2018-093-E AMS - Century Slate Company Replace roof at SDC

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DocuSign Envelope ID: B49FB256 -4ADF- 4759- AF63- 134AD44FC239 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 State of North Carolina AFFIDAVIT D — Good Faith Efforts County of (Note this form is to be submitted only by the apparent lowest responsible, responsive bidder.) If the goal of 10% participation by HUB Certified/ minority business is not achieved, the Bidder shall provide the following documentation to the Owner of his good faith efforts: Affidavit of I do hereby certify that on the (Name of Bidder) (Project Name) Project ID# Amount of Bid $ I will expend a minimum of % of the total dollar amount of the contract with HUB certified/ minority business enterprises. Minority businesses will be employed as construction subcontractors, vendors, suppliers or providers of professional services. Such work will be subcontracted to the following firms listed below. (Attach additional sheets if required) Name and Phone Number *Minority Category * *HUB Certified Y/N Work Description Dollar Value *Minority categories: Black, African American (B), Hispanic (H), Asian American (A) American Indian (1), Female (F) Socially and Economically Disadvantaged (D) ** HUB Certification with the state HUB Office required to be counted toward state participation goals. Examples of documentation that may be required to demonstrate the Bidder's good faith efforts to meet the goals set forth in these provisions include, but are not necessarily limited to, the following: 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 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 work to be subcontracted, location where bid documents can be reviewed, representative of the Prime Bidder to contact, and location, date and time when quotes must be received. B. Copies of quotes or responses received from each firm responding to the solicitation. C. A telephone log of follow -up calls to each firm sent a solicitation. D. For subcontracts where a minority business firm is not considered the lowest responsible sub - bidder, copies of quotes received from all firms submitting quotes for that particular subcontract. E. Documentation of any contacts or correspondence to minority business, community, or contractor organizations in an attempt to meet the goal. F. Copy of pre -bid roster G. Letter documenting efforts to provide assistance in obtaining required bonding or insurance for minority business. H. Letter detailing reasons for rejection of minority business due to lack of qualification. I. Letter documenting proposed assistance offered to minority business in need of equipment, loan capital, lines of credit, or joint pay agreements to secure loans, supplies, or letter of credit, including waiving credit that is ordinarily required. Failure to provide the documentation as listed in these provisions may result in rejection of the bid and award to the next lowest responsible and responsive bidder. Pursuant to GS143- 128.2(d), the undersigned will enter into a formal agreement with Minority Firms for work listed in this schedule conditional upon execution of a contract with the Owner. Failure to fulfill this commitment may constitute a breach of the contract. MBForms 2002- Revised May 2010 -1-