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CITY OF EVERETT PUBLIC WORKS <br /> SPECIAL PROVISIONS <br /> DOCUMENT 004539—MINORITY BUSINESS ENTERPRISE AFFIDAVIT <br /> L1 GENERAL <br /> A. Bidder shall fill out affidavit below,sign,and include with Bid. <br /> B. Although a set percentage of DBE's and WBE's subcontracts is not required in the performance <br /> of the work under this Contract,in the event that subcontractors will be used in the performance <br /> of this Contract, Bidder is required to solicit bids from DBE and WBE subcontractors as a <br /> condition to qualify for award of contract. <br /> C. Failure to solicit subcontract bids from DBE or WBE subcontractors or failure to list <br /> them below shall disqualify a contract Bidder from consideration for contract award. <br /> D. During Contract performance, or in any event prior to final payment, Bidder shall provide the <br /> City with the names and addresses of all DBE and WBE subcontractors actually awarded <br /> subcontracts and performing work under the contract. <br /> E. In the event that a subcontract bid is solicited and listed below and a subcontract is not awarded <br /> to the DBE/WBE so listed, Contractor shall state the reasons such subcontract was not awarded <br /> to the DBRTWBE and shall state the DBE/WBE quote together with the actual subcontract price <br /> paid and the name of the subcontractor to whom the work was subsequently awarded. <br /> F. List all DBE and WBE subcontractors and suppliers from which bids or quotes for work on this <br /> project have been solicited: <br /> Name of Firm Address Work Involved <br /> C I LA(Lo(,)(G sy rrrA5 r/✓A on) <br /> c tc <br /> 0.15 Ga(z=e. t(tt<cit.QP ,iv ? s N eNr, & <br /> 1. Please estimate the percentage of work that will be subcontracted to DBE's and WBE's <br /> subcontractor and/or suppliers: l a <br /> 2. Please estimate the percentage of your force on this project that will be made up of <br /> minority group members: (p tie <br /> I CERTIFY THAT THE ABOVE IS TRUE AND COMPLETE TO THE BEST OF MY <br /> KNOWLEDGE.AND BELIEF AND AGREE TO PROVIDE ALL ABOVE INFORMATION <br /> REQUESTED BY THE CITY REGARDING DBE/WBE SUBCONTRACT WORK. <br /> Sigilaiure: Date: January 31, 2017 <br /> Matt Vernon, President <br /> END OF DOCUMENT 004539 <br /> WFP Operations Building Seismic Retrofit-Rebid ranuaty 6, 2017 <br /> WO#UP3600 004539- 1 <br /> Provided to Builders Exchange of WA, Inc. For usage Conditions Agreement see www.bxwa.com - Always Verify Scal <br />