Form A - Compliance Plan - City Of Milwaukee - Department Of Public Works Sbe Participation For Subcontractors And/or Material Suppliers

(Rev. 05/ 2013)

FORM A - COMPLIANCE PLAN - CITY OF MILWAUKEE – DEPARTMENT OF PUBLIC WORKS

SBE PARTICIPATION FOR SUBCONTRACTORS AND/OR MATERIAL SUPPLIERS

PRIME CONTRACTOR’S NAME:___________________________________________________

OFFICIAL NOTICE NUMBER: __________________

DATE:______________________

TOTAL BID AMOUNT:_______________________

TOTAL SBE AMOUNT:____________________

This Form A must be completed in its entirety and is a required submission in conjunction with a Bid or Request for Proposal. Submit either with the bid or within 3 days of being notified as the

apparent low bidder. List all proposed SBE subcontractor(s) and/or material supplier(s) for this project. NOTE: To receive full credit, SBE’s must perform commercially useful work at the job

site. ONLY up to twenty percent (20%) credit may be given under certain circumstances to SBE suppliers or other SBE contractors who assist in management of the project. I/We propose to

utilize the following SBE subcontractor(s) and/or material supplier(s):

Fill in BID REQUIREMENTS: _____%SBE

LIST DESIGNATION:

PERCENT

AMOUNT

SBE FIRM(S) NAME

EXPLAIN WORK TO BE

AUTHORIZED SBE(S)

WHETHER SUPPLIER

OF BID

ADDRESS/CONTACT PERSON

PERFORMED/MATERIAL

OWNER/REPRESENTATIVE

OR CONSTRUCTION

AND PHONE NUMBER

SUPPLIED

SIGNATURE OF

LABOR

ACKNOWLEDGEMENT

1.

2.

3.

4.

5.

I certify that the information included on this Form A is true and complete to the best of my knowledge. I further understand and agree that this Form A is a condition of my Bid/RFP

responsiveness. Failure to submit this form and/or meet the specified SBE requirements may render the Bid/RFP nonresponsive.

CONTRACTOR: ______________________________________________________________________________ DATE: ______/______/______

(SIGNATURE & TITLE REQUIRED)

REVIEWED BY OSBD ANALYST: ______________________________________________________________ DATE: ______/______/______

DEPARTMENT OF PUBLIC WORKS: ____________________________________________________________ DATE: ______/______/______