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Request for Proposals Bulletin: City of South Bend, Indiana - <br />Project: Construction InsiaLcii <br />ofBendix Drive from q"atiirop S80 <br />Bridges - Des. 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 />11ttl)s:Hfinancia1�rnis.iu, Rovl scl yeast/EMPLOYl—, ;/ERP/c/SOl:., APPS MWBE.SO1 ICI -C 1 1IT C3mmLD?& <br />I certified that I have contacted the certified 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 INDOT's Economic Opportunity Division. <br />SUBCONSULTANTS <br />DBE SUBCONSULTANTS TO BE APPLIED TOWARD GOAL <br />Certified DBE Name Service Planned Estimated Percentage to be Paid to <br />DBE* <br />FMcCormick Engineering LLC 13.1 5% <br />DBE SUBCONSULTANTS TO BE USED BEYOND GOAL <br />Certified DBE Name Service Planned Estimated Percentage to be Paid to <br />DBE* <br />Total Percentage Credited toward DBE Goal: 5 % <br />DBE Total Percentage of Voluntary DBE Work Anticipated over DBE Goal: % <br />Name of Company: <br />Date: _ww 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 1 <br />