157-25 Exhibit.pdf

(prior to negotiations) (Prime Consultant and each Sub-Consultant) Request for Proposal No. Ttem No. AFFIRMATIVE ACTION CERTIFICATION I do herby certify thatit is the intention ofmy company to affirmatively seek out and consider DBEs certified in the State of New Jersey, to participate as part of this proposal. (For listing of DBE certified firms see http:/Avww.njucp.net/ Tunderstandanda gree thata ll sub consulting in connection with this proposal, whether undertaken prior to orsubsequent to the notice to proceed, shall be in accordance with therequirements forthe Disadvantaged Business Enterprise Program, included elsewhere in this RFP. I understandanda gree that no subcontracting shall be approved or commenced until the Department of Transportation has reviewed and approved thea ffirmative actions taken bymy company orme. T understand thatutilization of certified DBEs is in addition to allother equal employment requirements of this RFP. Tacknowledge thatthis certification is to be madean integral part of this proposal. Tunderstandanda gree thatthe submission of a blank certification may cause the proposal to be rejected. I hereby certify that contacthas been made with the certified DBEs listed in this certification, and that, if my company becomes the CONSULTANT, the certified DBEs have tentatively agreed to perform the services listed below. I understand thatneither my company nor! will be penalized foramounts achieved over or under the amount shown for 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 priorapproval 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 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