Exhibit A               The Office of Physical Plant

DBE Contractor/Supplier Utilization Form               The Pennsylvania State University

 

1.      This document shall be completed in its entirety and FURNISHED with the BID. The Contractor’s bid amount shall include utilization of certified minority    and/or women owned businesses to the extent possible certified by one of the following entities: Department of General Services Bureau of Minority & Women Business Opportunities (DGS BMWBO), Federal Department of Transportation, National Minority Development Council (NMSDC) or its affiliates, Southeastern PA Transportation Authority (SEPTA), Women Business Enterprise National Council (WBENC), Pennsylvania Unified Certification Program (PA UCP),

Pennsylvania Department of Transportation (Penn DOT), National Women Business Owners Corporation (NWBOC), Minority Business Enterprise Council (MBEC), National Gay and Lesbian Chamber of Commerce (NGLLC), and U.S. Department of Veteran Affairs.

 

2.       The information contained herein shall remain confidential and shall be shared with the Owner and Owner’s representative only.

 

3.       The Owner DBE goal is 10% when Penn State holds the trade contract.  W hen Trade Contracts are held by the CM or DB, the DBE goal is 15% or more.

 

 

 

 

 

DBE Name

 

 

Contact Name

& Phone No.

Check (X) DBE Designation

Check (X) DBE Designation

 

 

 

Description of Work

 

 

Projected Contract

$ Amount

MBE

W BE

LGBT

VOB

Contractor

Supplier

1.

 

 

 

 

 

 

 

 

 

 

$

2.

 

 

 

 

 

 

 

 

 

 

$

3.

 

 

 

 

 

 

 

 

 

 

$

4.

 

 

 

 

 

 

 

 

 

 

$

5.

 

 

 

 

 

 

 

 

 

 

$

6.

 

 

 

 

 

 

 

 

 

 

$

7.

 

 

 

 

 

 

 

 

 

 

$

8.

 

 

 

 

 

 

 

 

 

 

$

9.

 

 

 

 

 

 

 

 

 

 

$

10.

 

 

 

 

 

 

 

 

 

 

$

 

 

$

 

 

 

 

 

07/14/2017