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Standard RFP Form Ver. 8-22-18 <br />(Rev. 06/27/18) <br />Des. #: 1801240 <br />Affirmative Action Certification (AAC) for Disadvantaged Business Enterprises (DBE) <br />I hereby certify that my company intends to affirmatively seek out and consider Disadvantaged Business Enterprises (DBEs) certified <br />by the State of Indiana's DBE Program and the Kentucky Transportation Cabinet (KYTC) DBE Program to participate as part of this <br />proposal. An Agreement between INDOT and KYTC established reciprocal acceptance of certification of DBE firms in their <br />respective states under the Unified Certification Program (UCP) pursuant to 49 CFR §26.81(e) and (I). <br />I acknowledge that this certification is to be made an integral part of this proposal. I understand and agree that the submission of a <br />blank certification may cause the proposal to be rejected. I certify that I have consulted the following DBE websites to confirm that <br />the firms listed below are currently certified DBEs: <br />INDOT: Ittltllas°/ie nlal s.indot.in i)v/D1ImE orator/" <br />KYTC: 11t1�ti:/JtM atatn�gtortatiaaxt.0 .ors/( r,+IN j%gitts t��c9 SattWtl� l'tt�r�ca)arNt1a �ttfl`'aCe� taidktl lmm'11i)tttrr;1 it <br />I certify that I have contacted the certified DBE's listed below, and if my company becomes the CONSULTANT, these DBEs have <br />tentatively agreed to perform the services as indicated. I understand that neither my company nor I will be penalized for DBE <br />utilization that exceeds the goal. After contract award, any change to the firms listed in this Affirmative Action Certification to be <br />applied toward the DBE goal must have prior approval by INDOT's Economic Opportunity Division. <br />I. DBE Subconsultants to be applied toward DBE coal for the RFP item: <br />II. DBE Subconsultants to be utilized beyond the advertised DBE goal for the RFP item: <br />Estimated Total Percentage Credited toward DBE Goal: y/ <br />Estimated Percentage of Voluntary DBE Work Anticipated over DBE Goal: 0% <br />Company Name: _ Shrewsberry & Associate-,,, LL.C. <br />Signature: Date _17 January 20 1_._ <br />* It is understood that these individual firm percentages are estimates only and that percentages paid may be greater or less as a result <br />of negotiation of contract scope of work. My firm will use good faith efforts to meet the overall DBE goal through the use of these <br />or other certified and approved DBE firms. <br />6 <br />i <br />