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(Rev. 06/27/2018) <br />Request for Proposal Number:Des # 1400637 <br />,„ <br />RFP Item Description: Road Pr, canslarr;bon for Obvo $0oel from Prairie Avenue to the railroad south of Tucker Drive <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: )tttps lma�tapi mm:n:dotmmrri gov DBELocato(Z <br />KYTC: htt) s �,/ transLqp tatlolro pyv:il Rohts an&Srn all:B3usinesw DevelcrP Ila f ertiifie d DBE Direct gy a� <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 />I. DBE Subconsultants to be applied toward DBE goal for the RFP item: <br />Certified DBE Name Service Planned Estimated Percentage to be <br />Paid* <br />McCormick Engineering 13. -Construction Inspection 3 % <br />�.... w __._ . <br />f I tit °� <br />i�%�� <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 be <br />Paid* <br />WW ...::. Vi. . . ................. . .... % <br />. .......... <br />m.... <br />- - - - - ----------- - - . . . <br />t <br />F_ <br />0 <br />Estimated Total Percentage Credited toward DBE Goal: 3 0 <br />Estimated Percentage of Voluntary DBE Work Anticipated over DBE Goal: <br />Company Name: American StrUCturepOlnt, Inc. <br />Signature: <br />£, 09/24/2019 <br />! 1Date: <br />*It is understood that these individual 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 />