M/WBE Utilization Plan - Form 1 Revised: 01/29/2014
MBE/WBE UTILIZATION PLAN - FORM 1
BIDDER/PROPOSER HEREBY STATES that all MBE/WBE firms included in this Plan are certified MBEs/WBEs by at least one of the entities listed in the General
Conditions – Section 19.
I. BIDDER/PROPOSER MBE/WBE STATUS: (check the appropriate line)
____ Bidder/Proposer is a certified MBE or WBE firm. (If so, attach copy of current Letter of Certification)
____ Bidder/Proposer is a Joint Venture and one or more Joint Venture partners are certified MBEs or WBEs. (If so, attach copies of Letter(s) of
Certification, a copy of Joint Venture Agreement clearly describing the role of the MBE/WBE firm(s) and its ownership interest in the Joint
Venture and a completed Joint Venture Affidavit – available online at www.cookcountyil.gov/contractcompliance)
____ Bidder/Proposer is not a certified MBE or WBE firm, nor a Joint Venture with MBE/WBE partners, but will utilize MBE and WBE firms either
directly or indirectly in the performance of the Contract. (If so, complete Sections II below and the Letter(s) of Intent – Form 2).
II. Direct Participation of MBE/WBE Firms Indirect Participation of MBE/WBE Firms
NOTE: Where goals have not been achieved through direct participation, Bidder/Proposer shall include documentation outlining efforts to
achieve Direct Participation at the time of Bid/Proposal submission. Indirect Participation will only be considered after all efforts to
achieve Direct Participation have been exhausted. Only after written documentation of Good Faith Efforts is received will Indirect
Participation be considered.
MBEs/WBEs that will perform as subcontractors/suppliers/consultants include the following:
MBE/WBE Firm: ____________________________________________________________________________
Address: __________________________________________________________________________________
E-mail: ___________________________________________________________________________________
Contact Person: ___________________________________ Phone: __________________________________
Dollar Amount Participation: $__________________________________________________________________
Percent Amount of Participation: _____________________________________________________________%
*Letter of Intent attached? Yes _______ No _______
*Current Letter of Certification attached? Yes _______ No _______
MBE/WBE Firm: ___________________________________________________________________________
Address: __________________________________________________________________________________
E-mail:____________________________________________________________________________________
Contact Person: ___________________________________ Phone: __________________________________
Dollar Amount Participation: $__________________________________________________________________
Percent Amount of Participation: _____________________________________________________________%
*Letter of Intent attached? Yes _______ No _______
*Current Letter of Certification attached? Yes _______ No _______
Attach additional sheets as needed.
* Letter(s) of Intent and current Letters of Certification must be submitted at the time of bid.
