2004-02-24_REVISION - M1977153 (2)

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STATEMENT OF INTENT TO USE SMALL OR DISADVANTAGBD BUSINESS ENTBRPRISHS (SDHH) All Bidders shall complete the form below for the involvement of SDBES on this project and shall submit the form with their bid. IF THIS FORM IS NOT COMPLETED IN DETAIL, SIGNED AND SUBMITTED WITH THE BID, SUCH BID WILL BE CONSIDERED INFORMAL BY THE BOARD OF WATER COMMISSIONERS AND WILL BE REJECTED. IN DETERMINING IF THE PERSON OR ENTITY SUBMITTING A BID HAS MET THE GOAL(S) OR HAS MADE A GOOD FAITH EFFORT TO MEET THAT GOAL(S), CLARIFICATIONS TO THE STATEMENT n OF INTENT RECEIVED BY 5:00 P.M. ON THE DAY OF BID OPENING WILL BE CONSIDERED TO THE EXTENT THEY CLARIFY, CORRECT OR IDENTIFY SDBES SUBS OR SECOND TIER SUBS THAT COULD HAVE BEEN INCLUDED WITH THE BID. The following SDBES will be utilized: Name Schedule of Values Item No. Type of Work Subcontractor Amount of Contract Supplier Name Schedule of Values Item No. Type of Work Subcontractor Amount of Contract Supplier Name Schedule of Values Item No. Type of Work Subcontractor Amount ofContract Supplier Name Schedule of Values Item No. Type of Work Subcontractor Amount of Contract Supplier By executing this document, the Bidder hereby certifies that it fully intends to employ the SDBES listed on this STATEMENT OF INTENT TO USE SMALL OR DISADVANTAGED BUSINESS ENTERPRISES. Should one or more listed SDBES be deleted after the bid has been submitted or if it becomes necessary to replace an SDBE, the CONTRACTOR MUST FIRST OBTAIN THE APPROVAL OF THE OWNER (See page SDBE-4: Replacement of SDBE). Total Program Participation Achieved: (Signature of Authorized Representative of Bidder) SDBE ~ of Bidder) (Print or type name and title of authorized representative of Bidder) (Address of Bidder) e) (BOARD OF WATER COMMISSIONERS ) (CONSTRUCT SLURRY WALL AROUND ) (HAZELTINE, ROAD RUNNER REST II) (AND BRINKMANN-WOODWARD GRAVEL ) (RESERVOIRS ) (SP 06700A ) BF-6