Bid Response Form

SEPTA SOLICITATION STATISTICS

In accordance with Federal Regulation 49 CFR part 26.11, SEPTA must maintain bidding statistics on all contractors and subcontractors bidding on contracts. Please include copies of this form with your bid/proposal package to any subcontractors/subconsultants. You are required to return the form for each bidder/proposer with your bid/proposal package. This applies to both disadvantaged business enterprises (DBEs) and non- DBEs (a DBE is a firm which meets the certification criteria set forth in 49 CFR part 26).

Thank you for your assistance with this request. If you should have any questions, comments or suggestions, please contact SEPTA’s DBE Program Office at 215-580-7278, or via email at DBEProgram@septa.org.

The information gathered on this form will be used for statistical purposes only and is set forth under 49 CFR part 26.

Firm Name:

Firm Address:

Description of Services:

NAICS Codes:

(www.census.gov/epcd/www/naics.html)

Status:

DBESBEOBE

Month/Year firm established:

Company Owner(s) Ethnic Group Membership: (optional)

Black

Hispanic

Native American

Asian Pacific

Subcontinent Asian

Other (specify)

Annual Gross Receipts of the Firm: (check one)

Project Name:

Bid Number:

Name:

Date:

Title:

Telephone No.:

Facsimile No.:

Email Address:

I acknowledge all the information provided on this form is complete and accurate.

Less than $500,000	$500,000 - $1 Million
$1 Million - $5 Million	$5 Million - $10 Million
$10 Million - $20 Million	Above $20 Million