

Certification #

Total SB Participation $0.00

Total Dollar Amount

Firm

Dollar Amount

$0.00Total Contract Amount

Contract Amount for SB/LB Requirement:

Local Business Firm

SUBCONTRACTOR/SUBCONSULTANT UTILIZATION REPORT

SB Participation Requirement:

LB Participation Requirement:

Total Contract Amount:

Dollar Amount

Small Business Participation (SBE/AE, SBE/CONS, SBE/GS)

#DIV/0!

Minority Business Firm

ONLY LIST FIRMS THAT ARE BEING UTILIZED TO MEET THE LB REQUIREMENT ON THE CONTRACT

Expiration Date

Small Business Firm


#DIV/0!

#DIV/0!

$0.00Total Minority Participation

#DIV/0!

#DIV/0!

Prime - Exclusions from SB/LB Participation Requirement (if applicable)

#DIV/0!#DIV/0!

#DIV/0!#DIV/0!

V. 2018.11 Page 1 of 1

Contractor/Consultant:

MDX Procurement/Contract No.:

MDX Work Program No.:

MDX Project/Service Title:

MDX APPROVED CERTIFICATIONS PURSUANT TO MIAMI-DADE COUNTY'S SMALL BUSINESS PROGRAMSBE/AESBE/CONSSBE/GS Yes

MDX APPROVED CERTIFICATIONS PURSUANT TO THE MDX LOCAL BUSINESS PARTICIPATION POLICY Revised: YesLB

FEDERAL/STATE PROGRAM: Ownership/control of firm of 51% or greater of a minority. Revision #:DBEMBEBHW

Authorized Signature:

Print Name:Date:

Title:

Date:

Type of Certification(s) Type of Work Performing

#DIV/0!#DIV/0!

#DIV/0!

#DIV/0!

#DIV/0!

#DIV/0!

#DIV/0!#DIV/0!

#DIV/0!#DIV/0!


Minimum % of Work to be Performed By Contractor/Consultant:

Women-Owned: Reviewed By:

Small Business Enterprise - Construction:

Print Name:

Small Business Enterprise - Goods and Services:

Small Business Enterprise - Architectural and Engineering:

MDX WILL UTILIZE THIS SPREADSHEET, AMONGST OTHER PURPOSES, TO TRACK THE CONSULTANT/CONTRACTOR ACHIEVEMENT OF THE SB/LB PARTICIPATION REQUIREMENT THROUGHOUT THE TERM OF THE CONTRACT. ANY DEVIATION OF THE SB/LB PARTICIPATION REQUIREMENT AS DETAILED HEREIN SHALL BE ADDRESSED IN WRITING TO MDX. PLEASE BE AWARE THAT PENALTIES SHALL BE APPLIED AND POSSIBLE CONTRACT TERMINATION MAY BE

EXERCISED BY MDX FOR NON-COMPLIANCE OF THE SB/LB PARTICIPATION REQUIREMENT.

Hispanic:

Original (At Contract Execution):

FOR MDX PROCUREMENT USE ONLY

#DIV/0!

#DIV/0!

#DIV/0!

#DIV/0!

Local Business:

Disadvantaged Business Enterprise: Minority Business Enterprise:

Black:

$0.00

#DIV/0!

Type of Work Performing

#DIV/0!

#DIV/0!

#DIV/0!#DIV/0!

#DIV/0!#DIV/0!

#DIV/0!

#DIV/0!#DIV/0!

#DIV/0!

#DIV/0!Dollar Amount

#DIV/0!

#DIV/0!

#DIV/0!

#DIV/0!#DIV/0!

$0.00

#DIV/0!#DIV/0!


Total Overall %

Total Overall %

#DIV/0!


Type of Work PerformingExpiration Date

#DIV/0!#DIV/0!

Type of Certification(s) Certification #

Total LB Participation

#DIV/0!

Total Overall %

Remainder of Team#DIV/0!

Dollar AmountCertification #COMPLETE FOR ALL REMAINING TEAM MEMBERS INCLUSIVE OF SMALL BUSINESS & LOCAL BUSINESS FIRMS NOT UTILIZED TO MEET SB AND/OR LB REQUIREMENT ABOVE

Type of Certification(s)#DIV/0!

Type of Certification(s)COMPLETE FOR ALL APPLICABLE TEAM MEMBERS, INCLUSIVE OF SMALL BUSINESS AND/OR LOCAL BUSINESS, ALREADY LISTED ABOVE

Expiration Date

#DIV/0!#DIV/0!

#DIV/0!


#DIV/0!

Total Overall %Type of Work Performing

$0.00


#DIV/0!

#DIV/0!#DIV/0!

Certification #

Total SB Participation $0.00

Total Dollar Amount

Firm

Dollar Amount

$0.00Total Contract Amount


Local Business Firm


SB Participation Requirement:

LB Participation Requirement:

Total Contract Amount:

Dollar Amount


#DIV/0!

Minority Business Firm


Expiration Date

Small Business Firm


#DIV/0!

#DIV/0!

$0.00Total Minority Participation

#DIV/0!

#DIV/0!


#DIV/0!#DIV/0!

#DIV/0!#DIV/0!

SAMP

LE

jquirogaOval

jquirogaOval

jquirogaOval

jquirogaOval

mmatalonText Box

mmatalonText Box

mmatalonText BoxA

mmatalonText BoxB

mmatalonText BoxC

mmatalonText BoxD

mmatalonText BoxE

jquirogaOval

jquirogaOval

jquirogaOval

jquirogaOval

jquirogaOval

mmatalonText BoxF

mmatalonText BoxG

mmatalonText BoxH

mmatalonText BoxI

mmatalonText BoxJ

mmatalonText BoxK

jquirogaOval

jquirogaOval

jquirogaOval

jquirogaOval

jquirogaOval

jquirogaOval

jquirogaOval

jquirogaOval

jquirogaOval

jquirogaOval

jquirogaOval

jquirogaOval

jquirogaOval

jquirogaOval

jquirogaOval

jquirogaOval

jquirogaOval

jquirogaOval

jquirogaOval

jquirogaOval

jquirogaOval

jquirogaOval

jquirogaOval

jquirogaOval

mmatalonText BoxN

mmatalonText BoxO

mmatalonText BoxP

mmatalonText BoxQ

mmatalonText BoxR

mmatalonText BoxS

mmatalonText BoxT

mmatalonText BoxU

mmatalonText BoxV

mmatalonText BoxM

mmatalonText BoxL

mmatalonPencil

mmatalonPencil

mmatalonPencil

mmatalonPencil

mmatalonText BoxW

mmatalonText BoxX

mmatalonText BoxZ

mmatalonText BoxAA

mmatalonText BoxAB

mmatalonText BoxY

mmatalonPencil

mmatalonPencil

mmatalonPencil

mmatalonPencil

mmatalonPencil

mmatalonPencil

mmatalonPencil

mmatalonPencil

mmatalonPencil

mmatalonPencil

mmatalonPencil

mmatalonPencil

mmatalonPencil

mmatalonPencil

mmatalonPencil

mmatalonPencil

mmatalonText BoxAD

mmatalonText BoxAC

mmatalonText BoxAE

mmatalonText BoxAF

mmatalonText BoxAG

mmatalonLine

mmatalonLine

mmatalonLine

mmatalonLine

mmatalonLine

mmatalonLine

mmatalonLine

mmatalonLine

V. 201507 Page 1 of 3

Instructions to complete: Subcontractor/Subconsultant Utilization Report Intent: The intent of this form is to monitor the utilization by the Contractor/Consultant of Subcontractor(s)/ Subconsultant(s); SB’s and LB’s throughout the term of the Contract, inclusive of any renewals/ authorized time extensions as may be applicable. Instructions: A) Include Contractor’s/Consultant’s legal entity name.

B) Include MDX Procurement/Contract No. (MDX, RFP, RFQ, ITB, ITN-XX-XX, as applicable).

Example: RFP-13-01. C) Include Work Program Number (112XX.XXX, 836XX.XXX, 874XX.XXX, 878XX.XXX, 924XX.XXX

Example: 11211.060, 83608.030, 87404.031, 87801.051, 92405.030. For Contracts that do not have a Work Program Number, enter N/A.

D) Include Project/Service Title.

Example: Central Boulevard Reconstruction/Design Build Services E) Include the SB Participation Requirement percentage pursuant to the Contract, as applicable.

Example: 10%, 15%, or N/A. F) Include the LB Participation Requirement percentage pursuant to the Contract, as applicable.

Example: 10%, 15%, or N/A. G) Include the Total Contract Amount inclusive of Contingency Amount, Insurance and Bonds, as

applicable. H) Include the Percentage of Work to be performed by the Contractor/Consultant pursuant to the

section of the RFP/RFQ/ITB/ITN entitled Percentage of Work to be Performed by Bidder/ Proposer. Example: 30%, 35%, 40%. For Contracts that do not have this requirement, enter N/A.

Instructions to complete: Subcontractor/Subconsultant Utilization Report

V. 201507 Page 2 of 3

I) Include the Contract Amount for SB/LB Participation Requirement. i) For Professional Services Contracts, this is the Total Contract Amount, unless exclusions

are approved by MDX. ii) For Design-Build and Construction Contracts, the Contract Amount for SB/LB Participation

Requirement shall exclude costs for Insurance, Bonds, Contingency Amount and Optional Services, if applicable. Example: Total Contract Amount $10,000,000.00

Cost for Insurance and Bonds $100,000.00 Contingency Amount $100,000.00 Contract Amount for SB/LB Participation Requirement $9,800,000.00.

J) Include all information for the approved/proposed Small Business firms that are being utilized to

meet the SB Participation Requirement on the Contract.

Please note that information included in this section shall become the committed Small Business Participation Requirement for the Contract.

K) The Total Overall % is automatically calculated by the Dollar Amount for the Small Business being

divided by the Contract Amount for SB/LB Requirement. L) The sum total of all SB Participation in dollars being committed to the Contract is automatically

calculated. M) The sum total of the Total Overall % being committed to the Contract for Small Businesses is

automatically calculated. N) Include all information for the approved/proposed Local Business firms that are being utilized to

meet the LB Participation Requirement on the Contract. Please note that information included in this section shall become the committed Local Business Participation Requirement for the Contract.

O) The Total Overall % is automatically calculated by the Dollar Amount for the Local Business being

divided by the Contract Amount for SB/LB Requirement. P) The sum total of all LB Participation in dollars being committed to the Contract is automatically

calculated. Q) The sum total of the Total Overall % being committed to the Contract for Local Businesses is

automatically calculated. R) Include all information for the approved/proposed Remaining Team Members inclusive of Small

Business & Local Business dollar amounts not being utilized to meet SB and/or LB Participation Requirement as indicated in J and N.

S) The Total Overall % is automatically calculated by the Dollar Amount for the Remaining Team

Member being divided by the Total Contract Amount for SB/LB Requirement.

Instructions to complete: Subcontractor/Subconsultant Utilization Report

V. 201507 Page 3 of 3

T) The sum total of all Remaining Team Members in dollars is automatically calculated. U) The sum total of the Total Overall % for the Remaining Team Members is automatically calculated. V) The sum total of the Contract Amount for SB/LB Requirement and percentage is automatically

calculated and must equal the Contract Amount for SB/LB Requirement at the top of the form. W) Include any amounts excluded by contract from the SB/LB Participation Requirement. See bullet I

for further clarification. X) The Total Contract Amount is automatically calculated by adding V and W and must equal G. Y) Include all information for Minority Participation, inclusive of Small Business; Local Business; and

Remaining Team Members already listed above in J, N and R, as may be applicable. Z) The Total Overall % is automatically calculated by the Dollar Amount for the Minority

Participation being divided by the Total Contract Amount for SB/LB Requirement. AA) The sum total of all Minority Participation in dollars is automatically calculated. AB) The sum total of the Total Overall % for Minority Participation is automatically calculated. AC) Signature of Authorized Officer to contractually bind and enter into contractual arrangements

and/or agreements on behalf of the company. AD) Printed name for Authorized Officer. AE) Title of Authorized Officer. AF) Date form signed by Authorized Officer. AG) For MDX Procurement use only. NOTES: 1. Firms may appear in more than one section of the Subcontractor/Subconsultant Utilization

Report. However, a firm may not be utilized to meet both the Small Business Participation Requirement and the Local Business Participation Requirement on the Contract.

2. The Subcontractor/Subconsultant Utilization Report has been attached in Excel format to this file.

SB Utilization ReportSubcontractor-Subconsultant Utilization Report - With Bubbles - FINAL2 - 7-21-15.pdfSB Utilization ReportUntitled

Instructions to complete Sub Utilization Report - FINAL2 - 7-21-15.pdfH) Include the Percentage of Work to be performed by the Contractor/Consultant pursuant to the section of the RFP/RFQ/ITB/ITN entitled Percentage of Work to be Performed by Bidder/ Proposer.

Subcontractor-Subconsultant Utilization Report - FINAL2 - 7-21-15.pdfSB Utilization Report

Subcontractor-Subconsultant Utilization Report - Draft - 11-1-18.pdfSB Utilization Report


Subcontractor-Subconsultant Utilization Report with Instructions - 11-5-18.pdfSB Utilization ReportSubcontractor-Subconsultant Utilization Report - With Bubbles - FINAL2 - 7-21-15.pdfSB Utilization ReportUntitled

Instructions to complete Sub Utilization Report - FINAL2 - 7-21-15.pdfH) Include the Percentage of Work to be performed by the Contractor/Consultant pursuant to the section of the RFP/RFQ/ITB/ITN entitled Percentage of Work to be Performed by Bidder/ Proposer.

Subcontractor-Subconsultant Utilization Report - FINAL2 - 7-21-15.pdfSB Utilization Report


SB Utilization Report


Contractor/Consultant:SB Participation Requirement:

MDX Procurement/Contract No.:LB Participation Requirement:

MDX Work Program No.:Total Contract Amount:

MDX Project/Service Title:Minimum % of Work to be Performed By Contractor/Consultant:




Small Business FirmType of Certification(s)Type of Work PerformingDollar AmountTotal Overall %

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

Total SB Participation$0.000.00%$0.00



Local Business FirmType of Certification(s)Certification #Expiration DateType of Work PerformingDollar AmountTotal Overall %

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

Total LB Participation$0.000.00%$0.00

Remainder of Team

COMPLETE FOR ALL REMAINING TEAM MEMBERS INCLUSIVE OF SMALL BUSINESS & LOCAL BUSINESS FIRMS NOT UTILIZED TO MEET SB AND/OR LB REQUIREMENT ABOVE

FirmType of Certification(s)Certification #Expiration DateType of Work PerformingDollar AmountTotal Overall %

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%0.00%

0.00%0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%$0.00

0.00%

Total Dollar Amount$0.000.00%

Contract Amount for SB/LB Requirement:$0.000.00%$0.00


Total Contract Amount$0.00


COMPLETE FOR ALL APPLICABLE TEAM MEMBERS, INCLUSIVE OF SMALL BUSINESS AND/OR LOCAL BUSINESS, ALREADY LISTED ABOVE

Minority Business FirmType of Certification(s)Certification #Expiration DateType of Work PerformingDollar AmountTotal Overall %

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

0.00%

Total Minority Participation$0.000.00%

MDX WILL UTILIZE THIS SPREADSHEET, AMONGST OTHER PURPOSES, TO TRACK THE CONSULTANT/CONTRACTOR ACHIEVEMENT OF THE SB/LB PARTICIPATION REQUIREMENT THROUGHOUT THE TERM OF THE CONTRACT. ANY DEVIATION OF THE SB/LB PARTICIPATION REQUIREMENT AS DETAILED HEREIN SHALL BE ADDRESSED IN WRITING TO MDX. PLEASE BE AWARE THAT PENALTIES SHALL BE APPLIED AND POSSIBLE CONTRACT TERMINATION MAY BE EXERCISED BY MDX FOR NON-COMPLIANCE OF THE SB/LB PARTICIPATION REQUIREMENT.

MDX APPROVED CERTIFICATIONS PURSUANT TO MIAMI-DADE COUNTY'S SMALL BUSINESS PROGRAMFOR MDX PROCUREMENT USE ONLY

Small Business Enterprise - Architectural and Engineering:SBE/AE

Small Business Enterprise - Construction:SBE/CONS

Small Business Enterprise - Goods and Services:SBE/GSOriginal (At Contract Execution):o Yes

MDX APPROVED CERTIFICATIONS PURSUANT TO THE MDX LOCAL BUSINESS PARTICIPATION POLICYRevised:o Yes

Local Business:LB

FEDERAL/STATE PROGRAM: Ownership/control of firm of 51% or greater of a minority.Revision #:

Disadvantaged Business Enterprise:DBE

Minority Business Enterprise:MBE

Black:B

Hispanic:H

Women-Owned:WReviewed By:

Authorized Signature:Print Name:

Print Name:

Date:

Title:

Date:

&C&"+,Regular"&10V. 2018.11&R&"+,Regular"&10Page 1 of 1

Sheet2

Sheet3

Sheet1

SAMPLE - Miami-Dade Expressway Authority | MDX · N) Include all information for the...

Documents

Transcript of SAMPLE - Miami-Dade Expressway Authority | MDX · N) Include all information for the...