Summer Food Service Program_IFB - Chicago Park District

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SCHEDULE A Statement of Prime Submitter Regarding Its MBE/WBE Utilization Plan TO BE COMPLETED BY SUBMITTER ONLY Submitter: ______________________________________ Project: Is the submitter a certified MBE/WBE? MBE: Yes No WBE: Yes No If yes, attach all current Letters of Certification. NOTE: CERTIFICATION OF THE SUBMITTER AS AN MBE SATISFIES ONLY THE MBE GOAL; THE WBE GOAL MUST STILL BE MET. CERTIFICATION OF THE SUBMITTER AS A WBE SATISFIES ONLY THE WBE GOAL; THE MBE GOAL MUST STILL BE MET. CERTIFICATION OF THE SUBMITTER AS BOTH MBE AND WBE MAY SATISFY ONE GOAL ONLY. The submitter intends to perform work in connection with this project as a: GENDER: RACE/ETHNICITY: TYPE OF FIRM: Male Black/African American Partnership Female Hispanic American Sole Proprietorship Asian American Corporation White American Joint Venturer Other Other All MBE/WBE firms included in the following plan must be certified as such by a public or private organization such as the City of <strong>Chicago</strong>, <strong>Chicago</strong> Minority Supplier Development Council (CMSDC), Women Business Development Center (WBDC), and the Small Business Administration. I. Participation of MBE/WBE Firms In determining the manner of MBE/WBE participation in the performance of this contract, the submitter shall consider involvement with MBE/WBE firms as joint venture partners, subcontractors, and suppliers of goods and services, either directly or indirectly. A. If submitter is a joint venturer and one or more joint venture partners are certified MBEs or WBEs, attach copies of Letters of Certification and a copy of the Joint Venture Agreement clearly describing the role of the MBE/WBE firm(s) and its ownership interest in the joint venture. B. Proposing MBE/WBE subcontractors/suppliers/consultants to perform work or supply goods or services not directly related to the performance of this contract is considered to be indirect participation. MBE/WBE Subcontractors/Suppliers/Consultants: 1. Name of MBE/WBE: Address: Contact Person: E-mail: ______________________________________________ Phone: Fax: _______________________ MBE/WBE Participation: Dollars $ Percent: % Will this subcontractor be used for direct or indirect participation? (circle one) Schedule B and all current certification letters attached? Yes No 76
2. Name of MBE/WBE: Address: Contact Person: E-mail: ______________________________________________ Phone: Fax: _______________________ MBE/WBE Participation: Dollars $ Percent: % Will this subcontractor be used for direct or indirect participation? (circle one) Schedule B and all current certification letters attached? Yes No 3. Name of MBE/WBE: Address: Contact Person: E-mail: ______________________________________________ Phone: Fax: _______________________ MBE/WBE Participation: Dollars $ Percent: % Will this subcontractor be used for direct or indirect participation? (circle one) Schedule B and all current certification letters attached? Yes No 4. Name of MBE/WBE: Address: Contact Person: E-mail: ______________________________________________ Phone: Fax: _______________________ MBE/WBE Participation: Dollars $ Percent: % Will this subcontractor be used for direct or indirect participation? (circle one) Schedule B and all current certification letters attached? Yes No 5. Name of MBE/WBE: Address: Contact Person: E-mail: ______________________________________________ Phone: Fax: _______________________ MBE/WBE Participation: Dollars $ Percent: % Will this subcontractor be used for direct or indirect participation? (circle one) Schedule B and all current certification letters attached? Yes No 77
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SECTION A SUMMER FOOD SERVICE PROGR
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SECTION C INSTRUCTIONS TO BIDDERS 1
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SECTION D SCOPE OF SERVICES 1. Cont
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• Date of production • Quantity
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whichever occurs last, through __Fe
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SECTION G GENERAL PROVISIONS 1. Thi
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Exhibit A - Program Sites Name and
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Page 25 and 26: Exhibit A - Program Sites Name and
Page 57 and 58: EXHIBIT B - MENUS Sponsor shall att
Page 59 and 60: EXHIBIT C REQUIRED MEAL PATTERNS SU
Page 61 and 62: GROUP E • Cookies 1 , with nuts,
Page 63 and 64: Bidder Responsibility and Bid Respo
Page 65 and 66: Bid-Rigging Certification _________
Page 67 and 68: DISCLOSURE OF LOBBYING ACTIVITIES C
Page 69 and 70: DISCLOSURE OF LOBBYING ACTIVITIES C
Page 71 and 72: P. The term “schedules” means t
Page 73 and 74: their Schedule Bs. The Park Distric
Page 75: 1. SCHEDULE A [STATEMENT OF PRIME B
Page 79 and 80: II. Summary of MBE/WBE Plan: A. MBE
Page 81 and 82: ALTERNATE SCHEDULE A SIGNATURE PAGE
Page 83 and 84: MBE/WBE UTILIZATION REPORTING REQUI
Page 85 and 86: SUSTAINABILITY STATEMENT Attach add
Page 87 and 88: 5. Tax identification number (optio
Page 89 and 90: 5. IF THE UNDERSIGNED IS ANY OTHER
Page 91 and 92: If the letters "NA," the word "None
Page 93 and 94: If the letters "NA," the word "None
Page 95 and 96: segregated by explicit directive or
Page 97 and 98: EDS CERTIFICATION Under penalty of
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Summer Food Service Program_IFB - Chicago Park District

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