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Standard RFP Form Ver. 1/2023 <br />6 <br />(Rev. 06/27/18) <br />Des. #: 2100025 <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 (f). <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: https://entapps.indot.in.gov/DBELocator/ <br />KYTC: https://transportation.ky.gov/Civil-Rights-and-Small-Business-Development/Pages/Certified-DBE-Directory.aspx <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 goal for the RFP item: <br />Certified DBE Name Service Planned Estimated Percentage to <br />be Paid* <br />% <br />% <br />% <br />% <br />II. DBE Subconsultants to be utilized beyond the advertised DBE goal for the RFP item: <br />Certified DBE Name Service Planned Estimated Percentage to <br />be Paid* <br />% <br />% <br />% <br />% <br />Estimated Total Percentage Credited toward DBE Goal:___________ <br />Estimated Percentage of Voluntary DBE Work Anticipated over DBE Goal:__________ <br />Company Name: ____________________________________________________________________ <br />Signature: ___________________________________________ Date: ________________________ <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 />Etica Group, Inc 13.1 Construction Inspection 10 <br />Etica Group, Inc 13.1 Construction Inspection 7 <br />Apex Consulting and Surveying, Inc <br /> 3% <br /> 7 % <br />11/22/2023