Metropolitan Development

METROPOLITAN DEVELOPMENT

AND HOUSING AGENCY

VENDOR APPLICATION FORM

DIVERSITY BUSINESS ENTERPRISE PROGRAM

Metropolitan development and housing agency

Complete and MAIL REGISTRATION FORM TO:
metropolitan development and housing agency
C/O Ron Chenault
712 South Sixth Street
nASHVILLE, TENNESSEE 37206
IMPORTANT! NOTARY AND COPY OF CERTIFICATION REQUIRED FOR CLAIMING MINORITY, WOMEN, SMALL BUSINESS ENTERPRISE STATUS /
BUSINESS
Federal Id #
______
Date______

______

firm name: ______

phone: (_____)______fax: (_____)______

mailing address: ______

______

______

email address: ______

contacts in firm (for inquiries): ______

______

# years in business under present name: ______

# years performing work specialty: ______

total bonding capacity $ ______

surety: ______Bond rate:______

has firm: failed to complete a contract? ______

been involved in bankruptcy or reorganization? ______

pending judgment claims or suits against it? ______

if answer to any of the preceding is yes, submit details on separate sheet.

your contractor licensing number: ______

licensing state: ______

license classifications: ______

home improvement license #: ______

expiration date: ______

DIVERSITY INFORMATION

Is your company 51% Owned or Operated by a Minority Group? Yes ___ No___

If yes, check the ethnic category and indicate % of ownership:

American Indian/Alaskan Native _____%

African American _____%

Hispanic _____%

Asian/Pacific Islander _____%

Other ____% ______(please indicate)

Is your company 51% Owned or Operated by Women? Yes ______% No___

Is your company certified as a minority, small, or women-owned business

by an agency or association? Yes___ No___

If yes, please name the entity of certification: ______

Please provide copy of certification letter or certificate

* Must have certification to be recognized as MBE, WBE, or SBE status with MDHA.

Has your company worked on a previous project for MDHA before: Yes___ No___

If yes what year?______What Project ______and what your role/and or what services did you provide? ______

have you been involved in any litigation with any public agency including the state of TENNESSEE? ______(y) ______(n) if yes, explain.

i, hereby certify that the above information is true and complete to the best of my knowledge.

signature: ______

Officer of the Firm

name: ______title: ______

type of firm: (_____) corporation

(_____) partnership

(_____) Limited liability

(_____) sole proprietor

NOTARY ACKNOWLEDGEMENT:

STATE OF______)

COUNTY OF______)

ON______,20____, BEFORE ME,______,

PERSONALLY APPEARED______, PERSONALLY KNOWN TO ME (OR PROVED TO ME ON THE BASIS OF SATISFACTORY EVIDENCE) TO BE THE PERSON(S)WHOSE NAME(S) IS/ARE SUBSCRIBED TO THE WITHIN INSTRUMENT AND ACKNOWLEDGED TO ME THAT HE/SHE/ THEY EXECUTED THE SAME IN HIS/HER/THEIR AUTHORIZED CAPACITY(IES), AND THAT BY HIS/HER/THEIR SIGNATURE(S) ON THE INSTRUMENT THE PERSON(S), OR THE ENTITY UPON BEHALF OF WHICH THE PERSON (S) ACTED, EXECUTED THE INSTRUMENT.

WITNESS MY HAND AND OFFICIAL SEAL.

SIGNATURE OF NOTARY:______

PRINTED FULL NAME OF NOTARY:______

MY COMMISION EXPIRES:______

Definitions For Determining Minority, Women And Small-Owned Firms

The guidelines for determining minority, women and small-owned firms are defined as follows:

“MINORITY” means a person who is a citizen or lawful permanent resident of the United States and who is:

o  Black (a person having origins in any of the black racial groups of Africa);

o  Hispanic (a person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race);

o  Asian American (a person having origins in any of the original peoples of the Far East, Southeast

o  Asia, the Indian subcontinent, or the Pacific Islands); or

o  American Indian and Alaskan Native (a person having origins in any of the original peoples of North America).

“MINORITY BUSINESS ENTERPRISE” shall mean a minority business:

A continuing, independent, for profit business which performs a commercially useful function, and is at least 51 percent owned and controlled by one or more minority individuals; or, in the case of any publicly owned business, at least 51 percent of the stock of which is owned and controlled by one or more minorities. Whose management and daily business operations are controlled by one or more of minority individuals. “Control” as used in the above clause, means exercising the power to make policy decision. “Operate," as used in the above clause, means being actively involved in the day-to-day management of the business.

“WOMEN BUSINESS ENTERPRISE” shall mean women business:

A continuing, independent, for profit business which performs a commercially useful function, and which is at least 51 percent owned and controlled by one or more women; or, in the case of any publicly owned business, at least 51 percent of the stock of which is owned and controlled by one or more women. Whose management and daily business operations are controlled by one or more of such individuals. “Control” as used in the above clause, means exercising the power to make policy decision. “Operate," as used in the above clause, means being actively involved in the day-to-day management of the business.

SMALL BUSINESS ENTERPRISE AS DEFINED IN SECTION 4.44.010 OF THE METROPOLITAN CODE OF LAWS;

A Small Business satisfies all of the following criteria:

(a)  A United States business which is independently owned and operated, and which is not dominant in its field of operation or an affiliate or subsidiary of a business dominant in it’s field of operation.

(b)  Either has no more than the following number of employees or has no more than the following annual sales volume for the applicable industry; and

INDUSTRY / ANNUAL SALES VOLUME / MAXIMUM NUMBER OF EMPLOYEES*
Agriculture, Forestry, Fishing / $500,000 / 9
Architectural/Design/Engineering / $2,000,000 / 30
Construction / $2,000,000 / 30
Educational / $1,000,000 / 9
Finance, Insurance, Real Estate / $1,000,000 / 9
Information Systems/Technology / $2,000,000 / 30
Manufacturing / $2,000,000 / 99
Marketing/Communications/Public Relations / $2,000,000 / 30
Medical/Healthcare / $2,000,000 / 30
Mining / $1,000,000 / 49
Retail Trade / $750,000 / 9
Service Industry / $500,000 / 9
Transportation, Commerce and Utilities / $1,000,000 / 9
Wholesale Trade / $1,000,000 / 19

(c)  Meets the following additional criteria:

1.  Has demonstrated capability to perform independently a substantial portion of the contract they seek, or a substantial portion or the subcontract for which they are proposed by a bidder or offeror, as specified by the Purchasing Agent;

2.  Not share or jointly use office space, production, marketing and sales, business support systems, personnel, or equipment with any business not classified by Metro as a small business (i.e., a large business);

3.  Has existed as a legal business entity for a minimum of one year (twelve months of continuous business enterprise), performing independently and satisfactorily and achieving a minimum of $35,000.00 sales income (collected sales dollars not simply booked sales);

4.  Not to be owned, controlled, or directed by individuals or groups of individuals who own, control or direct a large business involved in the same category of work as the business for which small business status is sought;

5.  If a supplier, be an authorized regular distributor with normal wholesale agreements for the Product or products to be supplied; and

6.  If a construction contractor, be licensed as required by the state to perform the work for which it has submitted a bid or has been proposed by a prime as a subcontractor.

*NOTE: Employee means a person (or persons) employed on a full-time (or full-time equivalent), a permanent basis. Full-time equivalent includes employees who work 30 hours per week or more. Full-time equivalent also includes the aggregate of employees who work less than 30 hours a week, where the work hours of such employees add up to at least 40 hour work week. The totality of the circumstances, including factors relevant for tax purposes, will determine whether persons are employees of a concern. Temporary employees, independent contractors or leased employees are not employees for these purposes. The owner(s) are excluded from this classification.

Minority, women and small-owned firms are required to provide proof of their eligibility in accordance with these guidelines.

CERTIFYING AGENCIES

1.  Governor’s Office of Diversity Business Enterprise (GODBE)

Sheila Simpson, Program Director

27th Floor, William R. Snodgrass TN Tower

312 8th Avenue North, Nashville, TN 37243

615-253-4657

2.  Office of Minority and Women Business Assistance

Michelle Lane, Director Office of Minority and Women Business Assistance

John Irvin, Minority-Small Business Liaison

Metropolitan Government of Nashville and Davidson County

https://smartrac.nashville.gov

222 Third Avenue North, Suite 650

Nashville, TN 37201

615-880-2814

3.  U. S. Small Business Administration

Kena Dixon. Business Development Specialist

50 Vantage Way, Suite 201, Nashville, TN 37228

615-736-7426

4.  Tennessee Department of Transportation

Small Business Development

Deborah Luter, Director

Ross Webb

505 Deaderick Street, Suite 400

Nashville, TN 37243

651-741-3681

5.  Tennessee Minority Supplier Development Council (TMSDC)

Cheri Henderson, Executive Director

220 Athens Way, Suite 105, Plaza 1, Nashville, TN 37228

615-259-4699

6.  Nashville Transit Authority

Patricia Downs, Capital Grants Administrator/DBE Liaison Officer

130 Nestor Street, Nashville, TN 37210

615-862-6208

*Please List numbers corresponding to services your company has the capability to provide:

Page 2 2/9/2017

DIVISION 1 GENERAL

REQUIREMENTS

1001 Specified in Specification

1010 Plan Holders List

1020 New Plan Holders List

1021 Pest Control

1022 Window Cleaners

1023 Watchman Services

1024 Progress Photos

1025 CPM

1050 Building Cleaning Services

1051 Waste & Recycling Services

1165 General Cleanup

1171 Spec Phone Install

1210 Tower Cranes

1213 Crane Erection

1221 Mobile Tower Cranes

1261 Pump Concrete

1400 CQC Subs

1401 Field Testing & Inspection

1402 Field Engineering & Surveying

1500 Field Office Trailer Subs

1501 Scaffolding Suppliers

1600 Const. Material, Tools & Equip

1740 Final Cleanup

1900 Blueprinting Companies

1920 Temporary Heating

1950 Professional & Spec. Consul.

DIVISION 2 SITE CONSTRUCTION

2005 Trucking

2010 Tank Removal

2013 Filter Fabric Fence

2090 Contaminated Soil Removal

2100 Clearing & Erosion Control

2110 Demolition

2150 Asbestos Removal

2160 Retention Systems

2167 Reinforced Earth Walls

2200 Earthwork

2201 Site Preparation

2224 Pipe Boring & Jacking

2227 Waste Material Disposal

2228 Fill Materials

2229 Trucking, Hauling

2230  Water Pressure Cleaning Sys.

2240 Pond Liners

2245 Dewatering & Water Wells

2250 Soil Treatment & Stabilization

2270 Modular Block Wall

2300 Pile Foundations

2301 Tunneling, Boring & Jacking

2350 Caissons

2370 Drilled Piers

2371 Augercast Piles

2400 Sheeting, Shoring Underpinnig

2401 Slurry Walls

2500 Utility Services

2510 Water Distribution

2515 Sanitary Sewage

2530 Vibrofloatation

2540 Elect. Duck Bank & Vaults

2550 Site Utilities

2551 Pipe Fittings

2600 Drainage & Containment

2601 Subdrainage

2602 Storm Drainage

2610 Conc & Unit Paving Subs

2611 Asphalt Paving

2612 Athletic Paving - Surfacing

2615 Pavement Marking

2618 Solar Pavement Markers/

Lighting Brick

2620 Curbs & Gutters

2625 Stone Curbs

2630 Manholes

2640 Synthetic - Athletic Surfacing

2710 Fences and Gates

2720 Road & Parking Appurtenances

2721 Car Stops

2722 Flexible Pavement

2723 Rigid Pavement

2725 Sidewalks

2726 Unit Pavers

2727 Porous Pavement

2730 Playing Fields, Equipment

2735 Tennis Courts

2740 Fountains

2750 Irrigating System

2760 Gate Operators

2770 Precast Conc Retaining Walls

2800 Landscaping

2805 Prefabricated Bridges

2810 Fiberglass Planters

2825 Interior Landscape

2850 Railroad Work

2870 Site & Street Furnishings

2890 Traffic Signs & Signals

2895 Boardwalk Reconstruction

2900 Marine Work

2930 Protective Marine Struc.

2950 Tunneling

DIVISION 3 CONCRETE

3100 Concrete Formwork Subs

3101 Ready-mix Conc Suppliers

3102 Conc Placing & Finishing Subs

3103 Spec Formwork Mat’l & Liners

3104 Conc Pumping Subs

3200 Conc Reinforcing Material

3201 Conc Reinforcing Placement

3230 Stressing Tendons

3300 Concrete

3321 Insul Conc Decks:zonolite, Perl

3340 Prestressed Concrete

3357 Concrete Cutting

3362 Gunite - Shotcrete

3365 Vibration Isolation

3401 Precast Concrete

3411 Hollow Core Floor Planks

3420 Precast Structural Conc

3430 Precast Prestressed Conc

3440 Precast Concrete Erection

3452 Glass Fiber Reinf Precast Conc

3470 Precast Tilt - up

3490 Tunnel Frmd Cst-in-place Conc

3500 Cementitious Decks - Gypsum

3501 Insulating-low Density Conc

3510 Special Concrete Finishes

3593 Concrete Sawing

3700 Conc Restoration & Cleaning

3800  Mass Concrete

DIVISION 4 MASONRY

4200 Unit Masonry

4220 Glass Block Masonry

4250 Cast Stone Subs & Suppliers

4300 Brick Paving

4400 Stone

4422 Marble

4450 Limestone

4451 Simulated Stone

4475 Granite

4500 Restoration Work

4550 Refractories

DIVISION 5 METALS

5100 Structural Steel Material

5101 Structural Steel Erection

5160 Space Frames

5170 Pipe Fabricators

5200 Metal Joists

5300 Metal Decking

5400 Cold Rolled Metal Framing

5500 Miscellaneous Metals

5522 Aluminum Handrails & Railings

5600 Ornamental Metals

5716 Column Covers

5800 Expansion Control

DIVISION 6 WOOD & PLASTICS

6100 Rough Carpentry - Labor

6101 Rough Carpentry - Material

6130  Heavy Timber Construction

6140 Wood Framing

6170 Prefabricated Structural

Wood

6210 Misc Finish

6220 Millwork & Architectural

Wood

6410 Cabinetwork

6600 Plastic Fabrications

6630 Eggcrath Diffusers

DIVISION 7 THERMAL & MOISTURE

PROTECTION

7100 Waterproofing

7110 Membrane Waterproofing

7150 Dampproofing

7200 Insulation

7210 Building Insulation

7212 Rigid Insulation

7215 Sprayed - on Insulation

7221 Perlite Deck

7240 Roof & Deck Insulation

7241 Ext Insul & Finish System

7270 Firestopping

7300 Shingles & Roofing Tiles

7301 Slate Roofing

7320 Thatch Roofing

7400 Preformed Roofing & Siding

7410 Gutters & Downspouts

7411 Preformed Metal Siding

7415 Residential Siding

7500 Membrane Roofing

7501 Roofing

7510 Built-up Bituminous Roofing

7530 Elastomeric Roofing

7535 Modif. Bituminous Sheet Roof.

7541 Foam Roofing

7570 Traffic Topping

7600 Flashing & Sheet Metal

7630 Roofing Specialties

7800 Roof Accessories

7810 Skylights

7900 Sealants

DIVISION 8 DOORS AND WINDOWS

8100 Metal Doors & Frames

8110 Hollow Metal Work

8120 Aluminum Doors & Frames

8130 Stain. Steel Doors & Frames

8200 Wood & Plastic Doors