![](media/image1.png){width="0.4597222222222222in"
height="0.4076388888888889in"}EVALUATION OF CONTRACTOR\'S GOOD FAITH
EFFORTS\
TO MEET THE CONTRACT DBE REQUIREMENT

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<tbody>
<tr class="odd">
<td colspan="3"><h3 id="contractor">Contractor:</h3></td>
<td colspan="7"><h3 id="section">     </h3></td>
</tr>
<tr class="even">
<td><h3 id="date">Date:</h3></td>
<td colspan="4"><h3 id="section-1">     </h3></td>
<td colspan="2"><h3 id="location">Location:</h3></td>
<td colspan="3"><h3 id="section-2">     </h3></td>
</tr>
<tr class="odd">
<td><h3 id="section-3"></h3></td>
<td colspan="4"><h3 id="of-meeting">(of meeting)</h3></td>
<td colspan="2"><h3 id="section-4"></h3></td>
<td colspan="3"><h3 id="section-5"></h3></td>
</tr>
<tr class="even">
<td colspan="2"><h3 id="project">Project:</h3></td>
<td colspan="8"><h3 id="section-6">     </h3></td>
</tr>
<tr class="odd">
<td colspan="2"><h3 id="section-7"></h3></td>
<td colspan="8"><h3 id="name-and-number">(name and number)</h3></td>
</tr>
<tr class="even">
<td colspan="4"><h3 id="dbe-goal">DBE Goal: %</h3></td>
<td colspan="4"><h3 id="section-8">     </h3></td>
<td><h3 id="section-9">$</h3></td>
<td><h3 id="section-10">     </h3></td>
</tr>
<tr class="odd">
<td colspan="6"><h3 id="contractors-commitment">Contractor's Commitment:
%</h3></td>
<td colspan="2"><h3 id="section-11">     </h3></td>
<td><h3 id="section-12">$</h3></td>
<td><h3 id="section-13">     </h3></td>
</tr>
</tbody>
</table>

*Obtain the following information from the contractor and verify each
action taken by the contractor.*

1)  Did the contractor advertise in general circulation, trade
    association, and minority-focus media concerning the subcontracting
    opportunities available on this contract?\
    Yes No

> If yes, provide the following information.
>
> Name of publications:      
>
> Dates of publications:      
>
> Verification by obtaining copies of ads from contractor. *(Attach to
> this form.)*
>
> EVALUATION:      

2)  Did the contractor provide written notice to a reasonable number of
    specific DBEs that their interest in the contract was being
    solicited in sufficient time to allow the DBEs to participate
    effectively? Yes No

> If yes, provide the following information.
>
> Names of firms:      
>
> Capability of firms doing the work:      
>
> Dates of letters:      
>
> Verification by obtaining copies of letters sent and confirmation from
> DBEs that they received the letters, or other forms of documentation
> of contacts made. *(Attach to this form.)*
>
> EVALUATION:      

3)  Did the contractor follow up initial solicitations of interest by
    contacting DBEs to determine with certainty that they were or were
    not interested in participating? Yes No

> If yes, provide the following information.
>
> Names of firms:      
>
> Dates of contacts:      
>
> Verification by confirming with DBEs that contact was made and
> obtaining telephone logs or other documentation. *(Attach to this
> form.)*
>
> EVALUATION:      

4)  Did the contractor select portions of the work that could be
    performed by available DBEs in order to increase the likelihood of
    meeting the DBE goals (including, where appropriate, breaking down
    the contract into economically feasible units to facilitate DBE
    participation)?\
    Yes No

> If yes, provide the following information.
>
> Is the amount selected sufficient to meet the goal? Yes No
>
> Are the items reasonable for subcontracting? Yes No
>
> [Bid Items]{.underline} [Dollar Amounts]{.underline}
>
>      
>
> EVALUATION:      

5)  Did the contractor provide interested DBEs with adequate information
    about the plans, specifications, and requirements of the contract?
    Yes No

> If yes, provide the following information.
>
> What information was provided?      
>
> What DBE firms received the information?      
>
> What dates?      
>
> Verification that contacts were made and that the information was
> provided by calling the DBE firms identified by the contractor.
>
> EVALUATION:      

6)  Did the contractor negotiate in good faith with interested DBEs, not
    rejecting DBEs as unqualified without sound reasons based on a
    thorough investigation of their capabilities?\
    Yes No

> If yes, provide the following information.
>
> Negotiated the content of bid items and possible adjustments thereto?
> Yes No
>
> If yes, describe and verify with DBEs.      
>
> Negotiated bid items to be included in a package and possible
> adjustments thereto?\
> Yes No
>
> If yes, describe and verify with DBEs.      
>
> Negotiated the terms and conditions of the subcontract and possible
> adjustments thereto?\
> Yes No
>
> If yes, explain and verify with DBEs.      
>
> Negotiated the bonding and insurance requirements and possible
> adjustments thereto?\
> Yes No
>
> If yes, describe and verify with DBEs.      
>
> Negotiated the addition of bid items to be subcontracted? Yes No
>
> If yes, explain and verify with DBEs.      
>
> Total quotations received:      
>
> DBE quotations rejected:      
>
> Reasons for rejection:      
>
> EVALUATION:      

7)  Did the contractor assist interested DBEs in obtaining bonding,
    lines of credit, or insurance required by the contractor or ITD? Yes
    No

> If yes, provide the following information.
>
> Names of firms assisted:      
>
> Assistance provided:      
>
> EVALUATION:      

8)  Did the contractor assist interested DBEs in obtaining necessary
    equipment, supplies, materials, or related assistance or services?
    Yes No

> If yes, provide the following information.
>
> Names of firms assisted:      
>
> Assistance provided:      
>
> EVALUATION:      

9)  Did the contractor effectively use the services of available
    minority community organiza­tions; minority contractors\' groups;
    local, state, and federal minority business assistance offices; and
    other organizations that provide assistance in the recruitment and
    placement of DBEs? Yes No

> If yes, provide the following information.
>
> Names of organizations contacted:      
>
> Verification that contact was made and describe the service provided.
>      
>
> EVALUATION:

10) What other actions did the contractor make to increase the DBE
    participation on this project?

>      
>
> EVALUATION:      

**SUMMARY**

     

Evaluated By:

> Contract Compliance Officer Date

Approved Denied

> Chief of Civil Rights Date

Attachments: