Minority Business Development
900 East Broad Street
City Hall, 16th Floor
Richmond, VA 23219
Office: (804) 646-5947
Fax: (804) 646-0136
http://www.richmondgov.com/MBD
MBE/ESB Past Good Faith Efforts
Participation Form
All firms listed in this directory have registered with the City of Richmond as a minority
owned business (MBE) or certified as an Emerging Small Business (E SB). It should be
noted, that there are MBE businesses listed i n this directory that are not certified. Therefore,
any prime contractor/vendor desiring to use a registered MBE firm t hat is not certified, must
be aware, that the registered MBE firm has 180 days to get certified or before the completio n
of the contract, whichever is less, or the prime contractor/vendor risks not receiving credit
toward the minority participation goal for the said project .
MBE/ESB-5 Past Good Faith Efforts Participation Form Revised Date 1/13/2014
COMPANY
DATA
COMPANY NAME:
CONTRACT NAME/NO:
CONTACT NAME:
PHONE #
Fax#
Email Address:
How long has your firm been in Business?
If you can verify your firm has made past good faith efforts in the Public or Private Sector to engage MBE/ESB firms
through subcontracting, joint venture, mentor-protégé, or apprenticeship opportunities over the past three (3) years,
you may be eligible to earn additional points for this project. Please include valid documentation to support this
claim. Feel free to attach additional pages, if necessary. Enter Below Code for Ownership of each MBE Firm.
1 = African American 2 = Hispanic American 3 = Asian American
4 = American Indian 5 = Other (Specify Below)
Yes may be eligible Complete section below No not eligible
DID YOU
MEET
THE MBE
GOAL?
SCOPE OF WORK
MBE/ESB COMPANY
NAME/CONTACT
PERSON/PHONE
MBE/
ESB
Code
DEFINTIONS
GOOD FAITH MBE/ESB PARTICIPATION
EFFORTS
EMERGING SMALL BUSINESS
The sum total of efforts by a particular business
to provide equitable participation of minority
business enterprise or emerging small business
subcontractors. For past efforts, this sum total
shall be comprised of the record of
participation by minority business enterprises
and emerging small businesses through
subcontracting or joint ventures. For future
efforts, it shall be comprised of such efforts,
which are proposed to allow equitable
participation of minority business enterprise or
emerging small business subcontractors.
A business that (1) has been certified by the
Office of Minority Business Development
for a period of seven years or less.,(2) has
annual gross receipts for each of its three
fiscal years preceding application for
certification of $500,000 or less if engaged
in the construction business or of $250,000
or less if engaged in non-construction
business, (3) has fewer than ten employees,
(4) is not a subsidiary of another business
and does not belong to a group of
businesses owned and controlled by the
same individuals, (5) has its principal place
of business within the City of Richmond
Enterprise Zone, (6) possesses a City
business license, and (7) pays personal
property, real estate, and business taxes to
the City of Richmond.
Bidder and the MBE/ESB agree that the MBE/ESB shall not subco ntract or assign any work described herein to another entity without prior written
approval of the City of Richmond.
THE UNDERSIGNED HEREBY CERTIFIES THAT S/HE HAS READ THE TERMS OF THIS COMMITMENT AND IS AUTHORIZED TO BIND
THE BIDDER TO THE COMMITMENT HEREIN SET FORTH.
SIGNATURE OF AUTHORIZED OFFICIAL: DATE:
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