THIS FORM MUST BE COMPLETED
SCHEDULE OF INTENT AFFIDAVIT
COMMUNITY SMALL BUSINESS ENTEPRISE PROGRAM
Name of Prime Contractor Firm ______________________________________________________________________ Contact Person ______________________________________
Address ___________________________________________________________________________________________ Phone ______________________ Fax ____________________
Project Name ______________________________________________________________________________________ Project Number ______________________________________
CSBE Contract Measure _______________________________________
This form must be completed by the Prime Contractor and the CSBE Subcontractor that will be utilized for scopes of work on the project. Bidders must include this form in a separate envelope
at the time of bid submission. This form must also include the percentage for CSBE make-up, if applicable.
Name of Prime Contractor
Type of CSBE work to be performed by Prime Contractor
% of Bid
Prime Contractor Total Percentage:
The undersigned intends to perform the following work in connection with the above contract:
of Bid CSBE
Name of Subcontractor
Type of CSBE work to be performed by Subcontractor
Subcontractor Total Percentage:
I certify that the representations contained in this form are to the best of my knowledge true and accurate.
Prime Print Name
Prime Print Title
The undersigned has reasonably uncommitted capacity sufficient to provide the required goods or services, all licenses and permits necessary to provide such goods or services, ability to obtain
bonding that is reasonably required to provide such goods or services consistent with normal industry practice, and the ability to otherwise meet the bid specifications.
Subcontractor Print Name
Subcontractor Print Title
Check this box if this project is a set-aside and you are performing 100% of the work with your own work forces.
Check this box if Form DBD 305A and Form DBD 305B have been submitted in your pricing envelope.
DBD 400 (Revised 06/10)