RFP 368

MARYLAND DEPARTMENT OF HUMAN RESOURCES MINORITY CONTRACTOR UNAVAILABILITY CERTIFICATE SECTION I (TO BE COMPLETE D BY PRIME CONTRACTOR) I HEREBY CERTIFY THAT ____________________________________________________________ ( N a m e o f C o n t r a c t o r ) CONTACTED ________________________________________________ MDOT CERT # __________ (Name of MBE Subcontractor) ___________________________________________________________________ ON ______________ (Complete Address of MBE Subcontractor) (Date) TYPE OF WORK/SERVICE REQUESTED: _____________________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________________________ To the best of my knowledge and belief, said Minor ity Business Enterprise is either unavailable to perform the work/services requested in relation to this contract or is unable to prepare a bid/quote for the following reason(s): _____________________________________________________________________________________ _____________________________________________________________________________________ SIGNATURE OF PERSON COMPLETING THIS FORM: ____________________________________ PRINTED NAME _______________________________________________ DATE ________________ SECTION II (TO BE COMPLETED BY CERTIFIED MINORITY BUSINESS ENTERPRISE) IT IS HEREBY CERTIFIED THAT ________________________________ MDOT CERT # _________ (Name of Certified MBE Subcontractor) _____________________________________________________________________________________ (Complete Address of Certified MBE Subcontractor) WAS OFFERED THE OPPORTUNITY TO BID/PREPARE A QUOTE ON THE ABOVE REFERENCED CONTRACT. THE ABOVE STATEMENT(S) ARE TRUE AND ACCURATE ACOUNTS OF WHY A BID OR QUOTE WAS NOT SUBMITTED ON THIS CONTRACT. SIGNATURE OF PERSON REPRESENTING THE MBE: ____________________________________ PRINTED NAME __________________________________________________ DATE _____________ TELEPHONE NUMBER: __________ ________________ FAX NUMBE R: ______________________ RETURN THIS FORM TO: DONNA FOSTER, MBE LIAISON DEPARTMENT OF HUMAN RESOURCES, OFFICE OF EMPLOYMENT AND PROGRAM EQUITY 1st Floor, 311 W. SARATOGA STREET, BALTIMORE, MD 21201-3521