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DocuSign Envelope ID:4E43C797-33A3-4C29-9D23-96EA82AC437C <br /> Do not submit with the bid Do not submit with the bid Do not submit with the bid Do not submit with the bid Do not submit with the bid <br /> State of North Carolina AFFIDAVIT D — Good Faith Efforts <br /> County of <br /> (Note this form is to be submitted only by the apparent lowest responsible, responsive bidder.) <br /> If the goal of 10% participation by HUB Certified/minority business is not achieved, the Bidder shall <br /> provide the following documentation to the Owner of his good faith efforts: <br /> Affidavit of I do hereby certify that on the <br /> (Name of Bidder) <br /> (Project Name) <br /> Project ID# Amount of Bid $ <br /> 1 will expend a minimum of % of the total dollar amount of the contract with HUB certified/ <br /> minority business enterprises. Minority businesses will be employed as construction subcontractors, <br /> vendors, suppliers or providers of professional services. Such work will be subcontracted to the <br /> following firms listed below. (Attach additional sheets if required) <br /> Name and Phone Number *Minority **HUB Work Dollar Value <br /> Category Certified Description <br /> Y/N <br /> *Minority categories: Black,African American (B), Hispanic(H), Asian American (A)American Indian (1), <br /> Female (F) Socially and Economically Disadvantaged (D) <br /> ** HUB Certification with the state HUB Office required to be counted toward state participation goals. <br /> Examples of documentation that may be required to demonstrate the Bidder's good faith efforts to meet the goals set forth in these provisions <br /> include,but are not necessarily limited to,the following: <br /> A.Copies of solicitations for quotes to at least three(3)minority business firms from the source list provided by the State for each subcontract <br /> to be let under this contract(if 3 or more firms are shown on the source list). Each solicitation shall contain a specific description of the <br /> work to be subcontracted,location where bid documents can be reviewed,representative of the Prime Bidder to contact,and location, <br /> date and time when quotes must be received. <br /> B.Copies of quotes or responses received from each firm responding to the solicitation. <br /> C.A telephone log of follow-up calls to each firm sent a solicitation. <br /> D.For subcontracts where a minority business firm is not considered the lowest responsible sub-bidder,copies of quotes received from all <br /> firms submitting quotes for that particular subcontract. <br /> E.Documentation of any contacts or correspondence to minority business,community,or contractor organizations in an attempt to meet the <br /> goal. <br /> F.Copy of pre-bid roster <br /> G.Letter documenting efforts to provide assistance in obtaining required bonding or insurance for minority business. <br /> H.Letter detailing reasons for rejection of minority business due to lack of qualification. <br /> I.Letter documenting proposed assistance offered to minority business in need of equipment,loan capital,lines of credit,or joint pay <br /> agreements to secure loans,supplies,or letter of credit,including waiving credit that is ordinarily required. <br /> Failure to provide the documentation as listed in these provisions may result in rejection of the bid and award to the next lowest responsible <br /> and responsive bidder. <br /> Pursuant to GS143-128.2(d), the undersigned will enter into a formal agreement with Minority Firms for <br /> work listed in this schedule conditional upon execution of a contract with the Owner. Failure to fulfill <br /> this commitment may constitute a breach of the contract. <br /> MBForms 2002-Revised May 2010 -1- <br />