To be eligible for award of this Agreement/Task Order, the Prime Consultant must fill out and submit, as part of its Statement of Qualifications (SOQ) or response to an Request For Additional Information (RFAI), the following DBE Utilization Plan relating to DBE requirements. The Contracting Agency shall consider as nonresponsive and shall reject any SOQ or response to an RFAI that does not contain a DBE Utilization Plan which properly demonstrates that the Prime Consultant will meet the DBE participation requirements in one of the manners provided in the proposed Agreement/Task Order. The Prime Consultant must submit “Good Faith Effort” (GFE) documentation within 48 hours upon notification of award only in the event the Prime Consultant’s efforts to solicit sufficient DBE participation have been unsuccessful. If submitting a GFE, the Prime Consultant needs to check the GFE Box below, agreeing to submit GFE within 48 hours. The successful Prime Consultant’s DBE Utilization Plan shall be deemed a part of the resulting Agreement/Task Order. Information on certified firms is available from OMWBE, telephone (306) 664-9750 or Toll Free (866) 208-1064.

certifies that the DBE firms listed below have been contacted regarding participation on this project. If this Prime Consultant is successful on this project and is awarded the Agreement/Task Order, it shall assure that sub-consulting agreements are executed with those firms where an “Amount to be Applied Towards Goal” is listed. (If necessary, use additional sheet.)

Name of DBE	Certification No.	Prime Consultant or Sub-consultant	Description of Work	Amount to be Applied Towards Goal*

DBE Sub-consulting Goal:	DBE Total: **

Good Faith Effort (GFE): By checking this GFE box, the Prime Consultant is stating that their attempts to solicit sufficient DBE participation have been unsuccessful and GFE will be submitted within 48 hours of notification of award. Failure to check this box will result in the Prime Consultant’s SOQ or response to the RFAI being deemed nonresponsive.

* See the section “Crediting DBE Participation Toward Meeting the Goal” in the DBE Participation attachment of the Agreement/Task Order.

** The Contracting Agency will utilize this amount to determine whether or not the Prime Consultant has met the goal. In the event of an arithmetic difference between this total and the sum of the individual amounts listed above, then the sum of the amounts listed shall prevail and the total will be revised accordingly. Participation in excess of the goal amount will be considered voluntary or race-neutral participation.