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Request for Proposals Bulletin: C'i1y of South Bend Indiana - <br />Project: Constmrction has ectora fog leca�astramctioaa- <br />ofBend x Drive krona Latl ro Street to 1-80 <br />Bridges - Les. No. 1400634 - <br />LaPorte District <br />AFFIRMATIVE ACTION CERTIFICATION <br />I do hereby certify that my company intends to affirmatively seek out and consider Disadvantaged Business <br />Enterprises (DBEs) certified in the State of Indiana to participate as part of this proposal. I acknowledge that this <br />certifications to be made an integral part of this proposal. I understand and agree that the submission of a blank <br />certification may cause the proposal to be rejected. I certify that I have consulted the following DBE website to <br />confirm that the firms listed below are currently certified DBEs: <br />Ines://fiend that lI havemconta/ted�he ctertfied�') L /1 g /c/SOI. APP;S G'�! WB' E.SOl 1�'BE CE '. il. l ?& <br />DBEs listed below, and if my company becomes the CONSULTANT, <br />these DBEs have tentatively agreed to perform the services as indicated. <br />I understand that neither my company nor I will be penalized for DBE utilization that exceeds the goal. After contract <br />award, any change to the firms listed in this Affirmative Action Certification to be applied toward the DBE goal must <br />have prior approval by MDOT's Economic Opportunity Division. <br />SUBCONSULTANTS <br />DICE SUBCONSULTANTS TO BE APPLIED TOWARD GOAL. <br />Certified DBE Name Service Planned <br />McCormick Engineering LLC U 13.1 <br />DBE SUBCONS'UI,TA,NTS To BE USED BEYOND GOAL <br />Certified DBE Name <br />Service Planned <br />Total Percentage Credited toward DBE Goal: /o �° 5 <br />Estimated Percenta a to be Paid to <br />DBE* <br />5% <br />Estimated Percentage to be Paid to <br />DBE* <br />DBE Total Percentage of Voluntary DBE Work Anticipated over DBE Goal: % <br />Name of Company: <br />By: <br />111 <br />Date: December 11 2018 <br />Paul A. Hummel, P.E., Senior Vice President/Senior Civil Engineer <br />*It is understood that these individual firm percentages and dollar amounts are estimates only and that amounts paid <br />may be greater or less as a result of negotiation of the contract scope of work. My firm will use good faith efforts <br />to meet the overall DBE goal through the use of these or other certified and approved DBE firms. <br />Page 1 of I <br />