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NOTICE TO DESIGN/OTHER CONSULTANTS Bidder’s List of Quoters Collection Form The term “Quoter” shall include subcontractors and suppliers of materials with whom the Contractor contracts directly. Project Name: ___________________________________________________________________ Project No.: ___________________________________________________________ Bidder/Contractor Name: _______________________________ Address: ___________________________________ Telephone#: ________________ Email:___________________ LISTING OF QUOTERS FIRM NAME, ADDRESS PHONE NUMBER DESCRIPTION OF WORK Dollar Amt. of Bid Proposal Will Firm Be Used DBE OR NON- DBE STATUS AGE OF FRIM ANNUAL GROSS RECEIPTS Name: ______________________________ Address:____________________________ _________________________________ Phone No.: __________________________ Email________________________________ ___ Yes ___ No DBE NON-DBE ___ Less than 1 year ___ 1 – 3 years ___ 4 – 7 years ___ 8 – 10 years ___ more than 10 years ___ Less than $500K ___ $500K - $1M ___ $1-2M ___ $2-5M ___ Greater than $5M Name: ______________________________ Address:_____________________________ _________________________________ Phone No.: __________________________ Email________________________________ ___ Yes ___ No DBE NON-DBE ___ Less than 1 year ___ 1 – 3 years ___ 4 – 7 years ___ 8 – 10 years ___ more than 10 years ___ Less than $500K ___ $500K - $1M ___ $1-2M ___ $2-5M ___ Greater than $5M APPENDIX C FORM BLDC / DBE C In accordance with 49 CFR Part 26, the Department of Public Works (DPW) will establish it Annual DBE goal using a Bidders List. The Bidders List will be a compilation of all quotes received by the Design/Other Consultants during the advertising period. The Bidders List will be used to determine the relative availability of DBEs. At the time the bid is submitted to the Contracting Officer/DPW, the Design/Other Consultants shall list, on Form BLCC, the quotes received for the project, using additional sheets as necessary. The listing shall include EACH quoter’s name, address, telephone number, age of firm, annual gross receipts of the firm and whether the quoter is a Virgin Islands certified DBE. FAILURE TO COMPLY WITH THIS REQUIREMENT SHALL RENDER A BID NON-RESPONSIVE AND THE BID SHALL BE REJECTED. LISTING OF QUOTERS (attach additional sheets if necessary) The undersigned hereby declares that the information set forth on this form is current, complete and accurate. Authorized Signature: ________________________________________ Date: _____________________ Printed Name: _____________________________________________ Title: ______________________ FIRM NAME, ADDRESS PHONE NUMBER DESCRIPTION OF WORK Dollar Amt. of Bid Proposal Will Firm Be Used DBE OR NON- DBE STATUS AGE OF FRIM ANNUAL GROSS RECEIPTS Name: _________________________________ Address:________________________________ _________________________________ Phone No.: ______________________________ Email____________________________________ ___ Yes ___ No DBE NON-DBE ___ Less than 1 year ___ 1 – 3 years ___ 4 – 7 years ___ 8 – 10 years ___ more than 10 years ___ Less than $500K ___ $500K - $1M ___ $1-2M ___ $2-5M ___ Greater than $5M Name: __________________________________ Address:_________________________________ _________________________________ Phone No.: _______________________________ Email____________________________________ ___ Yes ___ No DBE NON-DBE ___ Less than 1 year ___ 1 – 3 years ___ 4 – 7 years ___ 8 – 10 years ___ more than 10 years ___ Less than $500K ___ $500K - $1M ___ $1-2M ___ $2-5M ___ Greater than $5M Name: ___________________________________ Address:_________________________________ _________________________________ Phone No.: _______________________________ Email_____________________________________ ___ Yes ___ No DBE NON-DBE ___ Less than 1 year ___ 1 – 3 years ___ 4 – 7 years ___ 8 – 10 years ___ more than 10 years ___ Less than $500K ___ $500K - $1M ___ $1-2M ___ $2-5M ___ Greater than $5M