Contractor Utilization Plan Form (Page 4 of 4) in pdf

Bidder/Proposer presents the following participants in this solicitation and any resulting Contract.

Counts for 60% toward small business goal when purchased from small business regular dealer (see Instructions to

Bidders/Proposers).

Section 4 –

Indicate if

Percent of

SUPPLIERS – DEALERS

SBE/DBE

Contract Effort

Type of Work to be Performed or

Y/N

Price

60%

Materials Supplied

(IFB ONLY)

% of

SBE

DBE

Effort

60%

Name of

____________________________________

Business

____________________________________

Tax ID No.

____________________________________

Business

Address

____________________________________

Telephone No.

____________________________________

Fax No.

____________________________________

Contact Person

____________________________________

Email Address

Name of

____________________________________

Business

____________________________________

Tax ID No.

____________________________________

Business

Address

____________________________________

Telephone No.

____________________________________

Fax No.

____________________________________

Contact Person

____________________________________

Email Address

TOTAL AMOUNT OF PROPOSAL

SB Goal

PRIME:

$_________________

______%

SUBCONTRACTOR(S):

$_________________

______%

SUPPLIER(S) MANUFACTURERS:

$_________________

______%

SUPPLIERS(S) DEALERS:

$_________________

______%

TOTAL AMOUNT:

$__________________

______%

The Contractor agrees to adhere to this Plan submitted unless a waiver is received from the Office of Small Business. Any changes in the Plan regarding the

proposed use of certified subcontractors in discharging the contract duties must be approved by the Office of Small Business. The approval of the Office of Small

Business will not be unreasonably withheld upon a showing of good cause to make the change.

Submitted By: _____________________________________________

Business Name: ______________________________________

Signature of Owner/Officer of Business

(Date)

Address: _________________________________________________

Telephone/Email:______________________________________