09/20/2000 Program
MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
DISADVANTAGED BUSINESS ENTERPRISE PROGRAM
(DBE PLAN)
FOR
FLORIDA KEYS MARATHON AIRPORT
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Willie L. Hudson
Riverview Consultants, Inc.
1010 East Adams Street
Jacksonville, FL 32202
Reviewed for legal
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Calvin J. Allen I
DISADVANTAGED BUSINESS ~NTERPRISE PROGRAM
FOR
MONROE COUNTY'S
BOARD OF COUNTY COMMISSIONERS
AT
MARATHON AIRPORT
DISADVANTAGED BUSINESS ENTERPRISE
CONTENTS
PART I
General Information .... ................... ... ...... ......... ........ ....... ...... ........ 1
Policy Statement (26.1 & 26.23)........................................................ 2
Definitions (26.5) .. .......... ... ... ...... ...... ...... ... ............... ................. ... 4
Liaison Officer and Duties (26.25)..................................................... 8
Services Offered to DBEs .............................................................. 10
Use of Socially And Economically Disadvantaged
Individual Owned Banks (26.27)........................................................ 12
Program Updates (26.21)..................................................... ........... 12
Quotas (26.43).............. ....................................... .............. ........ 12
DBE Directory (26.31).................................................. ...... .......... 13
Over-Concentration (26.33)........... ... ......... ...... ............... ............ ....... 13
Good Faith Efforts (26.53)............................................................... 14
Counting DBE Participation Toward Goals (26.55)............................... 16
Nondiscrimination Assurance (26.7).. ...... ......... ......... ... ... ... ...... ... ... 18
Prompt Payment (26.29).. ........ ......... ...... ....... .................... ...... ... ... 18
Certification Standards (26.61-26.91) ............................................... 19
Unified Certification Program (26.81)................................................. 20
Personal Net Worth........................................................................ 22
Bidder's List.. ......... ...... ... ..................... ........ ......... .... ... ...... ... ....... 23
Reporting To DOT......................................................................... 23
Monitoring and Enforcement Mechanisms (26.37) .............................. 23
Methods to Assure Compliance by Prime and Subcontractors............... 24
Confidentiality.. ......... ......... ............ ... ... ...... .................. ............ ... 25
Procedures used to Require Contractors To Identify DBEs .................... 25
Assurances and Required Contract Clauses (26.13) 26
PART II - APPENDICIES
Certification Forms (26.67)
Schedule A - DBE Application
Schedule B - Joint Venture Application
Renewal Form - DBE Recertification Form
DBE Forms 1, 2, 3 and 4
PART III - ATTACHMENTS
Attachment 1 - Organizational Chart
Attachment 2 - Personal Financial Statement
Attachment 3 - Social & Economic Eligibility Statement
ii
PART 1
MARATHON AIRPORT'S GENERAL INFORMATION
Name
Marathon Airport
Location
Marathon, Florida
Population (1990 census)
8,857
Public Body
Monroe County Board of County Commissioners
(The Board)
Signature Body
Mayor of Monroe County's Board
Local Contact/DBELO
Mr. Peter Horton, Director of Airports
Address :
Phone Number:
E-mail:
3491 S. Roosevelt Blvd
Key West, FL 33040
(305) 296 - 7223
hortonp@mail.state.fl.us
Marathon Airport will continuously seek to include DBE businesses in its contracting activities.
Marathon Airport's Improvement Program (AlP) is subject to the Federal Department of
Transportation's 49 CFR Part 26 Participation by Disadvantaged Business Enterprises
requirements.
It is anticipated that the Marathon Airport will continue to receive federal airport funds in excess
of $500,000 per year for the foreseeable future. The Airport, therefore, expects to meet the
FAA-assisted funding threshold in each of these fiscal years, which mandates the Airport's
participation in the Department of Transportation's DBE Program as specified in 49 CFT Part
26.21 (a) (3).
POLICY STATEMENT AND OBJECTIVES (49 CFR 26.1 & 26.23)
This Disadvantaged Business Enterprise Program (DBE) has been established by Monroe
County Board of County Commissioners for Marathon Airport ( the Airport) in accordance with the
requirements of the U.S. Department of Transportation's guidelines at 49 CFR Part 26.
It is the policy of Monroe County Board of County Commissioners (the Board) to recognize
the authority and applicability of the United States Department of Transportation's Rules and
Regulations governing Disadvantaged Business Enterprise participation. The Board is also
committed to the implementation of these Rules and Regulations through its approved
Disadvantaged Business Enterprise (DBE) Program. Furthermore, the objectives of the Monroe
County Board of County Commissioners are:
1. That Disadvantaged Business Enterprises shall be assured, to the fullest extent possible, the
opportunity to participate in the performance of contracts assisted in whole or in part with
Federal funds, and
2. That no person, subject to the activities of the Board shall, on the basis of race, color,
national origin, or sex, be excluded from participation in, denied the benefits of, or otherwise
discriminated against in connection with the award and performance of any contract
assisted in whole or in part with Federal funds.
3. To create a level playing field on which DBEs can compete fairly for DOT-assisted contracts;
and ensure that the DBE Program is narrowly tailored in accordance with 49 CFR Part 26.
4. To ensure that only firms which fully meet the Department of Transportation's eligibility
standards are permitted to participate as DBEs.
5. To help remove barriers to the participation of DBEs in DOT-assisted Contracts.
Mr. Peter Horton, Director of Airports, the Disadvantaged Business Enterprise Liaison Officer
(DBELO), shall be responsible for implementing the Disadvantaged Business Enterprise (DBE)
Program including the general coordination, development and management of the DBE Program;
and to develop opportunities so that DBEs are provided an equitable opportunity to bid on
contracts awarded by the Board. Additionally, the County's Purchasing Department, having the
responsibility of administering purchase orders; and the Airport's Manager, having the
responsibility for Construction and Engineering and/or Professional Services contracts, also have
responsibilities for assisting with Program implementation. An organization chart displaying the
DBELO's position in the organization is found in Attachment 1 to this program.
2
NOW, THEREFORE BE IT RESOLVED, that the Monroe County Board of County
Commissioners, as a recipient of federal funding assistance through the Airport Improvement
Program (AlP), acknowledges and commits itself to the expanded Program issued by the
Department of Transportation (DOT) and Titled 49 CFR, Part 26 "Participation by Disadvantaged
Business Enterprises in Department of Transportation Program."
As the operator of Marathon Airport, the Monroe County Board of County Commissioner is
monitored for DBE Program compliance by the Civil Rights Staff of the Federal Aviation
Administration (FAA), and has always maintained acceptable norms. It is the stated policy of the
governing body of the Airport that this same measure of compliance will be maintained in its
dealings with DBEs. This signed document represents the Airport's assurance of compliance
with Part 26.
This policy position for Marathon Airport will be implemented by the adoption of the
"Disadvantaged Business Enterprise Program for the Monroe County Board of County
Commissioners" .
The Monroe County Board of County Commissioners will disseminated this policy statement to
Marathon Airport personnel and to all departments of the Board's jurisdiction. The Board has
also distributed this statement to DBE and non-DBE business communities that perform work on
the Board's DOT-assisted contracts via newspaper and DBE trade organizations.
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3
DEFINITIONS (49 CFR 26.5)
The terms used in this program have the meanings as defined in 49 CFR 26.5, and Marathon
Airport expressly incorporates all of the definitions contained in 26.5, including:
1. Affiliation has the same meaning the term has in the Small Business Administration (SBA)
regulations, 13 CFR Part 121. (a) Except as otherwise provided in 13 CFR Part 121, concerns
are affiliates of each other when, either directly or indirectly: (I) One concern controls or has
the power to control the other; or (ii) A third party or parties controls or has the power to
control both; or (iii) An identity of interest between or among parties exists such that affiliation
may be found. (b) In determining whether affiliation exists, it is necessary to consider all
appropriate factors, including common ownership, common management and contractual
relationships. Affiliates must be considered together in determining whether a concern meets
small business size criteria and the statutory cap on the participation of firms in the DBE
program.
2. Alaska Native means a citizen of the United States who is a person of one-fourth degree or
more Alaskan Indian (including Tsimshian Indians not enrolled in the Metlaktla Indian
Community), Eskimo, or Aleut blood, or a combination of those bloodlines. The term includes,
in the absence of proof of a minimum blood quantum, any citizen whom a Native village or
Native group regards as an Alaska Native if their father or mother is regarded as an Alaska
Native.
3. Alaska Native Corporation (ANC) means any Regional Corporation, Village Corporation,
Urban Corporation, or Group Corporation organized under the laws of the State of Alaska in
accordance with Alaska Native Claims Settlement Act, as amended (43 U.S.C. 1601, et seq.).
4. Compliance means that a recipient has correctly implemented the requirements of this part.
5. Contract means a legally binding relationship obligating one party to furnish supplies or
services (including, but not limited to, construction and professional services) and another to
pay for them. Contractor means one who participates, through a contract or subcontract (at
any tier), in a DOT-assisted highway, transit, or airport program.
6. Contractor means one who participates, through a contract or subcontract (at any tier), in a
DOT-assisted highway, transit, or airport program.
7. Department or DOT means the U.S. Department of Transportation, including the Office of
the Secretary, the Federal Highway Administration (FHWA), the Federal Transit
Administration (FTA), and the Federal Aviation Administration (FAA).
8. Disadvantaged Business Enterprises or DBE means a for-profit small business concern-
(a) That is at least 51 percent owned by one or more individuals who are both socially and
economically disadvantaged or, in the case of a corporation, in which 51 percent of the stock
is owned by one or more such individuals; and (b) Whose management and daily business
operations are controlled by one or more of the socially and economically disadvantaged
individuals who own it.
4
9. DOT -Assisted Contract means any contract between a recipient and a contractor (at any
tier) funded in whole or in part with DOT financial assistance, including letters of credit or loan
guarantees, except a contract solely for the purchase of land.
10. Good Faith Efforts means efforts to achieve a DBE goal or other requirement of this part
which, by the scope, intensity, and appropriateness to the objective, can reasonably be
expected to fulfill the program requirement.
11. Immediate family member means father, mother, husband, wife, son, daughter, brother,
sister, grandmother, grandfather, grandson, granddaughter, mother-in-law, or father-in-law.
12. Indian tribe means any Indian tribe, band, nation, or other organized group or community of
Indians, including any ANC, which is recognized as eligible for the special programs and
services provided by the United States to Indians because of their status as Indians, or is
recognized as such by the State in which the tribe, band, nation, group, or community resides.
13. Joint venture means an association of a DBE firm and one or more other firms to carry out a
single, for-profit business enterprise, for which the parties combine their property, capital,
efforts, skills and knowledge, and in which the DBE is responsible for a distinct, clearly
defined portion of the work of the contract and whose share in the capital contribution, control,
management, risks, and profits of the joint venture are commensurate with its ownership
interest.
14. Native Hawaiian means any individual whose ancestors were natives, prior to 1778, of the
area, which now comprises the State of Hawaii. Native Hawaiian Organization means any
community service organization serving Native Hawaiians in the State of Hawaii which is a
not-for-profit organization chartered by the State of Hawaii, is controlled by Native
Hawaiians, and whose business activities will principally benefit such Native Hawaiians.
15. Native Hawaiian Organization means any community service organization serving Native
Hawaiian in the State of Hawaii which is a not-for-profit organization chartered by the State of
Hawaii, is controlled by Native Hawaiians, and whose business activities will principally benefit
such Native Hawaiians.
16. Non compliance means that a recipient has not correctly implemented the requirements of
this part.
17. Operating Administration or OA means any of the following parts of DOT: the Federal
Aviation Administration (FAA), Federal Highway Administration (FHWA), and Federal Transit
Administration (FTA). The "Administrator" of an operating administration includes his or her
designees.
18. Personal Net Worth means the net value of the assets of an individual remaining after total
liabilities are deducted. An individual's personal net worth does not include: The individual's
ownership interest in an applicant or participating DBE firm; or the individual's equity in his or
her primary place of residence. An individual's personal net worth includes only his or her
own share of assets held jointly or as community property with the individual's spouse.
5
19. Primary Industry Classification means the four digit Standard Industrial Classification (SIC)
code designation, which best describes the primary business of a firm. The SIC code
designations are described in the Standard Industry Classification Manual.
20. Primary Recipient means a recipient, which receives DOT financial assistance and passes
some, or all of it on to another recipient.
21. Principal place of business means the business location where the individuals who manage
the firm's day-to-day operations spend most working hours and where top management's
business records are kept. If the offices from which management is directed and where
business records are kept are in different locations, the recipient will determine the principal
place of business for DBE program purposes.
22. Program means any undertaking on a recipient's part to use DOT Financial assistance,
authorized by the laws to which this part applies.
23. Race-Conscious measure or program is one that is focused specifically on assisting only
DBEs, including women-owned DBEs.
24. Race-Neutral measure or program is one that is, or can be used to assist all small business.
For the purposes of this part, race-neutral includes gender-neutrality.
25. Recipient is any entity, public or private, to which DOT financial assistance is extended,
whether directly or through another recipient, through the programs of the FAA, FHWA, or
FT A, or who has applied for such assistance.
26. Secretary means the Secretary of Transportation or his/her designee.
27. Set-Aside means a contracting practice restricting eligibility for the competitive award of a
contract solely to DBE firms.
28. Small Business Administration or SBA means the United States Small Business
Administration.
29. Small business concern means a small business concern as defines pursuant to section 3
of the Small Business Act and Small Business Administration regulations implementing it (13
CFR Part 121) that also does not exceed the cap on average annual gross receipts specified
in Sec. 26.65(b) of 49 CFR Part 26.
30. Socially and economically disadvantaged individual means any individual who is a citizen
(or lawfully admitted permanent resident) of the United States and who is-an individual in the
following groups, members of which are rebuttably presumed to be socially and economically
disadvantaged: (I) "Black Americans," which includes persons having origins in any of the
Black racial groups of Africa; (ii) "Hispanic Americans," which includes persons Mexican,
Puerto Rican, Cuban, Dominican, Central or South American, or other
6
Spanish or Portuguese culture or origin, regardless of race; (iii) Native Americans," which
includes persons who are American Indians, Eskimos, Aleuts, or Native Hawaiians; (iv)
"Asian-Pacific Americans," which includes persons whose origins are from Japan, China,
Taiwan, Korea, Burma (Myanmar), Vietnam, Laos, Cambodia (Kampuchea), Thailand,
Malaysia, Indonesia, the Philippines, Brunei, Samoa, Guam, the U.S. Trust Territories of the
Pacific Islands (Republic of Palau), the Commonwealth of the Northern Marianas Islands,
Macao, Fiji, Tongam, Kirbati, Juvalu, Nauru, Federated States of Micronesia, or Hong Kong;
(v) "Subcontinent Asian Americans," which includes persons whose origins are from India,
Pakistan, Bangladesh, Bhutan, the Maldives Islands, Nepal or Sri Lanka; (vi) Women; (vii)
Any additional groups whose members are designated as socially and economically
disadvantaged by the SBA, at such time as the SBA designation becomes effective.
31. Tribally-owned means any concern at least 51 percent owned by an Indian tribe as
defined in this section.
32. You refers to recipient, unless a statement in the text of this part or the context requires
otherwise (i.e., "You must do XYZ' means that recipients must do XYZ).
7
DESIGNATION OF DISADVANTAGED LIAISON OFFICER & DUTIES (49 CFR 26.25)
Mr. Peter Horton, the Director of Airports, is designated as the DBE Liaison Officer (DBELO).
Mr. Horton can be reached at 3491 South Roosevelt Blvd., Key West, FL 33040,phone number
(305) 296 - 7233; and e-mail (hortonp@mail.state.fl.us). The DBELO has direct, independent
access to the Mayor of the Board, who is the equivalent to the CEO of an organization, and shall
advise the Board of issues and policies concerning the DBE program as it applies to Airport
matters; and reports directly to the County Administrator. The DBELO shall implement the DBE
Program through the use of subordinate airport staff, airport consultants, other outside
consultants, local community contacts and other Divisions within the County Government. The
DBELO has primary responsibility for the implementation of this Plan which shall be conducted,
as needed, to ensure 49 CFR, Part 26 compliance:
1. Developing, managing, and implementing the DBE Program on a day-to-day
basis;
2. Carrying out technical assistance activities for DBEs;
3. Identifying Disadvantaged Business Enterprises to participate in the Program.
4. Sets overall annual goals for Airport projects in order that DBEs are provided an
equal opportunity to compete for FAA assisted contracts awarded by the Board.
5. Gathers and reports statistical data and other information as required by DOT.
6. Reviews third party contracts and purchase requisitions for compliance with this
program.
7. Works with all departments to set overall annual goals.
8. Ensures that bid notices and requests for proposals are available to DBEs in a
timely manner.
9. Identifies contracts and procurements so that DBE goals are included in
solicitations (both race-neutral methods and contract specific goals) and
monitors results.
10. Analyzes the Airport's progress toward goal attainment and identifies ways to
improve progress.
11. Participates in pre-bid meetings.
12. Advises the Board, County Administrator, Airport Manger, and staff on DBE
matters.
13. Participates with legal counsel, consultants and project directors to determine
contractor compliance with good faith efforts.
8
14. Plans and participates in DBE training seminars and workshops.
15. Certifies DBEs according to the criteria set by DOT's 49 CFR, Part 26 guidelines
and acts as the Airport's liaison to the Uniform Certification Process.
16. Provides outreach activities to DBEs and community organizations to advise
them of opportunities.
17. If requested, provides DBEs with information and assistance in preparing bids,
obtaining bonding, insurance and other business needs
18. Maintains and updates the Airport's Directory of certified DBEs.
Other personnel who have been assigned DBE program responsibilities include:
1. The County Administrator, who is responsible for:
a. Providing information to the DBE Liaison Officer on contracting oppor-
tunities;
b. Consulting with the DBE Liaison Officer on procurement policies,
including bonding, licenses, and other requirements;
c. Explaining the DBE participation requirements at prebid conferences;
2. The Airport Manager who is responsible for:
a. Ensuring that solicitations contain the clauses and goals required by this
Program.
b. Bid Protest
3. The Monroe County Board of Commissioners' Attorney Office, which is
responsible for reviewing contracts of legal sufficiency.
9
SERVICES TO ASSIST DBEs TO COMPETE
In implementing the goals set out in this Program, the Liaison Officer may provide a number of
services to the DBE community which are designed to increase their ability to compete in the
contracting market. The basis of this service will be an information center designed to increase
the awareness of DBEs toward potential contracts, and contract procedures. The arrangement of
solicitations, time slots for the presentation of bids, the specifications and delivery schedules for
DBE participation in the contracts will be made available through the Liaison Officer who may
also provide assistance to DBEs to help in overcoming technical problems.
Some of the services offered by the DBELO are listed below:
1. Arranging solicitations or requests for proposals, time for presenting bids or
proposals, quantities, specifications and delivery schedules so as to facilitate
DBE participation.
2. Carrying out information and communication programs on contracting proce-
dures and specific contracting opportunities in a timely manner.
These procedures will be applied to all types of FAA-assisted contracts, including
those for professional, technical, consultant or managerial services; construction;
and the procurement of materials, supplies, facilities and equipment.
Efforts will be made to facilitate DBE participation in prime and subcontract
opportunities.
Other Actions
The following are other actions (good faith efforts) to provide "equal utilization" of DBEs to
participate in federal-assisted contracts:
1. If requested, provide information to DBE firms about Marathon Airport's
organization, functions and full range of contractual needs.
2. Offer instructions and clarification on bid specifications, the
Airport's procurement policy, procedures and general bidding
requirements.
3. Maintain a file of successful bid documents from past procurement
and permit DBEs to review and evaluate these documents.
4. Conduct debriefing sessions to explain why certain bids were
u nsuccessfu I.
5. Provide DBE firms with information on future procurement and
contracting schedules.
10
The information, data and services listed above may be distributed through a combination of
written materials, handbooks, seminars, workshops, specialized assistance or such other forms
as the DBELO determines to be appropriate and effective. The DBELO may also request
assistance from DBE trade associations or any other assistance agency which is capable and
willing to aid in efforts to assure DBE contractors the opportunity to compete.
In addition to the preparatory actions listed on the pervious page, the DBELO may inform DBE
contractors of actual opportunities through a combination of practices determined to be most
successful. These practices may include, but are not limited to:
1. The placement of bid notices in the Local Newspapers, Minority Newspapers,
and other regional newspapers for other specific contracts.
2. The development of mailing lists for newsletters including DBEs and their
associations.
3. The bid notices may be sent to DBE trade associations, technical assistance
agencies, minority and female economic development groups, and DBEs with
capabilities relevant to the bid notice as identified by the DBELO's data bank.
4. Bid specifications are made available to DBE contractor associations and
technical assistance agencies.
5. DBEs and DBE organizations may be provided with lists of majority firms who
are bidding as prime contractors.
6. A lead time of at least 20 days may be used by both the DBELO and firms
bidding as prime contractors for advertisement of all invitations for bids in order
that all firms have ample time to develop a complete bid package or proposal,
and secure necessary assistance.
7. A pre-bid conference may be held to provide firms with an opportunity to ask
questions about DBE requirements; and serve as a "match-maker" forum for
Prime and Sub-Contractors.
11
USE OF SOCIALLY AND ECONOMICALLY DISADVANTAGED
INDIVIDUAL OWNED BANKS (49 CFR 26.27)
The DBELO will maintain an up-to-date listing of local and regional banks which are owned and
managed by socially and economically disadvantaged individuals. The listing will reflect the latest
knowledge available to the Airport as to the full range of services in each bank listed. The
DBELO will serve as the Board's focal point to carry out the policy of the Board to utilize the
services of these banks to the greatest extent possible.
The Board's investigations indicate that there are no banks in this area which are known to be
owned by socially and economically disadvantaged individuals. Marathon Airport will investigate
any new banks established in the community in the future which are owned by socially and
economically disadvantaged individuals and use their services when feasible. When a bank,
owned and operated by socially and economically disadvantaged individuals, is opened at any
time during the period of this approved Program, the Board will provide notification to prime
contractors in the bid documents, and encourage prime contractors to make use of these
institutions.
The Minority & Women's Alliance, a group in Orlando, Florida which tracks the formation of such
institutions was contacted, and the DBELO, via the Airport's consultants, will maintain contact
with this group and the Florida Association of Minority Business Enterprise Officers (FAMBEO)
regarding this subject.
DBE PROGRAM UPDATES (49 CFR 26.21)
The Board will continue to carry out this program until all funds with DOT financial assistance
have been expended. We will provide all updates representing significant changes in the program
to DOT.
QUOTAS (49 CFR 26.43)
The Board does not use quotas, in any way, in the administration of this DBE program.
12
DBE DIRECTORY (49 CFR 26.31)
The DBELO has establish, and will maintain and update, a Disadvantaged Business Enterprise
Directory which shall be located in the Airport Director's Office at 3491 South Roosevelt Blvd,
Key West, FL 33040, phone number (305) 296 - 7223; and e-mail (hortonp@mail.state.fl.us).
This directory is available to the public and to contractors on request, and can be accessed by
contacting the DBELO.
The Directory indicates which firms have passed the Board's certification process.
The Directory shall contain the following minimum information on each firm listed:
1. Firm's Name
2. Type of Work
3. Address
4. Telephone Number
5. DBE status
6. Contact Person
7. Date of most recent DBE Certification
8. SIC Codes
Companies listed in the Directory are classified by the major type of work which the company is
capable of performing.
In the event a bidder names other DBEs that he/she desires to use, these firms will be included in
the Directory only after they have been certified by the DBELO.
The DBE Directory is available to bidders interested in meeting DBE goals or to locate DBEs
capable of performing work. All information in the Directory is reviewed and updated annually.
In the event a bidder desires more information about a listed DBE, they are encouraged to solicit
that information from the firm directly by contacting the person listed in the Directory.
OVER-CONCENlRA liON (49 CFR 26.33)
The Airport has not identified any over-concentration areas.
Good Faith Efforts (49 CFR 26.53)
13
Marathon Airport treats BIDDERS'/PROPOSERS' compliance with good faith efforts
requirements as a matter of responsiveness in all instances where a contract goal has been
established. BIDDERS/PROPOSERS are to make good faith efforts to identify and subcontract
portions of DOT assisted contracts to DBEs. The BIDDERS/PROPOSERS can demonstrate
that they have done so either by meeting the contract goal or documenting good faith efforts to
the DBELO. BIDDERS/ PROPOSERS who do not succeed in obtaining enough DBE
participation to meet the established contract goal are required to in order to remain under
consideration for a contract must submit, with their bid/proposal, evidence demonstrating Good
Faith Efforts.
The Airport will not award contracts to BIDDERS/ PROPOSERS until the DBELO has determined
that the "good faith efforts determination" has been made. See Page 30 item VI. In compliance
with 26.53, the Board ensures that good faith effort are required in every instance where a
contract goal has been established.
The DBELO, Mr. Peter Horton, is responsible for determining whether a BIDDER/PROPOSER
who has not meet the contract goal has, in fact, documented sufficient good faith efforts to be
regarded as a responsive BIDDER/PROPOSER. The Airport shall incorporate Appendix A to
Part 26 as its reference for good faith evaluation standards. A sufficient good faith effort shall be
determined by the bidders' records of:
A. Attending prebid meetings if any were held.
B. Advertising in local papers, minority/women focus media, and trade papers for a
period of at least 15 days before bids or proposals are due. (media schedules
permitting); and recruiting DBEs via DBE organizations.
C. Notify DBEs ,in writing ,of subcontracting opportunities.
D. Following up initial solicitations.
E. Efforts to divide work into areas for subcontracting to DBEs.
F. Providing adequate information about plans and specifications.
G. Attempts to negotiate in good faith with DBEs. Such efforts are to be shown by
producing the names, addresses, telephone numbers, particular subcontracts, and
information regarding each subcontract opportunity that was offered to each
DBE.
H. Provide help to the DBEs in overcoming bonding, financial, and insurance
problems relevant to the subcontract.
I. Use of DBE organizations for DBE recruitment.
Examples of good faith efforts are found in Appendix A to Part 26.
NOTE: See Page 30 item VI for the Required Contract Clauses
14
In order to comply with 26.53 (b)(2)(i-v), each bidder/offeror is required to submit, with his/her bid
or proposal, DBE Forms 1 ,2,and 3 which are documents requesting all of the items required by
these aforementioned portions of 26.53.
Administrative Reconsideration Procedures
Within 3 days of being informed by the Airport that is not responsible because it has not
documented sufficient good faith efforts, a bidder/offeror may request administrative
reconsideration. Bidder/offerors should make this request in writing to the following
Reconsideration Official..., Mr. James L. Roberts, the County Administrator, who chairs an
Appeal Team consisting of the Airport Manager and the County Attorney. The County
Administrator can be reached at Marathon Airport, 3491 South Roosevelt Blvd., FL 33040, phone
number (305) 296 - 7223. The Reconsideration Official will not have played any role in the
original determination that the bidder/offeror did not document sufficient good faith efforts.
As part of this reconsideration, the bidder/offeror will have the opportunity to provide written
documentation or argument concerning the issue of whether it met the goal or made adequate
good faith efforts to do so. The bidder/offeror will have the opportunity to meet in person with our
reconsideration official to discuss the issue regarding whether he/she met the goal or made
adequate good faith efforts to do so. The Airport will send the bidder offeror a written decision
on reconsideration, explaining the basis for finding that the bidder did or did not meet the goal or
make adequate good faith efforts to do so. The result of the reconsideration process is not
administratively appealable to the Department of Transportation.
Good Faith Efforts when a DBE is replaced on a contract
The Airport will require a contractor to make good faith efforts to replace a DBE that is terminated
or has otherwise failed to complete its work on a contract with another certified DBE, to the extent
needed to meet the contract goal. The Airport will require the prime contractor to notify the DBE
Liaison Officer immediately of the DBEs' inability or unwillingness to perform and provide
reasonable documentation.
In this situation, the Airport will require the prime contractor to obtain the DBELO's prior approval
of the substitute DBE and to provide copies of new or amended subcontracts, or documentation
of good faith efforts. If the contractor fails or refuses to comply in the time specified, our
contracting office will issue an order stopping all or part of payment/work until satisfactory action
has been taken. If the contractor still fails to comply, the contracting officer may issue a
termination for default proceeding.
15
COUNTING DBE PARTICIPATION TOWARD MEETING THE GOALS (49 CFR 26.55)
Marathon Airport will count participation toward its DBE goals in accordance with all of the
provisions of 49 CFR 26.55, including, but not limited to the guidelines outlined below. Although
the language may suggest otherwise, only the Federal share of the contract amounts is counted
toward the overall goal.
1. Once a firm is determined to be an eligible DBE under 49 CFR Part 26, the value of the
"work actually performed" by the DBE is counted toward the DBE goal.
2. Marathon Airport and its contractors will count toward the DBE goals that portion of the
total dollar value of a contract with a certified joint venture equal to the percentage of
ownership and control of the DBE partner in the joint venture.
3. Marathon Airport and its contractors will count toward the DBE goals the value of the
"work actually performed" by a firm owned and controlled by two socially and economically
disadvantaged individuals, each having a 50% interest in the firm.
4. Marathon Airport will count toward its Disadvantaged Business Enterprise goal only
expenditures to DBEs who perform a commercially useful function in the work of a
contract. A DBE is considered to perform a commercially useful function when it is
responsible for execution of a distinct element of the work of a contract and carrying out
its responsibilities by actually performing, managing, and supervising the work involved.
To determine whether a DBE is performing a commercially useful function, the DBELO
will evaluate the amount of work subcontracted, industry practices, and other relevant
factors.
5. Consistent with normal industry practices, a DBE may enter into subcontracts. If a DBE
contractor subcontracts a significantly greater portion of the work of the contract than
would be expected on the basis of normal industry practices, the DBE shall be presum-
ed not to be performing a commercially useful function. The DBE may present evidence
to the Airport to rebut this presumption. The decision by the Airport is subject to review
by the concerned operating administration. ..the FAA.
6. The Airport and its contractors will count toward the DBE goals 60 percent of
expenditures for materials and supplies required under a contract and obtained from a
DBE Regular Dealer, and 100 percent of such expenditures obtained from a DBE
manufacturer.
7. For purposes of this DBE program, a manufacturer is a firm that operates or maintains a
factory or establishment which produces, on it's premises, the materials or supplies
obtained by the Airport or a contractor.
16
8. A Regular Dealer is a firm which owns, operates, or maintains a store, warehouse, or
other establishment in which the materials or supplies required for the performance of
the contract are bought, kept in stock, and regularly sold to the public in the usual
course of business. To be a Regular Dealer, the firm must engage in, as its principal
business, and in its own name, the purchase and sale of the products in question. A
Regular Dealer in such bulk items as steel, cement, gravel, stone, and petroleum
products need not keep such products in stock, if it owns or operates distribution
equipment. Brokers and packagers will not be regarded as manufacturers or Regular
Dealers under this DBE program.
9. The Airport and its contractors may count toward the DBE goals the following
expenditures to DBE firms that are not manufacturers or regular dealers:
a. The fees or commissions charged for providing a bona fide service, such as
professional, technical, consultant or managerial services and assistance in the
procurement of essential personnel, facilities, equipment, materials or supplies
required for performance of the contract, provided that the fee or commission is
determined by the Airport to be reasonable and not excessive as compared with
fees customarily allowed for similar services.
b. The fees charged for delivery of material and supplies required on a job site (but
not the cost of the materials and supplies themselves) when the hauler, trucker,
or delivery service is not also the manufacturer of or a regular dealer in the mate-
rials and supplies, provided that the fee is determined by the Airport to be
reasonable and not excessive as compared with fees customarily allowed for
similar services.
c. The fees or commissions charged for providing any bonds or insurance
specifically required for the performance of the contract, provided that the fee or
commission is determined by the Airport to be reasonable and not excessive as
compared with fees customarily allowed for similar services.
17
REQUIRED CONTRACT PROVISIONS (49 CFR 26.7 and 26.29)
Nondiscrimination Assurance (26.7)
Monroe County Board of County Commissioners ,as a recipient of Federal funds, will never
exclude any person from participation in, deny any person the benefits of or otherwise
discriminate against anyone in connection with the award and performance of any contract
covered by 49CFR Part 26 on the basis of race, color, sex, or national origin.
In administering its DBE program, the Board will not, directly or through contractual or other
arrangements, use criteria or methods of administration that have the effect of defeating or
substantially impairing accomplishment of the objectives of the DBE program with respect to
individuals of a particular race, color, sex, or national origin.
Prompt Payment and RetainaQe (26.29)
These provisions are applicable to DBE and non DBE firms alike. The prime contractor agrees
to pay each subcontractor under this prime contract for satisfactory performance of its contract no
later than seven (7) days from the receipt of each payment the prime contractor receives from the
Board. The prime contractor agrees further to return retainage payments to all subcontractors
within seven (7) days after the subcontractor's work is satisfactorily completed. Any delay or
postponement of payment from the above referenced time frame may occur only for good cause
following written approval of the Board. This clause applies to both DBE and non-DBE
subcontractors.
The Board's penalties/sanctions/consequences for non-compliance to these prompt payment and
retainage provisions include, but are not limited to, non payment of Prime Contractor invoices.
The Airport's monitoring process for this provision is as follows:
~ The Prime Contractor shall submit with each invoice, a report of DBE expenditures.
~ The report shall show all DBE and non-DBE subcontractors, the amount of their
subcontract, the amount earned to date, the amount earned for that respective invoice
and the amount remaining to be earned.
~ The report shall also have each DBE subcontractor verify the amounts earned and paid to
date.
~ The prime contractor will not be reimbursed for work performed by subcontractors unless and
until the prime contractor ensures that the subcontractors are promptly paid for the work they
have performed.
Payments to the contractor (s) may be delayed until the progress report is submitted as
required.
18
Monitorinq Payments to DBEs
The Airport will require prime contractors to maintain records and documents of payments to
DBEs for three years following the performance of the contract. These records will be made
available for inspection upon request by any authorized representative of the Marathon
Airport or DOT. This reporting requirement also extends to any certified DBE subcontractor.
The Airport will keep a running tally of actual payment to DBE firms for work committed to them at
the time of contract award.
The Airport will perform interim audits of contract payments to DBEs. The audit will review
payments to DBE subcontractors to ensure that the actual amount paid to DBE subcontractors
equals or exceeds the dollar amount stated in the schedule of DBE participation.
CERTIFICATION STANDARDS (49 CFR 26.61-26.91)
The Airport staff, through its consultants, will use the certification standards of Subpart 0 - Part
26 and the certification procedures of Subpart E - Part 26 to determine the eligibility of firms to
participate as DBEs in DOT-assisted contracts. To be certified as a DBE, a firm must meet all
certification eligibility standards. The DBELO will make certification decisions based on the facts
as a whole.
The act of simply filling out the Disclosure Affidavit, Certification Application, in and of itself, does
not mean automatic certification with the Airport. The review process covers all items on the
Schedules. Potential DBEs applying for certification will be notified in writing as to whether their
application meets, or does not meet the eligibility standards.
Process
For information about the certification process or to apply for certification, firms should contact
Mr. Peter Horton, Marathon Airport, 3491 South Roosevelt Blvd., Key West, FL 33040; phone
number (305) 296 - 7223; and e-mail (hortonp@mail.state.fl.us).
The Airport, through its consultants, will certify the eligibility of DBEs and joint ventures involving
DBEs that are named by bidder/proposer for FAA-assisted contracts to be let by the Airport.
Any business which desires to participate as a DBE will be required to complete and submit an
Application for DBE Certification (Appendix 1) to the Airport's DBELO. Any business which
desires to participate as a joint venture DBE will, in addition, be required to complete an
Application for DBE Joint Venture Certification (Appendix 2). The schedules must be signed by
the authorized representative of the business and notarized. The required Schedule must
accompany the DBE participation information submitted to the Airport by bidder/proposer.
If we deny a firm's application or decertify it, the firm may not reapply until 12 months have
passed from our action.
19
UNIFORM CERTIFICATION STANDARDS
The Airport, through its consultants, will take at least the following steps in determining whether a
firm may be certified as a DBE:
1. Randomly perform an on-site visit to the offices of the firm and to any job sites on which
the firm is working at the time of the eligibility investigation.
2. Obtain the resumes or work histories of the principal owners of the firm and personally
interview these individuals.
3. Analyze the ownership of stock in the firm, if it is a corporation.
4. Analyze the bonding and financial capacity of the firm.
5. Determine the work history of the firm, including contracts it has received and work it
has completed.
6. Obtain or compile a list of equipment owned by, available to the firm, and the licenses of
the firm and its key personnel to perform the work it seeks to do as part of the DBE
program.
7. Obtain a statement from the firm indicating the type of work it prefers to perform as part of
the DBE program.
On-site Certification Visits
Per guidance from the FAA, office and job site visits may be omitted from the investigation in this
instance:
When the Airport recertifies a firm that it previously reviewed on-site, and eligibility
issues (e.g., change in ownership) have not arisen that make a second visit necessary.
In the absence of such issues, an on-site visit need be conducted only once.
Once certified, a DBE will be required to update its submission annually by submitting a new
affidavit or certifying that the application on file is still accurate. Firms are notified upon
certification that a new Schedule A must be submitted whenever there is a change in the firm's
ownership or control.
Unified Certification ProQram
The representative has asked FOOT to spearhead the process, has spoken with FOOT on
several occasions to assist in the UCP process, and participated in an FOOT sponsored UCP
teleconference on June 14, 2000. The DBELO, or a representative, will attend all future meetings
with other State of Florida DBELOs to discuss the process.
20
Appeals & De-certification Procedures
Mr. Peter Horton, who is the decision maker for initial decertification determination procedures,
can be reached at Marathon Airport, 3491 South Roosevelt Blvd., Key West, FL 33040; phone
number (305) 296 - 7223; e-mail (hortonp@mail.stateJl.us).
In the event we propose to remove a DBE's certification, we will follow procedures consistent with
26.87. To ensure separation of functions in a decertification, we have determined that the
County Administrator will serve as the decision maker in decertification proceedings. We have
established an administrative "firewall" to ensure that Mr. Horton, the DBELO, will not participate,
in any way, in the decertification informal meetings against the firm (including the decision to
initiate such a proceeding).
Whenever the Airport is advised that a firm is not eligible, or comes to believe that a firm with a
current certification is no longer eligible, the firm will be afforded the rudiments of due process
prior to revoking its eligibility. The steps to be used are:
1. A letter will be sent to the firm, stating that the Airport is contemplating de-certification,
or the firm has been denied certification. A brief description of the reasons for the
proposed action will be included.
2. The firm will be given an opportunity to respond, in person and in writing to present
information and arguments. An informal meeting shall be part of the process, but a
formal adversary proceeding will not be used.
3. Should the informal meeting uphold the DBELO's denial, the County Administrator
shall advise the firm, in writing, as to the decision and inform the firm that an appeal must
be filed within 90 days of the decision with the office named below.
County Administrator
Marathon Airport
3491 South Roosevelt Blvd
Key West, FL 33040
4. A request for an Appeal must be in writing, dated and signed, and should be made to
the address below after the Committee's decision has been rendered:
Departmental Office of Civil Rights
Department of Transportation
400 7th Street SW - Room 2401
Washington, D.C. 20590
The denial of certification by the Airport is final for the particular contract and any other contracts
being let at the time of the denial (except when the Department of Transportation reverses the
denial, following an appeal). Firms denied certification may correct deficiencies in their ownership
and control and reapply for certification after one year.
21
The Airport will promptly implement any DOT certification appeal decisions affecting the eligibility
of DBEs for our DOT-assisted contracting (e.g., certify a firm if DOT has determined that our
either our decertification determination, or denial of its application was erroneous).
Re-certification
The DBELO will review the eligibility of DBEs which are certified under former Part 23, to make
sure that they meet the standards of Subpart 0 of Part 26. The DBELO will complete this review
no later than three years from the most recent certification date of each firm.
For firms, which the DBELO has certified or reviewed and found eligible under Part 26, a desk
audit will be conducted every three years. In addition, the DBELO may randomly perform on-site
visits.
"No ChanQe" Affidavits and Notices of ChanQes (26.83)
The Airport require all DBEs to immediately inform us, in a written affidavit, of any changes in its
circumstance affecting its ability to meet size, disadvantaged status, ownership or control criteria
of 49 CFR Part 26 or of any material changes in the information provided with DBE's application
for certification.
The Airport also requires all owners of all DBEs it has certified to submit, annually, on the
anniversary date of their certification, a "no change" affidavit meeting the requirements of
26.83(j). The text of this affidavit is the following:
I swear (or affirm) that there have been no changes in the circumstances of (name of DBE firm)
affecting its ability to meet the size, disadvantaged status, ownership, or control requirements of
49 CFR Part 26. There have been no material changes in the information provided with (name of
DBE) application for certification, except for any changes about which you have provided written
notice to Marathon Airport under 26.83(1). (Name of firm) meets Small Business Administration
(SBA) criteria for being a small business concern and its average annual gross receipts (as
defined by SBA rules) over the firm's previous three fiscal years do not exceed $16.6 million.
The airport will notify all currently certified DBEs of these obligations.
Personal Net Worth
The Airport requires disadvantaged owners of applicant firms and of currently-certified DBEs
whose eligibility under Part 26 we review, to submit a statement of personal net worth (PNW) with
applications. If the presumed disadvantaged individual's PNW exceeds $750,000, that individual's
presumption of economic disadvantage is rebutted. When an individual's presumption of
social/economic disadvantage has been rebutted, his or her ownership and control of the
applicant firm cannot be used for DBE eligibility under this part unless the individual makes an
individual showing. (See Attachment 2 - Personal Financial Statement.)
The DBELO will exclude the individual's equity in his/her primary residence and the individual's
equity in the applicant firm per Part 26.67
22
Information Collection and ReportinQ/Bidder's List
The Airport, through its consultants, will create a bidders list, consisting of information about all
DBE and non-DBE firms that bid or quote on DOT-assisted contracts. For every firm, the
following information must be included:
1. Firm's Name
2. Firm's Address
5. Firm's status as a DBE or non-DBE
6. Firm's Age
7. Firm's Annual gross receipts
The bidder's list will be obtained via a contract clause requIring prime bidders to report the
names/addresses, and possibly other information, of all firms who quote to them on subcontracts.
The DBELO will continue to gather the information detailed above on all prime contractors who
submit bids/quotes on contracts.
ReportinQ to DOT
The Airport will report DBE participation to DOT as follows:
Marathon Airport will submit annually DOT Form 4630, as modified for use by FAA recipients.
Marathon Airport will report DBE participation on a quarterly basis, using DOT Form 4630. These
reports will reflect payments actually made to DBEs on DOT assisted contracts.
Monitoring and Enforcement Mechanisms (26.37)
The Airport will bring to the attention of the Department of Transportation any false, fraudulent, or
dishonest conduct in connection with the program, so that DOT can take the steps (e.g., referral
to the Department of Justice for criminal prosecution, referral to the DOT Inspector General,
action under suspension and debarment or Program Fraud and Civil Penalties rules) provided
26.109. We also will consider similar action under our own legal authorities, including
responsibility determinations in future contracts.
Other possible regulations, provisions, and contract remedies available to us in the events of non-
compliance with the DBE regulation by a participant in our procurement activities are shown on
page 26 (item 1I1...Compliance) of this document.
23
METHOD OF INSURING CONTRACTOR AND SUBCONTRACTOR
COMPLIANCE WITH DBE REQUIREMENTS (49 CFR 26.13)
The Airport will direct the use of the legal instrument of a contract clause to ensure compliance
with the bid specifications. After award of the contract, The DBELO may direct that audits and
reviews be conducted as necessary to ensure the Airport that the contractor is in compliance.
Contractors and DBE contractors must maintain DBE records for (3) three years after contract
performance, and they must make these records available for inspection by the Airport and the
DOT. This reporting requirement also extends to any certified DBE subcontractor.
Records of all progress payments made by prime contractors are required. Prime contractors
must also report to the DBELO when a DBE is terminated for any reason.
The Airport will keep a running tally of actual payment to DBE firms for work committed to them at
the time of contract award. (See page 19. ..Monitoring Payments to DBEs).
These records will be periodically verified by obtaining certified statements from DBE
subcontractors.
Other appropriate actions taken to ensure that prime contractors and subcontractors comply with
the DBE provisions will include the following:
1. Desk audits to review all material and information concerning the contractor's
compliance.
2. On-site reviews which include interviews, visits to project locations, and inspection
of documents and/or information not available at the desk audit which pertains to
the contractor's compliance.
3. Any additional investigation which may be deemed necessary due to a lack of
proper recordkeeping; failure of the prime contractor to cooperate; failure of DBEs
to cooperate; visible evidence of unsatisfactory performance; other evidence as
may warrant further investigation.
The Airport will make prompt compliance determinations regarding its prime contractors.
Documentation of noncompliance will include the specific areas in which the contractor/ sub-
contractor failed to comply. In these instances, appropriate legal action consistent with the DBE
and other contract provisions will be taken.
24
Updated Goal
The overall goal will be reviewed at least annually ,or when requested, and submitted to the FAA
Regional Civil Rights Officer. The review includes an analysis of projected versus actual DBE
participation. Unless otherwise requested, only this information, not the entire DBE program, will
be submitted. An update will be submitted even when the Airport does not anticipate awarding
any FAA-assisted contracts during the following 12-month period.
Confidentiality
The Board will safeguard from disclosure to third parties any information which may reasonably
be regarded as confidential business information, consistent with Federal, state, and local law.
Not withstanding any contrary provisions of state or local law, the Airport will not release personal
financial information submitted in response to the personal net worth requirement to a third party
(other than DOT) without written consent of the submitter.
PROCEDURES USED TO REQUIRE CONTRACTORS TO IDENTIFY DBEs
The Board policy is to pursue contractor participation in DOT-assisted projects in accordance with
49 CFR, Part 26.
Each bidder's attention is directed to the Board's policy indicating its desire to provide equal
opportunity for DBEs in all federally funded projects; and that they actively solicit and encourage
bids from qualified DBE subcontractors identified by the Board's DBELO.
25
ASSURANCE & REQUIRED CONTRACT CLAUSES (49 CFR 26.13)
UTILIZATION OF DISADVANTAGED BUSINESS ENTERPRISES
26.13(a) - Each financial assistance agreement which the Board signs with the FAA includes the
following:
I. Federal Financial Assistance AQreement Assurance - The Airport shall not discriminate
on the basis of race, color, national origin, or sex in the award and performance of any
DOT-assisted contract or in the administration of its DBE program or the requirements of
49 CFR Part 26. The Airport shall take all necessary and reasonable steps under 49CFR
Part 26 to ensure nondiscrimination in the award and administration of DOT-assisted
contracts. The Airport's DBE program, as required by 49 CFR Part 26 and as approved
by DOT, is incorporated by reference in this agreement. Implementation of this program
is a legal obligation and failure to carry out its terms shall be treated as a violation of this
agreement. Upon notification to the recipient of its failure to carry out its approved
program, the Department may impose sanctions as provided for under part 26 and may,
in appropriate cases, refer the matter for enforcement under 18 U.S.C. 1001 and/or the
Program Fraud Civil Remedies Act of 1986 (31 U.S.C. 3801 et seq.).
26.13(b) - Each contract which the Board signs with a contractor (and each subcontract the prime
contractor signs with a subcontractor) includes the following assurance:
The contractor, sub recipient or subcontractor shall not discriminate on the basis of race,
color, national origin, or sex in the performance of this contract. The contractor shall carry
out applicable requirements of 49 CFR Part 26 in the award and administration of DOT-
assisted contracts. Failure by the contractor to carry out these requirements is a material
breach of this contract, which may result in the termination of this contract or such other
remedy as the recipient deems appropriate.
II. DBE ObliQation - The contractor agrees to ensure that Disadvantaged Business
Enterprises as defined in 49 CFR Part 26, Subpart 0, have the equal opportunity to
participate in the performance of contracts and subcontracts. In this regard, all
contractors shall take necessary and reasonable steps in accordance with 49 CFR
Part 26 to ensure that Disadvantaged Business Enterprises have the equal
opportunity to compete for and perform contracts. Contractors shall not discriminate on
the basis of race, color, national origin or sex.
III. Compliance - All bidders, potential contractors, or sub-contractors for this contract are
hereby notified that failure to carry out the policy and the DBE obligation, as set forth
above, shall constitute a breach of contract which may result in non-selection;
termination of the contract; or such other remedy as deemed appropriate by the Airport.
Agreements between a bidder/proposer and a DBE, in which the DBE promises not to
provide sub-contracting quotations to other BIDDERS/PROPOSERS, are prohibited.
IV. Sub-contract Clauses - All bidders and potential contractors hereby assure that they will
include the above clauses in all sub-contracts which offer further sub-contracting
opportunities.
26
V. Additional Terms And Conditions
(A) DBE Goal:
Notification is hereby given that the overall goal for firms owned and controlled by
socially and economically disadvantaged individuals is a minimum 13.0 percent of
the dollar value of all FY2000 Federally funded contracts including alternates and
change orders. Each individual AlP where contract goals may have been
established shall include separate DBE goals based on the availability of DBEs;
and shall incorporate all of the "contract goal" requirements of 49 CFR, Part 26.
In the event that the bidder for this solicitation is certified and qualifies as a DBE,
the contract goal shall be deemed to have been met in accordance with the
Section on "COUNTING DBE PARTICIPATION TOWARD MEETING THE DBE
GOALS" .
BIDDERS/PROPOSERS are strongly encouraged to utilize eligible DBEs.
All bidders and proposers hereby assure that they will make sufficient
reasonable good faith efforts to meet the above stated goals. Moreover such
bidders or proposers hereby assure that they will meet the DBE participation
percentages submitted in their respective bids or proposals. Each of the
BIDDERS/PROPOSERS also agree to provide any additional information
requested by the Airport to substantiate DBE participation, including but not limited
to the written subcontract agreement between prime bidder and each
subcontractor for the work relative to this project.
(B) DBE Substitutions:
All bidders and proposers shall make a good faith effort to replace a DBE sub-
contractor, who is unable to perform successfully, with another DBE sub-
contractor. The Airport must approve all substitutions. There shall be no
substitutions or additions during the time period between the bid opening date
and the bid award date, unless required under the Decertification Provision.
Bidders or proposers may not make substitutions of DBE subcontractors after
bid award on the grounds that they have solicited a response from another
contractor whose price is more reasonable than the DBE submitted at bid
opening.
27
(C) DBE "Regular Dealers"
All BIDDERS/PROPOSERS may count sixty (60) percent of their expenditure for
the purchase of materials and supplies obtained from a DBE "Regular Dealer",
provided that the DBE supplier(s) perform a commercially useful function in the
supply process. A DBE is considered to be performing a commercially useful
function when he/she is responsible for execution of a distinct element of work of a
contract, and carrying out its responsibilities by actually performing, with its own
crew, managing and supervising the work involved.
For the purpose of calculating the percentage rate of participation by DBE(s),
those bidders using the service of socially and economically disadvantaged
individuals as brokers for the purpose of supplying materials or labor shall be
allowed zero (0) credit toward meeting the contract goal (obligation). The term
broker is defined as: A buyer and seller of goods or a negotiator between buyer
and seller, but without having custody of the property.
(D) COUNTING DBE PARTICIPATION TOWARD MEETING THE DBE GOAL:
BIDDERS/PROPOSERS may count DBE participation toward meeting DBE goal
as follows:
(a) The total dollar value of the contract awarded to an eligible DBE which
performs at least fifty-one percent (51 %) of the work with their own work
force; or the total of fifty-one percent of the work which is performed by the
eligible DBE's own work force and another eligible DBE subcontractor will
be counted toward the applicable DBE goal.
(b) Only that portion of the total dollar value of a contract which is actually
performed by an eligible DBE's own work force that is less than fifty-one
percent (51 %) or a combination of eligible DBE subcontractors equates
to less than fifty-one percent (51 %).
(c) A portion of the total dollar value of a contract with a joint venture, eligible
under the standards for certification, equal to the percentage of the
ownership and control of the DBE partner in the joint venture. A two-
party check, payable to the DBE and supplier is acceptable, only if any
discounts for early payment, etc. are paid to the DBE.
28
(E) Contract Award Criteria:
The award selection procedure for this solicitation will ensure that prime
contracts are awarded to competitors who make a good faith effort to meet or
exceed the established Disadvantaged Business Enterprise (DBE) goal.
1. Subject to other applicable provisions herein, bids or proposals will be considered
incomplete; and bidders will be considered ineligible to receive a contract award unless
the following forms (copies are a part of the bid documents) are completed and submitted
with the bid:
(a) DBE Form 1 - a list of proposed subcontractors.
(b) DBE Form 2- DBE Identification Affidavit
(c) DBE Form 3-Letter of Intent to perform as a Disadvantaged Business Enterprise
Subcontractor. One form for each MBE/WBE subcontractor listed on Schedules
1 and 2 must be completely filled out and executed by the proposed
subcontractor. Failure to submit this with the bid may preclude the bidder from
award. Forms are supplied with the contract documents. Additional copies may
be obtained from the same place where plans and specifications were received.
(d) DBE Form 4- DBE Unavailability Certification must be submitted with the bid
proposal if the DBE goal is not met.
2. The Board will count toward the established DBE project goal only those firms which
are certified as a DBE at bid opening.
The Airport reserves the right to "allow" the low bidder who has made an acceptable
good faith effort to increase his/her DBE sub-contract goals and other affirmative action
efforts, provided same does not increase the bid price of the respective project.
(F) ReportinQ Requirements - The awardee shall establish, maintain and submit
regular reports, as required, which will identify and assess progress in achieving
DBE sub-contract goals and other affirmative action efforts.
Progress reports shall be submitted with each periodic pay request or application
for payment. Any invoice not containing same will be disapproved until
the information is supplied.
The awardee is required to submit invoices each month for portions of work
completed during the month, including all DBE monies due for that period. The
awardee is also required to submit a DBE Utilization Form with each monthly
invoice.
29
Failure to comply with this requirement may constitute breach of contract and
may result in 'the termination of this contract, or such other remedy, as the Airport
may deem appropriate.
VI. Acceptable Good Faith Efforts - If any bidder fails to meet the DBE goals for this
solicitation, the bidder shall submit, with the bid, proof of good faith efforts, using the
guideline listed in Appendix A to 49 CFR 26, along with a written statement of efforts
made and reasons for not meeting said goals. (See DBE Form 4 which must be
submitted with a bid).
A list of the efforts that a bidder may make, and the Airport may use in making a
determination as to the acceptability of the bidder, are as follows:
(1) Whether the bidder attended any pre-solicitation or pre-bid meetings which were
scheduled by the Airport to inform DBEs of contracting and subcontracting
opportunities;
(2) Whether the bidder advertised in general circulation, trade association, and
minority-focus media concerning the sub-contracting opportunities;
(3) Whether the bidder provided written notice to a reasonable number of specific
DBEs that their interest in the contract was being solicited, in sufficient time to
allow the DBEs to participate effectively;
(4) Whether the bidder followed up initial solicitations of interest by contracting DBEs
to determine, with certainty, whether the DBEs were interested;
(5) Whether the bidder selected portions of work to be performed by DBEs in order
to increase in his/her chances of meeting the DBE goal (including, where
appropriate, breaking down contracts into economically feasible units to facilitate
DBE participation);
(6) Whether the bidder provided interested DBEs with adequate information about
the plans, specifications and requirements of the contract;
(7) Whether the bidder negotiated in good faith with interested DBEs, not rejecting
DBEs as unqualified without sound reasons based on a thorough investigation of
their capabilities.
(8) Whether the bidder made efforts to assist interested DBEs in obtaining bonding,
lines of credit, or insurance required by the Airport or contractor, and
30
(9) Whether the bidder effectively used the services of available minority and women
community organizations; minority and women contractors' groups; local, state
and Federal minority business assistance offices; and other organizations that
provide assistance in the recruitment and placement of socially and economically
individuals.
NOTE: The nine (9) items set forth above are merely suggested criteria and the Airport
may specify that bidders submit information on certain other actions which were
taken to secure DBE participation in an effort to meet the goal. A bidder may also
submit, to the owner, other information on efforts it made to meet the goal.
VII. Contractor Assurance - The bidder assures that he will meet or exceed one of the
following as appropriate:
A. The DBE participation goal as established in Paragraph V, Section A.
B. Make a good faith effort to meet Disadvantaged Business Enterprise (DBE) goal.
(Must submit proof with bid.)
31
General Instructions
1. Contract Goal - All BIDDERS/CONTRACTORS may meet the DBE contract goal
by using certified DBEs. Bidders who fail to achieve the contract goal(s) stated
in the bid document, must provide (with the bid) an explanation as to why the goal
was not achieved and documentation demonstrating that a "Good Faith Effort" was
made by the bidder as outlined in DBE Form 4.
*2. DBE Forms 1 & 2- All bidders/contractors shall complete and submit, with their
bids, DBE Forms 1 (Schedule of DBE Participation); and 2 (DBE subcontractor
Identification Affivavit).
*3. DBE Form 3 - Letter of Intent To Perform as a DBE Subcontractor - Each
subcontractor listed on DBE Forms 1 & 2 shall complete and sign a Letter of Intent
to Perform as a DBE Subcontractor.
4. Certification - BUSINESS/CONTRACTORS seeking to participate as DBEs
must be certified at the time of bid submittal. Check the DBE Directory or contact
the DBELO.
5. Copies of Forms - Contractors may duplicate as many forms as needed, or may
request additional forms from the Airport; and all DBE Program questions
should be directed to the DBELO.
*NOTE:
Items 2 & 3 ABOVE MUST BE SUBMITTED WITH THE BID IN ORDER
TO BE ELIGIBLE TO RECEIVE A CONTRACT AWARD.
32
PART II
APPENDICIES
APPENDIX TABLE
APPENDIX
Application For DBE Certification ________________________mm_____________m_m_mm_____mu 1
Application For DBE Joint Venture------------m----m--mmm--------mmm---------m-m 2
Application For Certification Renewal-------m------mmmm-m-mmm------------mum 3
DBE Forms 1,2,3,&4....................................... ........ ...... ............. ............... ..................... 4
33
APPENDIX 1
34
INFORMATION FOR DETERMINING
DISADVANTAGED BUSINESS ENTERPRISE ELIGIBILITY
If , at any time, Monroe County's Board of County Commissioners has reasons to
believe that any person or firm has willfully and knowingly provided incorrect
information or made false statements, or acted in a manner prohibited by its DBE
Program Plan, the responsible official shall refer the matter to the General Counsel of
the Department. He/she may initiate procedures for suspension or debarment as
necessary and/or refer the matter to the General Counsel of the Department. He/she
may initiate procedures for suspension or debarment as necessary and/ or refer the
matter to the Department of Justice as deemed appropriate.
1. Name of firm
2. Address of firm
3. Phone number of firm
4. Contact Persons
5. Nature of Business: Specify major services/products.
6. Geographical Area Served:
States
Counties
7. Years firm has been in business
8. Type of ownership: (Check one)
Corporation
Partnership
Sole Proprietorship
Joint Venture
Other (Specify)
Page lof 6
35
9. Ownership of firm: Identify those who possess 5 percent or more of the
firm's ownership. Columns (e) and (f) need to be filled out only if one or more
owners is not a socially and economically disadvantaged individual.
A
B
C
D
E
F
Name
Race
Years of Ownership Voting
Sex Ownership Percentage Percent
10. Control of firm: Identify by name, race, sex, and title in the firm of those
individuals (including owners and non-owners) who are responsible for day-to-
day management and policy decision making including, but not limited to, those
with prime responsibility for:
a. Financial Decisions
b. Management Decisions, such as:
(1) Estimating
(2) Marketing and Sales
(3) Hiring and Firing of
Management Personnel
(4) Purchase of Major Items or Supplies
c. Supervision of Field Operations
11. For each owner listed in number 10, list the contributions of money,
equipment, real estate, or expertise of each of the owners. (Attach a separate
sheet if necessary.)
Page 2 of 6
36
12. For each of those listed in number 10, provide as brief summary of the
person's experience and number of years with the firm, indicating the person's
qualifications for the responsibilities given him or her. (Attach a separate sheet
if necessary.)
13. Describe or attach a copy of any stock options or other ownership options
that are outstanding, and any agreements between owners or between owners
and third parties which restrict ownership or control of the disadvantaged
owners. (Attach a separate sheet if necessary.)
14. Identify any owner (see Item 9) or management official (see Item 10) of
named firm who is or has been an employee of another firm that has an
ownership interest in or a present business relationship with the named firm.
Present business relationships include shared space, equipment, financing, or
employees as well as both firms having some of the same owners.
15. What are the gross receipts of the firm for each of the last three years?
Year ending
Gross Receipts $
Year ending
Gross Receipts $
Year ending
Gross Receipts $
Page 3 of 6
37
16. Name of bonding company, if any:
Bonding Limit:
Source of letters of credit, if any:
17. Are you authorized to do business in the state as well as locally, including
all necessary licenses? Yes No
Attach one copy of the operating license, if any.
Type of Business
License Number
18. Specify the major items of equipment owned and/or leased by the firm.
Equipment Owned
Quantity Equipment Leased
Name/ Address
of Owner
Page 4 of6
38
19. Has the firm ever applied for or been denied DBE/MBE/WBE certification
with the City, Department of Transportation, or elsewhere?
Yes
Application Pending
No
If yes, name the certifying authority, date, and state circumstances of such
certification or denial.
Page 50f6
39
AFFIDAVIT
"The undersigned swears that the foregoing statements are true and correct and
include all material information necessary to identify and explain the operations
of
(name of firm) as well as the ownership thereof. Further, the undersigned agrees
to provide, through the prime contractor or, if no prime, directly to the grantee,
current, complete and accurate information regarding actual work performed on
the project, the payment therefore, and any proposed changes, if any, of the
foregoing arrangements and to permit the audit and examination of books,
records, and files of the named firm. Any material misrepresentation will be
grounds for terminating any contract which may be awarded and for initiating
action under Federal and State laws concerning false statement."
Note: If, after filing this Schedule A and before the work of this firm is completed
on the contract covered by this regulation, there is any significant change in the
information submitted, you must inform the grantee of the change through the
prime contractor or, if no prime contractor, inform the grantee directly.
Signature
Name (Print or Type)
Title
Date
State of
County of
On this _ day of
(name)
he or she was properly
, 20_, before me appeared
, to me personally and did state that
authorized by (name of firm)
to execute the affidavit and did so as his or her free act and deed.
(Seal)
Notary Public
Commission expires
Page 6 of 6
40
APPENDIX 2
41
SCHEDULE "B" - INFORMATION FOR DETERMINING JOINT VENTURE ELIGIBILITY
(This form need not be filled in if all joint venture firms are Disadvantaged owned.)
1. Name of joint venture
2. Address of joint venture
3. Phone number of joint venture
4. Identify the firms which comprise the joint venture. (The DBE partner must
complete Schedule "A".)
(a) Describe the role of the DBE firm in the joint venture.
(b) Describe very briefly the experience and business qualifications of each
non-DBE joint venturer.
5. Nature of the joint venture's business
6. Provide a copy of the business joint venture agreement.
7. What is the claimed percentage of DBE ownership?
8. Ownership of joint venture: (This need not be filled in if described in the joint venture
agreement, provided by question 6.)
(a) Profit and loss sharing
(b) Capital contributions, including equipment.
(c) Other applicable ownership interests.
Page 1 of 4
42
SCHEDULE "B" - INFORMATION FOR DETERMINING JOINT VENTURE ELIGIBILITY
continued)
9. Control of and participation in this contract. Identify by name, race, sex, and
"firm" those individuals (and their titles) who are responsible for day-to-day
management and policy decision making, including, but not limited to, those with
prime responsibility for:
(a) Financial decisions
(b) Management decisions, such as:
(1) Estimating
(2) Marketing and sales
(3) Hiring and firing of management personnel
(4) Purchasing of major items or supplies
(c) Supervision of field operations
NOTE: It, after filing this Schedule "B" and before the completion of the joint venture's work on the
contract covered by this regulation, there is any significant change in the information submitted,
the joint venture must inform the grantee, either directly or through the prime contractor if the joint
venture is a subcontractor.
Page 2 of 4
43
SCHEDULE "B" - INFORMATION FOR DETERMINING JOINT VENTURE ELIGIBILITY
(continued)
AFFIDAVIT
"The undersigned swear that the foregoing statements are correct and include all material
information necessary to identify and explain the terms and operation of our joint venture and the
intended participation by each joint venturer in the undertaking. Further, the undersigned
covenant and agree to provide to the grantee current, complete and accurate information
regarding actual joint venture work and the payment therefor and any proposed changes in any of
the joint venturer relevant to the joint venture, by authorized representatives of the grantee or the
Federal funding agency. Any material misrepresentation will be grounds for terminating any
contract which may be awarded and for initiating action under Federal or State laws concerning
false statements."
Name of Firm
Name of Firm
Signature
Signature
Name(Type or Print)
Name
Title
Title
Date
Date
Date
State of
City of
Page 3 of 4
44
SCHEDULE "B" - INFORMATION FOR DETERMINING JOINT VENTURE ELIGIBILITY
(continued)
AFFIDAVIT
On this day of , 20 , before me appeared (name)
, to me personally known, who being sworn did
execute the foregoing affidavit, and did state that he/she was properly authorized by (name of
firm) to execute the affidavit and did so as his or her free
act and deed.
Notary Public
City expires
(Seal)
Date
State of
City of
On this
day of
, 20 ,before me appeared (name)
, to me personally known, who being sworn did execute
state that he or she was properly authorized by (name of
to execute the affidavit and did so as his or
the foregoing affidavit, and did
firm)
her free act and deed.
Notary Public
City expires
(Seal)
Page 4 of 4
45
APPENDIX 3
46
MARATHON AIRPORT'S DISADVANTAGED
BUSINESS CERTIFICATION RENEWAL FORM
Date
Type of Business
Firm Name
Address
Telephone No.
Contact Person
Please check ( ) yes or no.
1. Have there been any changes in the ownership and control of the firm? YES () NO ( )
2. Are there any changes in the nature of the firm's business? YES () NO ( )
3. Have there been any changes in the firm's stock shares? YES () NO ( )
4. Have the officers of the firm changed? YES () NO ( )
5. Have there been any Profit Sharing Agreements? YES () NO ( )
Stock Transfer Agreements? YES () NO ( )
Third Party Agreements? YES ( ) NO ( )
For any of the above questions that a yes is checked, please submit exhibit which lists the
number and explain the change.
6. Submit the following documents with this renewal form:
License to do business in Marathon, Florida and any other necessary licenses. Federal
corporate tax return including all schedules. Specify the gross receipts of the firm for the
last 3 years.
Year Total Gross Receipts
$
$
$
7.
Bonding Company:
Telephone No.
8. Bonding Limits:
9.
Insurance Company
Telephone No.
Additional Changes/Comments:
47
APPENDIX 4
DBE Form 1
DBE Form 2
DBE Form 3
DBE Form 4
48
SCHEDULE OF DBE PARTICIPATION
Name of Bidder:
Project No.:
Project: Total Bid Amount:
NAME OF DBE ADDRESS TYPE OF WORK DBE
SUBCONTRACTOR SUBCONTRACTED
$
DBE PARTICIPATION TOTAL VALUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . .$
The attainment of DBE participation goals for this contract will be measured as a
percentage of the total dollar value of the contract.
The undersigned will enter into a formal agreement with the DBE Subcontractors
identified herein for work listed in this schedule conditioned upon execution of a
contract with
Sworn to and subscribed before Signature:
Title:
me, this _ day of
, 20_.
(SEAL) Name (Typed)
NOTARY PUBLIC
DBE FORM 1
49
DBE SUBCONTRACTOR IDENTIFICATION AFFIDAVIT
STATE OF
COUNTY OF
I HEREBY DECLARE AND AFFIRM THAT I AM THE
(Title - Owner, President, Co-Venturer, etc.)
and duly authorized representative of whose
(Name of Firm)
address is
I hereby declare and affirm that I am a DBE as defined by the contract documents
cited below, and that I will provide on request information to document this fact.
This firm is interested in quoting/bidding on the following categories of work being
procured for the Project No.
This firm has current DBE certification from the following agencies:
I DO SOLEMNLY DECLARE AND AFFIRM UNDER THE PENALTIES OF PERJURY THAT
THE CONTENTS OF THE FOREGOING DOCUMENT ARE TRUE AND CORRECT, AND
THAT I AM AUTHORIZED ON BEHALF OF THE FIRM TO MAKE THIS AFFIDAVIT.
(Date)
(Mfiant)
COUNTY OF
STATE OF
On this day of ,20_, before me,
, the above signed officer, personally appeared, known to me to
be the person described in the foregoing affidavit and acknowledged that he / she
executed the same in the capacity therein stated and for the purposes therein
contained.
In witness thereof, I hereunto set my hand and official seal.
(SEAL)
My Commission Expires
DBE FORM 2
50
LETTER OF INTENT TO PERFORM AS A SUBCONTRACTOR
TO:
(Name of General Contractor Proposing)
PROJECT NO.:
The undersigned intends to perform work in connection with the above project as:
_ an individual _ corporation
_ joint venture _ partnership
(Check All Applicable)
aDBE
The status of the undersigned is confirmed on the attached DBE Contractor
Identification Affidavit (DBE FORM 2).
The undersigned is prepared to perform the following described work in connection with
the above project:
(Specify in detail, work items or parts thereof to be performed)
at the following price: $
percent (%) of the dollar value of this subcontract will be further sublet
and/ or awarded to other than DBE firms.
The undersigned agrees to enter into a contract with you to perform the above work, if
you are awarded the prime contract.
(Date)
(Telephone No.)
(Name of DBE Subcontractor)
By:
(Firm Address)
(Signature)
Name:
(City and State)
(Typed)
Title:
DBE FORM 3
51
DBE UNAVAILABILITY CERTIFICATION
I,
of
, certify that on the dates below,
I invited the following DBE Subcontractor(s) to bid work items to be performed on
DATE OF
REQUEST
DBE
NAME OF SUBCONTRACTOR
WORK ITEMS SOUGHT
The following Subcontractors submitted bids which were not the low responsible bid:
$
$
$
$
$
DBE FORM 4
52
ATTACHMENTS
Organizational Chart
Personal Financial Statement
Social & Economic Eligibility Statement
53
Attachment 1
MONROE COUNTY'S BOARD OF COUNTY COMMISSIONERS' ORGANIZATION CHART
FOR MARATHON AIRPORT
Monroe County Board
of County Commissioner
(Mayor)
I
County Administrator
I
Director of Airports
(DBELO)
I
Airport Manager
54
A IT ACHMENT 2
PERSONAL FINANCIAL STATEMENT
As of .20_
Complete this form for: (1) each proprietor, or (2) each limited partner who owns 20% or more interest and each general partner, or (3)
stockholder owning 20% or more of voting stock, or (4) any person or entity providing a guaranty on the loan
Name
Business Phone
Residence Address
Residence Phone
City, State, & Zip Code
Business Name of Applicant/Borrower
ASSETS (Omit Cent) LIABILITIES (Omit Cent)
Cash on hands & In Banks ............ $ Accounts Payable ............................ $
Savings Accounts ......................... $ Notes Payable to Banks and Others ... $
(Describe in Section 2)
IRA or Other Retirement Account ..... $ Installment Account (Auto) ............... $
Accounts & Notes Receivable ......... $ Mo. Payments $
Life Insurance-Cash Surrender Installment Account (Other) ............ $
Value Only........................... $
(Complete Section 8) Mo. Payments $
Stocks and Bonds ..................... $
(Describe in Section 3) Loan on Life Insurance ................. $
Real Estate ................................ $
(Describe in Section 4) Mortgages on Real Estate.............. $
Automobile-Present Value ........... $ (Describe in Section 4)
Unpaid Taxes ............................... $
Other Personal Property .............. $ (Describe in Section 6)
(Describe in Section 5) Other Liabilities ............................ $
Other Assets ............................. $ (Describe in Section 7)
(Describe in Section 5) Total Liabilities........................... $
Net Worth .................................... $
Total $
Section I. Source of Income Contingent Liabilities
Salary.................................. .... $ As Endorser or Co-Maker ................ $
Net Investment Income ............... $ Legal Claims & Judgments .............. $
Real Estate Income ..................... $ Provision for Federal Income Tax ...... $
Other Income (Describe below)*... $ Other Special Debt.................. $
Description of Other Income in See lion I
* Alimony or child support payments need not be disclosed in "other Income" unlcss it is desired to have such payments counted toward
total income.
Section 2. Notes Payable to Bank and Others (Use attachments if neecssary. Each attachment must be
identified as a part of this statement and signed.)
Name and Addrcss of Original Current Payment Frequency How Secured or Endorsed
Noteholder(s) Balance Balance Amount (monthly. ctc) Type of Collateral
55
Section 3.
Number of Name of Securities Cost Market Value Date of
Shares Quotation/Exchange Quotation/Exchange Total Value
Section 4.
(List each parcel separately. Use attachment if necessary. Each attachment
must be identified as a part of this statement and signed.)
Property A Property B Property C
Type of Property
Address
Date Purchased
Original Cost
Present Market Value
Name & Address
of Mortgage Holder
Mortgage Account Number
Mortgage Balance
Amount of Payment
per MonthlYear
Status of Mortgage
Section 5.
(Describe, and if any is pledged as security, state name and address of lien holder,
amount of lien, terms of payment and if delinquent, deseribe delinquency)
Section 6. Unpaid Taxes (Describe in detail, as to type, to whom payable, when due, amount, and to what property, if any, a fax
lien attaches.)
Section 7. Other Liabilities (Describe in detail.)
Section 8. Life Insurance Held (Give face amount and cash surrender value of policies-names of insurance
company and beneficiaries)
I authorize SBA/Lender to make inquiries a.~ necessary to verify the accuracy ofthe statements made and to determine my
creditworthiness. I certify the above and the statements contained in the attachments are true as of the stated date(s). These statements
are made for the purpose of cithcr obtaining a loan or guaranteering a loan. I understanding FALSE statements may result in foreilure
of benefits and possible prosecution by the U.S. Attorney General (Reference 18 U.S.C. 1001)
Signature:
Signature:
Date:
Date:
Social Security Number:
Social Security Number:
56
Attachment 3
Eligibility Statement - Social and Economic Disadvantage
For
1. List all individuals claiming disadvantaged status.
Name of individual
Group
Membership
U.S. Citizen
Y/N
Place of
Birth
Sex
M/F
la. If you are a naturalized Citizen, please provide a copy of each:
(a) naturalization number; (b) date of citizenship; (c) county. state and court.
2. Has any individual(s) claiming disadvantaged status transferred any assets
within two years, in full or in part, to a spouse or any other person or entity,
including a trust? _Yes _ No. If yes, provide the following
information: the date of transfer; to whom the assets were transferred; amount paid for
the assets; the market value of the assets at the time of transfer; and the
purpose ofthe transfer.
3. All individuals claiming disadvantaged status must list thcir personal net
worth. excluding the equity in their primary residence and their ownership in
the applicant firm.
Name of Individual
Personal
Net Worth
$
$
Each individual claiming disadvantaged status must sign the following certification:
I certify that 1 am a member of one of the designated groups and I am identified as a member of one of the
designated groups. 1 also certify that my net worth is less the $750,000, excluding my ownership interest in the
applicantfirm and my equity in the primary residence. (please sign)
AFFIDAVIT
On this day of . 20 _' before me appeared (name)
, to me personally known, who being sworn did execute the foregoing
affidavit, and did state that he/she was properly authorized by (name of firm)
to execute the affidavit and did so as his or ber free act and deed.
Notary Public
City expires
(Seal)
Date
State of
57