Compliance Intent Form

Collects the submitter's details, project description, and plan for meeting MBE/WBE participation goals on a contract.

Use this template

Page 1

Program Overview

Submitter's Name

Company Name

Email Address

Phone Number

Project Name

Brief Project Description

Name of Primary URA Contact

Summarize how the project/contract will meet the 18% MBE goal and 7% WBE goal

List potential scope areas that can be subcontracted to MWBE firms

Detail engagement and outreach efforts planned to recruit MWBEs

List the names of any MWBEs that will be included as part of the team or invited to bid on work

List any barriers this project/contract might face in trying to meet the MWBE goals

Upload any supporting documents available to support claims of MWBE commitment

Max 10 MB per file

I Hereby Understand

I understand and agree to the terms of this compliance program

Type Name

Date

Signature