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(Rev.06/27/2018) <br />Request for Proposal Number: <br />RFP Item Description: Corby/Ironwood/Rockne Intersection Improvement, City of South Bend <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) <br />certified by the State of Indiana's DBE Program and the Kentucky Transportation Cabinet (KYTC) DBE Program to participate as <br />part of this proposal. An Agreement between INDOT and KYTC established reciprocal acceptance of certification of DBE firms in <br />their respective states under the Unified Certification Program (UCP) pursuant to 49 CFR §26.81(e) and (f). <br />I acknowledge that this certification is to be made an integral part of this proposal. I understand and agree that the submission <br />of a blank certification may cause the proposal to be rejected. I certify that I have consulted the following DBE websites to <br />confirm that the firms listed below are currently certified DBEs: <br />INDOT: I�� s�:f nLtarios,indot.in.gov/DBELc)catorI <br />KYTC: hLtps,.J traq§9 rtatio .lkky-_Fo L iivi R hts-and-Small-BLuSilless-Devein Bent f�� C:ertifled-DBE-Di�rccIory.aspx <br />I certify that I have contacted the certified DBEs 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 <br />be applied toward the DBE goal must have prior approval by INDOT's Economic Opportunity Division. <br />*It is understood that these indav dbal firm percentages are estimates only and that percentages paid may be greater or less as a result of <br />negotiation of the contract scope of work. My company 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 />