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<br />Page 25 of 43 <br /> <br />FORM 3.04 MINORITY WOMAN DISADVANTAGED BUSINESS ENTERPRISE (MWDBE) <br />AFFIDAVIT <br />INVITATION FOR BID #2022-047 <br />UNIT PRICE HVAC SERVICES AND REPAIRS <br /> <br />Contractor Name: <br /> <br />RCW 35.22.650 requires the following of the Contractor: <br />"Contractor agrees that the contractor shall actively solicit the employment of minority group members. <br />Contractor further agrees that the contractor shall actively solicit bids for the subcontracting of goods or services <br />from qualified minority businesses. Contractor shall furnish evidence of the contractor's compliance with these <br />requirements of minority employment and solicitation. Contractor further agrees to consider the grant of <br />subcontracts to said minority bidders on the basis of substantially equal proposals in the light most favorable to <br />said minority businesses. The contractor shall be required to submit evidence of compliance with this section as <br />part of the bid." <br />As used here , the term “minority business” means a business at least fifty -one percent (51%) of which <br />is owned by minority group members. Minority group members include, but are not limited to, African - <br />Americans, Women, Native Americans, Asian/Pacific Islander -Americans, and Hispanic -Americans. <br />1. List all minority businesses from which bids or quotes for goods or services on this project have been <br />solicited: <br />Name of Minority Business Address Goods or Services Involved <br /> <br /> <br /> <br />If Contractor did not solicit from minority businesses because Contractor on this project will not <br />subcontract any goods or services to any subcontractor or supplier, then Contractor must write “No <br />subcontractors or suppliers ” in the above table . <br /> <br />2. Estimate the percentag e of goods and services on this project that will be subcontracted to minority <br />businesses: ____________________________ <br />3. Bidder certifies that it actively solicits employment of minority group members. Estimate the <br />percentage of your force on this project that will be made up of minority group members: <br />__________________________________ <br />FAILURE TO FILL OUT COMPLETELY AND SIGN THIS CERTIFICATION WILL CAUSE REJECTION OF BID. <br />I CERTIFY THAT THE ABOVE IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. <br />Authorizing Official Signature:_______________________________________ Date: __________________