OTHER CATEGORIES. DISABLED INDIVIDUAL any person who: - has a physical or mental impairment that substantially limits one or more major life activity(ies) - has a record of such an impairment; or - is regarded as having such an impairment. β’ VIETNAM ERA VETERAN a veteran who served at any time between and including January 1, 1963 and May 7, 1975. β’ GENDER Male (M) or Female (F) PROC-1 (revised 2/2012) Xxxxxx Associates, P.C. 0000 Xxxxxxxx Xxx, Xxxxxxxxx, XX 00000 New York Metropolitan Area 201709_062 Bay Environmental Consulting LLC 000 Xxx Xxx, Xxxxxxx, XX 00000 x Xxxxxx Engineering (MBE) x 00 Xxxxxxx Xxxxxxxxx Xxxxx, Xxxxx 000X Permitting and Environmental/ Ecological Services Engineering Services XXX XXX 11/10/2017 Xxxxxx Associates, P.C. 0000 Xxxxxxxx Xxx, Xxxxxxxxx, XX 00000 Xxx Xxxx Xxxxxxxxxxxx Xxxx 000000_000 Xxxxxx Engineering 0000 Xxxxx 000, X. 000, Xx Xxxx. Station, NY SDVOB Civil Engineering / Building Assessments TBD SACKS (WBE) 00 Xxxxxxxx, Xxxxx 0000, XX, XX 00000 x Community Outreach / Public Participation TBD 11/10/2017 Page3 of 3 Xxxxxx Associates, P.C. 0000 Xxxxxxxx Xxx, Xxxxxxxxx, XX 00000 New York Metropolitan Area 201709_062 Rising Tide Waterfront Solution 000 Xxxxxxx Xxxxxxx, Xxxxx 000 11/10/2017 Section 3 Coastal Engineering, Underwater Inspection TBD REQUEST FOR WAIVER FORM INSTRUCTIONS: SEE PAGE 2 OF THIS ATTACHMENT FOR REQUIREMENTS AND DOCUMENT SUBMISSION INSTRUCTIONS. Offeror/Contractor Name: Federal Identification No.: Address: Solicitation/Contract No.: City, State, Zip Code: M/WBE Goals: MBE % WBE % By submitting this form and the required information, the offeror/contractor certifies that every Good Faith Effort has been taken to promote M/WBE participation pursuant to the M/WBE requirements set forth under the contract.
Appears in 1 contract
Samples: Master Design Contract
OTHER CATEGORIES. DISABLED INDIVIDUAL any person who: - has a physical or mental impairment that substantially limits one or more major life activity(ies) - has a record of such an impairment; or - is regarded as having such an impairment. β’ VIETNAM ERA VETERAN a veteran who served at any time between and including January 1, 1963 and May 7, 1975. β’ GENDER Male (M) or Female (F) PROC-1 (revised 2/2012) Xxxxxx AssociatesM/WBE Utilization Plan Inquiry No. 201711_065 1. Certified M/WBE Suppliers/Subcontractors Name, Address, Email Address, Telephone No. 2. Classification 3. Federal ID No. 4. Detailed Description of Work 5. Dollar value of Subcontracts/Supplies/Services and intended performance dates of each component of the contract EnTech Engineering, PC Construction Inspection $476,784 1/1/19 to 12/31/2020 00 Xxxxx Xxxxxx, 00xx Xxxxx XXX ESD Certified New York, NY 10004 π MBE Xxxxx Xxxxx, PE, President KS Engineers, P.C. 0000 Xxxxxxxx Xxx, Xxxxxxxxx, XX 00000 New York Metropolitan Area 201709_062 Bay Environmental Consulting LLC 000 Xxx Xxx, Xxxxxxx, XX 00000 x Xxxxxx Engineering (MBE) x 00 Xxxxxxx Xxxxxxxxx Xxxxx, Xxxxx 000X Permitting and Environmental/ Ecological Services Engineering Services XXX XXX 11/10/2017 Xxxxxx Associates, P.C. 0000 Xxxxxxxx Xxx, Xxxxxxxxx, XX 00000 Xxx Xxxx Xxxxxxxxxxxx Xxxx 000000_000 Xxxxxx Engineering 0000 Xxxxx 000, X. 000, Xx Xxxx. Station, NY SDVOB Civil Engineering / Building Assessments TBD SACKS (WBE) Administration; Inspection; Drafting $652,492 1/1/19 to 12/31/2020 00 Xxxxxxxx, Xxxxx 00000000 XXX ESD Certified New York, XXNY 10006 πΉ MBE Xxxxx Xxxxxx, XX 00000 x Community PE, President π WBE Certified Safety of NY, LLC Site Safety Inspection $313,400 1/1/19 to 12/31/2020 00 Xxxxxxxxx Xxxxxx XXX ESD Certified White Plains, NY 10603 π MBE Xxxxxx Xxxxxxxx, Executive Vice President Highland Planning LLC Public Outreach / Public Participation TBD 11/10/2017 Page3 of 3 1/1/19 to 12/31/2020 000 Xxxxx Xxxxxxx Xxxxxx Associates#0 XXX ESD Certified Rochester, P.C. 0000 Xxxxxxxx Xxx, Xxxxxxxxx, XX 00000 New York Metropolitan Area 201709_062 Rising Tide Waterfront Solution 000 Xxxxxxx NY 14620 π MBE Xxxxx Xxxxx Xxxxxxx, Xxxxx 000 11/10/2017 Section 3 Coastal AICP Prudent Engineering, Underwater Inspection LLP Hydrographic Survey TBD 1/1/19 to 12/31/2020 6390 Fly Road NYS ESD Certified East Syracuse, NY 13057 πΉ MBE Xxxxxx Xxxxxxxxxx, PE, Principal in Charge REQUEST FOR WAIVER FORM INSTRUCTIONS: SEE PAGE 2 OF THIS ATTACHMENT FOR REQUIREMENTS AND DOCUMENT SUBMISSION INSTRUCTIONS. Offeror/Contractor Name: Federal Identification No.: Address: Solicitation/Contract No.: City, State, Zip Code: M/WBE Goals: MBE % WBE % By submitting this form and the required information, the offeror/contractor certifies that every Good Faith Effort has been taken to promote M/WBE participation pursuant to the M/WBE requirements set forth under the contract.
Appears in 1 contract
Samples: Contract for Services
OTHER CATEGORIES. DISABLED INDIVIDUAL any person who: - has a physical or mental impairment that substantially limits one or more major life activity(ies) - has a record of such an impairment; or - is regarded as having such an impairment. β’ VIETNAM ERA VETERAN a veteran who served at any time between and including January 1, 1963 and May 7, 1975. β’ GENDER Male (M) or Female (F) PROC-1 (revised 2/2012) Xxxxxx AssociatesM/WBE Utilization Plan Inquiry No. 201711_065 1. Certified M/WBE Suppliers/Subcontractors Name, Address, Email Address, Telephone No. 2. Classification 3. Federal ID No. 4. Detailed Description of Work 5. Dollar value of Subcontracts/Supplies/Services and intended performance dates of each component of the contract EnTech Engineering, PC Construction Inspection $476,784 1/1/19 to 12/31/2020 00 Xxxxx Xxxxxx, 00xx Xxxxx NYS ESD Certified Xxx Xxxx, XX 00000 β‘ MBE Xxxxx Xxxxx, PE, President KS Engineers, P.C. Administration; Inspection; Drafting $652,492 1/1/19 to 12/31/2020 00 Xxxxxxxx, Xxxxx 0000 Xxxxxxxx XxxXXX XXX Certified Xxx Xxxx, XX 00000 β MBE Kamal Shahid, PE, President β‘ WBE Certified Safety of NY, LLC Site Safety Inspection $313,400 1/1/19 to 12/31/2020 00 Xxxxxxxxx Xxxxxx NYS ESD Certified Xxxxx Xxxxxx, XX 00000 β‘ MBE Xxxxxx Xxxxxxxx, Executive Vice President Highland Planning LLC Public Outreach TBD 1/1/19 to 12/31/2020 000 Xxxxx Xxxxxxx Xxxxxx #0 XXX XXX Certified Xxxxxxxxx, XX 00000 New York Metropolitan Area 201709_062 Bay Environmental Consulting LLC 000 β‘ MBE Xxxxx Xxxxx Xxxxxxx, AICP Prudent Engineering, LLP Hydrographic Survey TBD 1/1/19 to 12/31/2020 0000 Xxx Xxx, XxxxxxxXxxx XXX XXX Xxxxxxxxx Xxxx Xxxxxxxx, XX 00000 x β MBE Xxxxxx Engineering (MBE) x 00 Xxxxxxx Xxxxxxxxx XxxxxXxxxxxxxxx, Xxxxx 000X Permitting and Environmental/ Ecological Services Engineering Services XXX XXX 11/10/2017 Xxxxxx AssociatesPE, P.C. 0000 Xxxxxxxx Xxx, Xxxxxxxxx, XX 00000 Xxx Xxxx Xxxxxxxxxxxx Xxxx 000000_000 Xxxxxx Engineering 0000 Xxxxx 000, X. 000, Xx Xxxx. Station, NY SDVOB Civil Engineering / Building Assessments TBD SACKS (WBE) 00 Xxxxxxxx, Xxxxx 0000, XX, XX 00000 x Community Outreach / Public Participation TBD 11/10/2017 Page3 of 3 Xxxxxx Associates, P.C. 0000 Xxxxxxxx Xxx, Xxxxxxxxx, XX 00000 New York Metropolitan Area 201709_062 Rising Tide Waterfront Solution 000 Xxxxxxx Xxxxxxx, Xxxxx 000 11/10/2017 Section 3 Coastal Engineering, Underwater Inspection TBD Principal in Charge REQUEST FOR WAIVER FORM INSTRUCTIONS: SEE PAGE 2 OF THIS ATTACHMENT FOR REQUIREMENTS AND DOCUMENT SUBMISSION INSTRUCTIONS. Offeror/Contractor Name: Federal Identification No.: Address: Solicitation/Contract No.: City, State, Zip Code: M/WBE Goals: MBE % WBE % By submitting this form and the required information, the offeror/contractor certifies that every Good Faith Effort has been taken to promote M/WBE participation pursuant to the M/WBE requirements set forth under the contract.
Appears in 1 contract
Samples: Contract for Services
OTHER CATEGORIES. DISABLED INDIVIDUAL any person who: - has a physical or mental impairment that substantially limits one or more major life activity(ies) - has a record of such an impairment; or - is regarded as having such an impairment. β’ VIETNAM ERA VETERAN a veteran who served at any time between and including January 1, 1963 and May 7, 1975. β’ GENDER Male (M) or Female (F) PROC-1 (revised 2/2012) ATTACHMENT 1 1. Certified M/WBE Subcontractors/Suppliers 2. Classification 3. Federal ID No. 4. Detailed Description of Work (Attach additional sheets, ifnecessary) 6. Dollar Value of Subcontracts /Supplies/Services and intended performance dates of each A. America Science Team New York, Inc. 000 Xxxx 00xx Xxxxxx Associates, P.C. 0000 Xxxxxxxx Xxx, XxxxxxxxxXxx Xxxx, XX 00000 New York Metropolitan Area 201709_062 Bay X _ NYS ESD Certified MBE WBE Environmental Consulting LLC 000 Testing/ Laboratory Testing Services for Asbestos $30,000 2.00% B. Chrysalis Archaeological Consultants, Inc. 0000 Xxxxxxx Xxxx Brooklyn, NY 11234 _ X NYS ESD Certified MBE WBE Historic & Archaeological Resources $45,000 3.00% C. CSA Group Architects and Engineers P.C. 00 Xxxxxxxx, 00xx Xxxxx, Xxx Xxx, XxxxxxxXxxx, XX 00000 x X _ NYS ESD Certified MBE WBE Environmental Review $135,000 9.00% D. Environmental Management and Design Services, Inc. 00 Xxxx Xxxxx Xxxxx #000 Xxxxxxxxxx, XX 0000 X _ XXX ESD Certified MBE WBE Environmental Site Assessments $60,000 4.00% E. EMSL Analytical, Inc. 000 Xxxx 00xx Xxxxxx Engineering (MBE) x 00 Xxxxxxx Xxxxxxxxx Xxxxx, Xxxxx 000X Permitting and Environmental/ Ecological Services Engineering Services XXX XXX 11/10/2017 Xxxxxx Associates, P.C. 0000 Xxxxxxxx Xxx, XxxxxxxxxXxx Xxxx, XX 00000 Xxx Xxxx Xxxxxxxxxxxx Xxxx 000000_000 Xxxxxx Engineering 0000 Xxxxx 000, _ _ NYS ESD Certified MBE WBE Environmental Testing/ Laboratory Testing Services for Lead and Radon $30,000 2.00% X. 000, Xx Xxxx. Station, NY SDVOB Civil Engineering / Building Assessments TBD SACKS (WBE) 00 Xxxxxxxxxx & Xxxxxxxx, Xxxxx 0000, XXInc. 000 Xxxxxx Xxxxxx Xxxxxxxx, XX 00000 x Community Outreach / Public Participation TBD 11/10/2017 Page3 of 3 _ X NYS ESD Certified MBE WBE Environmental Review and Wetlands Delineations $135,000 9.00% G. First Environment, Inc. 00 Xxxxxxx Xxxxxx Associates, P.C. 0000 Xxxxxxxx Xxx, XxxxxxxxxXxx Xxxx, XX 00000 New York Metropolitan Area 201709_062 Rising Tide Waterfront Solution _ _ NYS ESD Certified MBE WBE Environmental Site Assessments $90,000 6.00% X. Xxxxxxx Xxxxx and Associates, Inc. 000 Xxxxxxx XxxxxxxXxxxxxxx Xxxxxx Xxxx, Xxxxx 000 11/10/2017 Section 3 Coastal EngineeringXxxx X, Underwater Inspection TBD REQUEST FOR WAIVER FORM Xxxxxxxx, XX 00000 _ X NYS ESD Certified MBE WBE Historic & Archaeological Resources $45,000 3.00% Name, Address, Email Address, Telephone No. M/WBE UTILIZATION PLAN INSTRUCTIONS: SEE PAGE 2 OF THIS ATTACHMENT FOR REQUIREMENTS AND DOCUMENT SUBMISSION INSTRUCTIONSThis form must be submitted with any bid, proposal, or proposed negotiated contract or within a reasonable time thereafter, but prior to contract award. This Utilization Plan must contain a detailed description of the supplies and/or services to be provided by each certified Minority and Women-owned Business Enterprise (M/WBE) under the contract. Attach additional sheets if necessary. Offeror/Contractor βs Name: Federal Identification No.Number: Address: Solicitation/Contract No.Solicitation Number: City, State, Zip Code: Telephone Number: Region/Location of Work: M/WBE GoalsGoals in the Contract: MBE % WBE % By submitting this form and the required information, the offeror/contractor certifies that every Good Faith Effort has been taken to promote M/WBE participation pursuant to the M/WBE requirements set forth under the contract.%
Appears in 1 contract
Samples: Contract for Services
