125-22 Attachment - Admin Procedures Appendices Final Revised March 2022.pdf

(prior to negotiations) (Prime Consultant and each Sub-Consultant) Request for Proposal No._______________ Item No._______________ AFFIRMATIVE ACTION CERTIFICATION I do herby certify that it is the intention of my company to affirmatively seek out and consider DBEs certified in the Stat e o f New Jersey, to participate as part of this proposal. (For listing of DBE certified firms see http://www.njucp.net/ I understand and agree that all sub consulting in connection with this proposal, whether undertaken prior to or subsequent t o the notice to proceed, shall be in accordance with the requirements for the Disadvantaged B u siness En terprise Pro gram, included elsewhere in this RFP. I understand and agree that no subcontracting shall be approved o r co mmenced u nt il t h e Department of Transportation has reviewed and approved the affirmative actions taken by my company or me. I understand that utilization of certified DBEs is in addition to all other equal employment requirements of this RFP. I acknowledge that this certification is to be made an integral part of this proposal. I understand and agree that the submission of a blank certification may cause the proposal to be rejected. I hereby certify that contact has been made with the certified DBEs listed in this cert if ica tio n, a nd t h at, if m y co mpany becomes the CONSULTANT, the certified DBEs have tentatively agreed to perform the services listed below. I understand that neither my company nor I will be penalized for amounts achieved over or u n d er t h e amo unt sh own f or voluntary DBE utilization that exceeds the goal. After contract award, any change to the firms listed in this Affirmative Action Certification under ra ce/gender conscious must have prior approval by NJDOT’s and NJ Division of Civil Rights and Affirmative Action (DCR/AA)- SUBCONSULTANTS DBE SUBCONSULTANTS TO BE APPLIED TOWARD GOAL (RACE/GENDER CONSCIOUS) Certified DBE Name & Address Service Planned Planned percentage to be paid to DBE DBE SUBCONSULTANTS TO BE USED BEYOND GOAL (RACE/GENDER CONSCIOUS) Certified DBE Name & Address

E Name & Address Service Planned Planned percentage to be paid to DBE DBE SUBCONSULTANTS TO BE USED BEYOND GOAL (RACE/GENDER CONSCIOUS) Certified DBE Name & Address Service Planned Planned percentage to be paid to DBE Total Percentage Credited toward DBE Goal (Race/Gender Conscious):___________ Total Percentage of Voluntary DBE Work Anticipated over DBE Goal (Race/Gender Neutral): _________ Name of Company: ___________________________________________________________________ By:______________________________________________________ Date: _____________________ RFP Requirements Page 6