Commitment To Contract With Dbe
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1
2COMMUNITY BUSINESS DEVELOPMENT PARTNERS
MILWAUKEE COUNTY
COMMITMENT TO CONTRACT WITH DBE
(This form is to be completed by the bidder/proposer and the DBE named for submission with bid/proposal)
PROJECT No.: ________________
PROJECT TITLE: __________________________________________________
TOTAL CONTRACT AMOUNT $ ________________________
DBE Goal:
Scope of Work
DBE Contract
% of Total
(*)
Name & Address of DBE
Detailed Description
Amount
Contract
(* Separate commitment form must be completed for each DBE firm)
Bidder/Proposer Commitment (To be completed by firm committing work to DBE)
I certify that the DBE firm listed quoted the identified service(s) and cost(s). I further acknowledge our firm having negotiated
with, and having received confirmation, on partnering, pricing and delivery from DBE firm listed herein. Our firm
(Phone No._________________), or one of our subcontractors, will
enter into contract with the DBE firm listed, for the service(s) and amount(s) specified when awarded this contract. A copy of
the contract between our firm and that of the named DBE will be submitted directly to CBDP within seven (7) days from
receipt of Notice-to-Proceed on this contract. The information on this form is true and accurate to the best of my knowledge.
I further understand that falsification, fraudulent statement, or misrepresentation will result in appropriate sanctions under
applicable law.
Signature of Authorized Representative
Name & Title of Authorized Representative
Date
Subscribed and sworn to before me this
day of
, 20
State of
. My Commission expires
.
Signature of Notary Public
[SEAL]
* Only firms certified as DBEs (within qualifying NAICS codes) by the State of Wisconsin UCP prior to bid/proposal opening will be credited on this contract
DBE Affirmation (To be completed by DBE Owner/Authorized Representative)
I affirm that the State of Wisconsin UCP has certified our company as a DBE, and that our company is currently listed
in the State of Wisconsin UCP Directory.
I acknowledge and accept this commitment to contract with my firm for the service(s) and dollar amount(s) specified
herein, as put forth by
.
I understand and accept that this commitment is for service(s) to be rendered in completion of the Milwaukee County
project specified herein to be completed with my own forces, unless otherwise approved by CBDP.
I affirm that approval from CBDP will be obtained prior to subletting any portion of this work awarded to my firm on
this project.
Signature of Authorized DBE Representative
Name & Title of Authorized DBE Representative
Date
FOR CBDP USE ONLY
Commitment number
of
Project Total:
(A)
(V)
$
Signature
Date
Authorized Signature
Date
DBE-14 (12/01/14) Previous Editions Obsolete
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