In the landscape of environmental protection and regulatory compliance, the EPA Form 6100-4 occupies a critical role, serving as the Disadvantaged Business Enterprise (DBE) Subcontractor Utilization Form. It is a document used by prime contractors to report the involvement of disadvantaged business enterprises in projects under the Environmental Protection Agency (EPA). The form requires detailed information such as the bid or proposal number, project name, primary contractor's contact details, and specifics about each DBE subcontractor engaged, including the type of work, estimated dollar amount of their contract, and their certification status as a Minority Business Enterprise (MBE) or Women’s Business Enterprise (WBE). This form is not just a procedural requirement but is part of a larger effort to ensure fairness and equal opportunity in the awarding of contracts funded by EPA financial assistance. The significance of the form extends beyond transparency, aiming to encourage and monitor the participation of disadvantaged businesses in EPA-supported projects. Moreover, it highlights the agency's commitment to minimizing the administrative burden on respondents, with an estimated completion time, and specifies the conditions under which updates are required, especially in the case of subcontractor replacement, abiding by the regulations set forth in 40 CFR Part 33 Section 33.302(c). The form also underlines the importance of accurate and honest reporting by requiring a certification under penalty of perjury by the prime contractor.
| Question | Answer |
|---|---|
| Form Name | Epa Form 6100 4 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | 6100 4 form, dbe subcontractor utilization form, epa 6100 4, dbe form |
Environmental Protection Agency
OMB Control No: _________
Approved: _________
Approval Expires: _________
|
|
|
|
|
|
Disadvantaged Business Enterprise Program |
||||
|
|
|
|
|
|
|
DBE Subcontractor Utilization Form |
|||
|
|
|
|
|
|
|
|
|
|
|
|
BID/PROPOSAL NO. |
|
|
PROJECT NAME |
|
|
|
|||
|
|
|
|
|
|
|
|
|
|
|
|
NAME OF PRIME BIDDER/PROPOSER |
|
|
|
|
|
||||
|
|
|
|
|
|
|
|
|
|
|
|
ADDRESS |
|
|
|
|
|
|
|
||
|
|
|
|
|
|
|
|
|
|
|
|
TELEPHONE NO. |
|
|
FAX NO. |
|
|
|
|||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||
|
The following subcontractors1 will be used on this project: |
|
|
|
||||||
|
|
|
|
|
|
|
|
|
||
|
COMPANY NAME, ADDRESS, PHONE |
|
TYPE OF WORK TO BE |
ESTIMATE |
CURRENTLY |
|||||
|
NUMBER, AND |
|
PERFORMED |
D DOLLAR |
CERTIFIED |
|||||
|
|
|
|
|
|
|
|
AMOUNT |
AS AN MBE |
|
|
|
|
|
|
|
|
|
|
OR WBE? |
|
|
|
|
|
|
|
|
|
|
||
|
|
|
|
|
|
|
|
|
|
|
|
I certify under penalty of perjury that the forgoing statements are true and correct. In the event of a |
|||||||||
|
replacement of a subcontractor, I will adhere to the replacement requirements set forth in 40 CFR Part 33 |
|||||||||
|
Section 33.302(c). |
|
|
|
|
|
|
|
||
|
|
|
|
|
|
|
|
|
|
|
|
Signature Of Prime Contractor |
|
|
|
Date |
|
|
|
||
|
|
|
|
|
|
|
|
|
|
|
|
Print Name |
|
|
Title |
|
|
|
|||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
1Subcontractor is defined as a company, firm, joint venture, or individual who enters into an agreement with a contractor to provide services pursuant to an EPA award of financial assistance.
EPA FORM
Environmental Protection Agency
OMB Control No: _________
Approved: _________
Approval Expires: _________
Disadvantaged Business Enterprise Program
DBE Subcontractor Utilization Form
The public reporting and recordkeeping burden for this collection of information is estimated to average fifteen (15) minutes. Burden means the total time, effort, or financial resources expended by persons to generate, maintain, retain, or disclose or provide information to or for a Federal agency. This includes the time needed to review instructions; develop, acquire, install, and utilize technology and systems for the purposes of collecting, validating, and verifying information, processing and maintaining information, and disclosing and providing information; adjust the existing ways to comply with any previously applicable instructions and requirements; train personnel to be able to respond to a collection of information; search data sources; complete and review the collection of information; and transmit or otherwise disclose the information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.
Send comments on the Agency’s need for this information, the accuracy of the provided burden estimates, and any suggested methods for minimizing respondent burden, including the use of automated collection techniques to the Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any correspondence. Do not send the completed EPA DBE Subcontractor Utilization Form to this address.
EPA FORM