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Standard RFP Form Ver. 8-22-18 <br />(Rev. 06-27-18) <br />Des. #: 1400637 <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 §26.8 1 (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 f have consulted the following DBE websites to confirm that <br />the firms listed below are currently certified DBEs: <br />fNDOT: httlas:// rat<aI I'LS tilIalJn' �Ivll I [I'ocator� <br />KYM —Ll---piiLllllr), -L' <br />3 J,FYI reqQJY.� Ll- 3t�ineqs-Levelo <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 neithet, 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 />Resolution Group 13.1 <br />3% <br />. . . .......... —.- . . .... . ... . .... . ..... % . . ... . . ....... <br />. ............... . ..... . . ....... .. . .......... % <br />.................. % <br />11. DBE Subconsultants to be utilized beyond the advertised DBE goal for the RFP item: <br />Certified DBE Name Service Planned Estimated Percentage to <br />Estimated Perce, <br />be Paid* <br />0 <br />0, <br />0 <br />0 <br />. ..... . . ........ . ..... . ..... % <br />% <br />Estimated Total Percentage Credited toward DBE Goal: 3% <br />Estimated Percentage of Voluntary DBE Work Anticipated over DBE Goal: n/a <br />Company Name: -71 United Consulting <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 />or other certified and approved DBE firms. <br />