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BIDDERS LIST <br />Bidder /Offerer: IFB /RFP No.: <br />THE DEPARTMENT OF TRANSPORTATION REQUIRES THE AUTHORITY TO CREATE AND MAINTAIN A "BIDDERS LIST" <br />CONTAINING INFORMATION ABOUT ALL FIRMS (DBE AND NON -DBE) THAT BID, PROPOSE OR QUOTE ON THE <br />AUTHORITY'S DOT- ASSISTED CONTRACTS, IN ACCORDANCE WITH 49 CFR PART 26.11. THE "BIDDERS LIST" IS <br />INTENDED TO BE A COUNT OF ALL FIRMS THAT ARE PARTICIPATING, OR ATTEMPTING TO PARTICIPATE, ON DOT - <br />ASSISTED CONTRACTS, WHETHER SUCCESSFUL OR UNSUCCESSFUL IN THEIR ATTEMPT TO OBTAIN A CONTRACT. <br />The Bidder /Offerer is to complete all requested information on Form H -3: "Bidders List" for every firm who <br />submitted a bid, proposal or quote, including the primary Bidder /Offerer, and submit this information at the time of <br />bid submission. However, if not elected to do so at the time of bid submission, Bidders /Offerers must submit <br />such information at the request of the Authority within the prescribed timeline set forth in the solicitation. The <br />AUTHORITY will utilize this information to assist in the AUTHORITY's overall annual DBE goal- setting process. <br />Name of Prime's Firm: Phone: ( ) - <br />Firm Address: FAX: () - <br />Type of work/services /materials provided: Number of years in business: Contact Person: Title: Is the firm <br />currently certified as a DBE under 49 CFR Part Check the box below for your firm's annual gross <br />26? No Yes. <br />receipts last year: <br />Less than $1 million <br />DBE Certification Eligibility (place an "X "): <br />African Asian Pacific American Less than $5 million <br />American <br />_Native _Woman Less than $10 million <br />American <br />_Hispanic American _Subcontinent Asian American Less than $15 million <br />Other More than $15 million <br />Enclosure4c Page 2 of 2 <br />19H -52 <br />Page 48 of 48 <br />