Note: If the procurement includes a list of bid items identified during the goal setting process as possible items of work for performance by MBE Firms, the bidder/offeror should make all of those items of work available to MBE Firms or explain why that item was not made available. If the bidder/offeror selects additional items of work to make available to MBE Firms, those additional items should also be included below. Identified Items of Work Was this work listed in the procurement? Does bidder/offeror normally self-perform this work? Was this work made available to MBE Firms? If no, explain why? Yes No Yes No Yes No: Yes No Yes No Yes No: Yes No Yes No Yes No: Yes No Yes No Yes No: Yes No Yes No Yes No: Yes No Yes No Yes No: Yes No Yes No Yes No: Yes No Yes No Yes No: Yes No Yes No Yes No: Yes No Yes No Yes No: Please check if Additional Sheets are attached. GOOD FAITH EFFORTS DOCUMENTATION TO SUPPORT WAIVER REQUEST Part 2 – identified MBE firms and record of solicitations Page of Prime Contractor Project Description Customer Service Center (CSC) Services OS/CSC-15-001-S Identify the MBE Firms solicited to provide quotes for the Identified Items of Work made available for MBE participation. Include the name of the MBE Firm solicited, items of work for which bids/quotes were solicited, date and manner of initial and follow-up solicitations, whether the MBE provided a quote, and whether the MBE is being used to meet the MBE participation goal. MBE Firms used to meet the participation goal must be included on the MBE Participation Schedule. Note: If the procurement includes a list of the MBE Firms identified during the goal setting process as potentially available to perform the items of work, the bidder/offeror should solicit all of those MBE Firms or explain why a specific MBE was not solicited. If the bidder/offeror identifies additional MBE Firms who may be available to perform Identified Items of Work, those additional MBE
Firms should also be included below. Copies of all written solicitations and documentation of follow-up calls to MBE Firms must be attached to this form. This list should be accompanied by a Minority Contractor Unavailability Certificate signed by the MBE contractor or a statement from the bidder/offeror that the MBE contractor refused to sign the Minority Contractor Unavailability Certificate (see Exhibit A to MBE Attachment D-1-B). If the bidder/offeror used a Non-MBE or is the identified items of work, Part 3 must be completed. Name of Identified MBE Firm & MBE Classification Describe Item of Work Solicited Initial Solicitation Date & Method Follow-up Solicitation Date & Method Details for Follow-up Calls Quote Rec’d Quote Used Reason Quote Rejected Firm Name: MBE Classification (Check only if requesting waiver of MBE subgoal.) African American-Owned Hispanic American- Owned American-Owned Women-Owned Other MBE Classification ____________________ Date:: Mail Facsimile Email Date: Phone Mail Facsimile Email Time of Call: Spoke With: Left Message Yes No Yes No Used MBE Used Non-MBE Self-performing Firm Name: MBE Classification only if requesting waiver of MBE subgoal.) African Hispanic American- Asian American-Owned Women-Owned MBE Classification ____________________ Date:: Mail Facsimile Email Date: Phone Mail Facsimile Email Time of Call: Spoke With: Left Message Yes No Yes No Used Other MBE Used Non-MBE Self-performing Please check if Additional Sheets are attached.
ATTACHMENT U – MAILING ADDRESSES OF LDSS OFFICES Solicitation Number: OS/CSC-15-001-S LOCAL DEPARTMENT OF SOCIAL SERVICES (LDSS) DIRECTORS Revised as of 3/5/14 LOCAL DEPARTMENT/DISTRICT OFFICE NAME – PHONE# - FAX# ALLEGANY COUNTY DSS One Frederick Street Cumberland, MD 21502-1420 Phone: (301) 784-7099 Phone: (301) 784-7022 Fax: (301) 784-7244 DSS 80 West Street Annapolis, MD Phone: (410) 269-4600 (410) 269-4604 (410) 269-4603 Fax: (410) 974-8566 DSS 1910 N. Broadway Street Baltimore, MD 21213 INTERIM DIRECTOR: DAVID H. THOMPSON Phone: 443-378-4600 Fax: 443-378-4601 Phone: (443) 378-4543 Office - 443-378-4705 Fax - 443-378-4701 Department of Health & Social Services Drumcastle Government Center 6401 York Road Baltimore, MD 21212 M.D., MBA, CPE DEPUTY DIRECTOR FOR SOCIAL SERVICES MARK MILLSPAUGH 410-887-3743 – Office 443-540-9571 - Cell 410-377-9390 - Fax Phone: (410) 853-3984 Fax: (410) 853-3955 COUNTY DIRECTOR: DIRECTOR: COUNTY ASSISTANT DIRECTOR: ASSISTANT DIRECTOR: ASSISTANT ASSISTANT DIRECTOR: DIRECTOR: DIRECTOR:
LOCAL DEPARTMENT/DISTRICT OFFICE NAME – PHONE# - FAX# CALVEET COUNTY DSS 200 Duke Street Prince Frederick, MD 20678 Phone: (443) 550-6999 Fax: (410) 286-7429 (443) 550-6922 Fax: (410) 286-7429 DSS 207 South Third Street Denton, MD G. Phone: (410) 819-4511 (410) 819-4467 Fax: (410) 819-4505 CARROLL COUNTY DSS 1232 Tech Court, Suite 1 Westminster, MD 21157 Phone: (410) 386-3306 Fax: (410) 386-3429 (410) 386-3355 Fax: (410) 386-8939 CECIL DSS 170 East Main Street Elkton, MD Phone: (410) 996-0150 Fax: (410) 996-0464 Phone: (410) 996-0374 Fax: (410) 996-0364 DSS 200 Kent Avenue La Plata, MD, 20646 (301) 392-6601 Fax: (301) -870-3958 Phone: (301) 392-6560 Fax: (301) 753-4353 DSS 627 Race Street Cambridge, MD 21613 INTERIM VICTORIA STANLEY (410) 901-4141 Fax: (410) 901-1047 INTERIM ASSISTANT BLUE (410) 901-4225 Fax: (410) 901-2927 DSS 100 East All Saints Street Frederick, MD 21701 Phone: (301) 600-4599 (301) 600-2403 Fax: (301) 694-4550 DSS 12578 Garrett Highway Oakland, MD 21550 Phone: (301) 533-3025 Phone: (301) 533-3081 Fax: (301) 334-5449 COUNTY COUNTY ROBINSON ASSISTANT ASSISTANT COUNTY ASSISTANT ASSISTANT DIRECTOR: ASSISTANT DIRECTOR: DIANE ASSISTANT DIRECTOR: COUNTY ASSISTANT DIRECTOR: DIRECTOR:
LOCAL DEPARTMENT/DISTRICT OFFICE NAME – PHONE# - FAX# DSS 2 South Bond Street Suite 300 Bel Air, Maryland 21014 W.A.G.E. Connection 975 Beards Hill Road Aberdeen, MD 21001 (410) 836-4955 Phone: (410) 836-4730 Fax: (410) 836-4581 OFFICE MANAGER: ROSALYN TAYLOR 410-297-6250 Fax: (410) 297-6134 HOWARD DSS 7121 Columbia Gateway Drive Columbia, MD 21046 Phone: (410) 410-872-8260 Fax: (410) 872-4200 ELAINE HUTCHISON Phone: (410) 872-8262 Fax: 410-872-4231 KENT DSS 350 High Street, P.O. Box 670 Chestertown, MD Phone: ( 410) 810-7720 Fax (410) 778-2932 FI HANDZO Phone: (410) 810-7621 Fax: (410) 778-9694 MONTGOMERY DHHS 401 Hungerford Drive, Suite 500 Rockville, MD 20850 & INTERIM SOCIAL SERVICES OFFICER : JOANN BARNES ( Fax: (240) 777-1464 “THE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK” LOCAL DEPARTMENT/DISTRICT OFFICE NAME – PHONE# - FAX# DSS 805 MD 20785 Phone: (301) 909-7017 Fax: (301) 909-7012 (FID): (301) 909-7020 Fax: (301) 909-7701 ASSISTANT ASSISTANT