X hits on this document

312 views

0 shares

0 downloads

0 comments

81 / 104

TCCD SMALL M/WBE SPECIFICATIONS FORM

Affidavit Statement

Project Name: ____________________________________________________________

Project No.: ____________________TCCD ______________ % : ___________________

FAILURE TO SUBMIT THIS COMPLETED AFFIDAVIT STATEMENT WITH THE BID AT TIME OF BID OPENING WILL RESULT IN THIS BID BEING CONSIDERED NONRESPONSIVE TO SPECIFICATIONS.

The undersigned bidder hereby certifies that they will comply with TCCD’s SMALL M/WBE

Program and the specifications of this bid in the following manner:

[Check all applicable categories]

1.

___ THE SMALL M/WBE PARTICIPATION WILL MEET OR EXCEED THE STATED

               ______________ %, WILL COMPLETE THE SMALL M/WBE UTILIZATION FORM.

2.

___ THE SMALL M/WBE PARTICIPATION WILL BE LESS THAN THE STATED

               ______________ %, WILL COMPLETE THE UTILIZATION FORM AND GOOD FAITH EFFORT

               FORM.

3.

___  NO SMALL M/WBE PARTICIPATION, WILL COMPLETE GOOD FAITH EFFORT FORM.

____________________________________________________________________________________

Authorized SignaturePrinted Signature

____________________________________________________________________________________

Title Contact Name and Title (if different)

___________________________________________________________________________________

Company NameContact Telephone Number(s)

__________________________________________________________________________________

AddressFax Number

_________________________________________________________________________________

City/State/Zip CodeDate

Document info
Document views312
Page views312
Page last viewedFri Dec 09 23:58:22 UTC 2016
Pages104
Paragraphs1402
Words16282

Comments