Www.dot.ny.gov



MWBE Pre-Letting Waiver Request

| |Facility (if applicable): |

|Project Description: |Contract Value: |

| |Contract Term: |

|Agency contact information: | |

|Name: | |

|Email: | |

|Phone number: | |

| | |

|Description: |

|Reason for Request: |

|Recommended Goal: MBE___% WBE___% |

Requests for M/WBE goal(s) with the PS&E submission require prior approval from the Office of Civil Rights, submission of an in-depth justification for the request and a contract goal assessment. The contract goal assessment should include the following:

a) A review of the standard goals established in the Goal Details table in the Annual Minority and Women Owned Business Program Goal Plan.

b) The contract and subcontract scope(s) of work. This should include a consideration of work items, quantity, contract terms, and materials.

c) The potential subcontract opportunities available in the prime contract. This should include a consideration of primary and secondary work operations.

d) The relevant availability data contained within the disparity study with respect to the scope of the contract and potential subcontracting opportunities.

e) The number and types of certified minority- and women-owned business enterprises found in the directory of certified minority- and women-owned businesses available to perform the State contract work.

f) The geographic location of the contract performance.

g) The extent to which geography is material to the performance of the contract.

h) The ability and willingness of certified minority- and women-owned enterprises located outside of the geographic location of contract performance, notwithstanding the regional location of the certified enterprise, to perform on the State contract.

i) The total dollar value of the work required by the State contract in relation to the dollar value of the subcontracting opportunities.

j) The relationship of the monetary size and term of the State contract to the monetary size and term of the project for which the State contract is awarded.

The Office of Civil Rights does/does not concur with the recommendation. Upon further consideration and review, the Office of Civil Rights recommends the contract goal(s) shall be as follows:

MBE: % WBE: %

______________________________ __________________________

Director, Office of Civil Rights Date

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