Fillable MassDOT Form AD3MW MWBE Letter Of Intent 2018 03 23 (Commonwealth of Massachusetts)

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MassDOT Form AD3MW MWBE Letter Of Intent 2018 03 23 (Commonwealth of Massachusetts)

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The MassDOT Form AD3MW MWBE Letter Of Intent 2018 03 23 (Commonwealth of Massachusetts) form is 2 pages long and contains:

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  • 3 check-boxes
  • 75 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Commonwealth of Massachusetts

BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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MassDOT Form AD3MW Page 1 of 2 Last Modified: March 23, 2018 (A)
Letter of Intent/Schedule of Participation
1
Minority/Women Business Enterprise (M/WBE)
2
Participation
(For State-sponsored Projects)
3
NOTE TO BIDDER: THE M/WBE GOAL FOR THIS PROJECT SHALL NOT BE LESS THAN %. IF THE GOAL IS NOT
MET, THE BIDDER MUST SUBMIT DOCUMENTATION OF A “GOOD FAITH EFFORT” TO THE SPONSOR, PRIOR TO
CONTRACT AWARD.
AIRPORT __________________________________________________ PROJECT NO. ___________________________________
PROJECT TITLE _____________________________________________________________________________________________
Name of General Contractor
Name of M/WBE Contractor
Address
City
State Zip Code Phone
1. The undersigned M/WBE firm intends to perform work in connection with the above referenced project as:
Check One:
An individual A partnership A corporation
A joint venture with:
Other
Attach extra sheets if necessary
2. The undersigned affirms that they are a duly authorized official representing the proposed M/WBE and affirms that its
certification has not expired nor been revoked.
(Attach a copy of the certification letter)
4
Check all that apply:
MBE
WBE
Other
Certification Agency Certification Number
3. If awarded the contract, the undersigned intend to enter into a subcontract to perform the work described on the
following sheet for the prices indicated.
1
Use a separate form for each M/WBE firm to be utilized on this project.
2
Must be register with the MA Supplier Diversity Office (SDO) and must be listed as a M/WBE with a valid certification when
work is completed. PBE contractors cannot be counted as M/WBE contractors.
3
For projects with no federal participation.
4
Certification must be completed prior to Contract Award.
MassDOT Form AD3MW Page 2 of 2 Last Modified: March 23, 2018 (A)
Contract
Item No.
Description of Work to be Performed by M/WBE Contractor
Estimated
Quantity
Unit Price
Item
Amount
Total amount credited to M/WBE contractor (add item amounts): TOTAL $
Proposed total contract price: $
The total price to M/WBE contractor for work performed under this contract is % of the proposed total
contract price. (See note to bidder above).
The undersigned certify that they will enter into a formal agreement upon execution of the contract for the above referenced
project pursuant to all conditions noted in attached documents, swearing and affirming under the pains and penalties of
perjury, that the foregoing information and appropriate attachments are true and accurate to the best of their knowledge.
Name of M/WBE Contractor
Authorized Signature
Name and Title
Date
Name of General Contractor
Authorized Signature
Name and Title
Date
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MassDOT Form AD3MW MWBE Letter Of Intent 2018 03 23 (Commonwealth of Massachusetts)

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Completed 26 July 2020

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