5700-52A MBE/WBE Utilization Under Federal Grants

United States

ENVIRONMENTAL PROTECTION AGENCY
Washington, DC 20460

OMB CONTROL NO.
APPROVED:
APPROVAL EXPIRES:

2090-0030
05/01/2008
12/22/2013

MBE/WBE UTILIZATION UNDER FEDERAL GRANTS
AND COOPERATIVE AGREEMENTS
PART I. (Reports are required even if no procurements are made during the reporting period.)
1A. FEDERAL FISCAL YEAR

1B. REPORTING PERIOD (Check ALL appropriate boxes)
□ 1st (Oct-Dec) □ 2nd (Jan-Mar) □ 3rd (Apr-Jun) □ 4th (Jul-Sep)

(Oct. 1-Sep 30)

□Semi-Annual (Oct-Mar) □ Semi-Annual (Apr-Sep)
□ Annual
□ Check if this is the last report for the project (Project completed).

20_______
1C. REVISION OF A PRIOR REPORT? Y
or N Year:
_________
Quarter: _________

BRIEFLY DESCRIBE THE REVISIONS YOU ARE MAKING:

2A. EPA FINANCIAL ASSISTANCE OFFICE ADDRESS ( ATTN: DBE
Coordinator)

3A. RECIPIENT NAME AND ADDRESS

2B. EPA DBE COORDINATOR

3B. RECIPIENT REPORTING CONTACT:

2C. PHONE:

Name:

Name:

E-mail:

Fax:

E-mail:

4A. FINANCIAL ASSISTANCE AGREEMENT ID NUMBER

5A. TOTAL ASSISTANCE AGREEMENT AMOUNT

(SRF State Recipients, refer to Instructions for Completion of blocks
4A, 5A and 5C.)

$_______________________

Fax:

4B. FEDERAL FINANCIAL ASSISTANCE PROGRAM TITLE or CFDA
NUMBER:

(SRF State Recipients, refer to Instructions for Completion of blocks
4A, 5A and 5C.)

EPA Share:

3C. PHONE:

5B. If NO procurement and NO accomplishments were made this reporting period (by the
recipients, sub-recipients, loan recipients, and prime contractors), CHECK and SKIP to Block
No. 7. (Procurements are all expenditures through contract, order, purchase, lease or barter of
supplies, equipment, construction, or services needed to complete Federal assistance
programs. Accomplishments, in this context, are procurements made with MBEs and/or WBEs.

□

Recipient Share: $_____________________

Total Procurements This Reporting Period

5C.

(Only include amount not reported in any prior reporting period)

Total Procurement Amount $________________________ (Include total dollar values awarded by recipient, sub-recipients and SRF loan recipients,
including MBE/WBE expenditures.)
5D.
Were sub-awards issued under this assistance agreement? Yes___ No____

Were contracts issued under this assistance agreement ? Yes____ No___

MBE/WBE Accomplishments This Reporting Period

5E.

Actual MBE/WBE Procurement Accomplished:
(Include total dollar values awarded by recipient, sub-recipients, SRF loan recipients and Prime Contractors.)
Construction

Equipment

Services

Supplies

Total

$MBE:

____________

_____________

_____________

_____________

0.00
________________

$WBE:

____________

______________

______________

_____________

0.00
________________

6. COMMENTS: (If no MBE/WBE procurements were accomplished during the reporting period, please explain what steps you are taking to achieve the
MBE/WBE Program requirements specified in the terms and conditions of the Assistance Agreement.)

7. NAME OF RECIPIENT’S AUTHORIZED
REPRESENTATIVE
8. SIGNATURE OF RECIPIENT’S AUTHORIZED
REPRESENTATIVE

TITLE

DATE

EPA FORM 5700-52A available electronically at http://www.epa.gov/osbp/pdfs/5700_52a.pdf

PART II.

MBE/WBE PROCUREMENTS MADE DURING REPORTING PERIOD
EPA Financial Assistance Agreement Number: _______________

1. Procurement Made By

2. Business
Enterprise

Recipient

Minority

SubRecipient
and/or SRF
Loan
Recipient

Prime

3. $ Value of
Procurement
Women

4. Date of
Procurement
MM/DD/YY

5. Type of
Product or
ServicesA

6. Name/Address/Phone Number of MBE/WBE
Contractor or Vendor

(Enter Code)

Type of product or service codes:
1 = Construction

2 = Supplies

3 = Services

4 = Equipment

Note: Refer to Terms and conditions of your Assistance Agreement to determine the frequency of reporting. Recipients are required to submit MBE/WBE reports to EPA beginning with the Federal fiscal year quarter
the recipients receive the award, continuing until the project is completed.
EPA FORM 5700-52A - (Approval Expires 12/22/13)

Instructions:

recipients under EPA’s DBE Program, an entity must be
properly certified as required by 40 CFR Part 33, Subpart
B.

A. General Instructions:
MBE/WBE utilization is based on 40 CFR Part 33. EPA
Form 5700-52A must be completed by recipients of
Federal grants, cooperative agreements, or other Federal
financial assistance which involve procurement of
supplies, equipment, construction or services to
accomplish Federal assistance programs.
Recipients are required to report 30 days after the end of
each federal fiscal quarter, semiannually, or annually, per
the terms and conditions of the financial assistance
agreement.

Agreements
awarded
prior to May
27, 2008
Agreements
awarded on
or after May
27, 2008

Quarterly
Reporting
Due Date
January 30,
April 30,
July 30,
October 30

Semiannual
Reporting
Due Date

Annual
Reporting
Due Date

N/A

October
30

N/A

April 30,
October 30

October
30

MBE/WBE program requirements, including reporting, are
material terms and conditions of the financial assistance
agreement.
B. Definitions:
Procurement is the acquisition through contract, order,
purchase, lease or barter of supplies, equipment,
construction or services needed to accomplish Federal
assistance programs.

U.S. citizenship is required. Recipients shall presume
that minority individuals include Black Americans,
Hispanic Americans, Native Americans, Asian Pacific
Americans, or other groups whose members are found to
be disadvantaged by the Small Business Act or by the
Secretary of Commerce under section 5 of Executive
order 11625. The reporting contact at EPA can provide
additional information.
A woman business enterprise (WBE) is a business
concern that is, (1) at least 51 percent owned by one or
more women, or, in the case of a publicly owned
business, at least 51 percent of the stock is owned by one
or more women and (2) whose daily business operations
are managed and directed by one or more of the women
owners. In order to qualify and participate as a WBE
prime or subcontractor for EPA recipients under EPA’s
DBE Program, an entity must be properly certified as
required by 40 CFR Part 33, Subpart B.
Business firms which are 51 percent owned by minorities
or women, but are in fact managed and operated by nonminority individuals do not qualify for meeting MBE/WBE
procurement goals. U.S. Citizenship is required.
Good Faith Efforts
A recipient is required to make the following good faith
efforts whenever procuring construction, equipment,
services, and supplies under an EPA financial assistance
agreement. These good faith efforts for utilizing MBEs
and WBEs must be documented. Such documentation is
subject to EPA review upon request:
1.

Include of MBEs/WBEs on solicitation lists.

A contract is a written agreement between an EPA
recipient and another party (also considered “prime
contracts”) and any lower tier agreement (also considered
“subcontracts”) for equipment, services, supplies, or
construction necessary to complete the project. This
definition excludes written agreements with another public
agency. This definition includes personal and
professional services, agreements with consultants, and
purchase orders.

2.

Assure that MBEs/WBEs are solicited once they
are identified.

3.

Divide total requirements into smaller tasks to
permit maximum MBE/WBE participation, where
feasible.

4.

Establish delivery schedules which will encourage
MBE/WBE participation, where feasible.

A minority business enterprise (MBE) is a business
concern that is (1) at least 51 percent owned by one or
more minority individuals, or, in the case of a publicly
owned business, at least 51 percent of the stock is owned
by one or more minority individuals; and (2) whose daily
business operations are managed and directed by one or
more of the minority owners. In order to qualify and
participate as an MBE prime or subcontractor for EPA

5.

Encourage use of the services of the U.S.
Department of Commerce's Minority Business
Development Agency (MBDA) and the U.S. Small
Business Administration to identify MBEs/WBEs.

6.

Require that each party to a subgrant,
subagreement, or contract award take the good
faith efforts outlined here.
C. Instructions for Part I:
1a.

1b.
1c.

2a-c.

4b.

Refer back to Assistance Agreement document
for this information.

5a.

Provide the total amount of the Assistance
Agreement which includes Federal funds plus
recipient matching funds and funds from other
sources.

Specify Federal fiscal year this report covers. The
Federal fiscal year runs from October 1st through
September 30th (e.g. November 29, 2010 falls
within Federal fiscal year 2011)
Check applicable reporting box, quarterly,
semiannually, or annually. Also indicate if this is
the last report for the project.
Indicate if this is a revision to a previous year,
half-year, or quarter, and provide a brief
description of the revision you are making.

*For SRF recipients only: SRF recipients will not
enter an amount in 5a. Please leave 5a blank.
5b.

Self-explanatory.

5c.

Provide the total dollar amount of ALL
procurements awarded this reporting period by
the recipient, sub-recipients, and SRF loan
recipients, including MBE/WBE expenditures.
For example: Actual dollars for procurement from
the procuring office; actual contracts let from the
contracts office; actual goods, services, supplies,
etc., from other sources including the central
purchasing/ procurement centers).

Please refer to your financial assistance
agreement for the mailing address of the EPA
financial assistance office for your agreement.
The “EPA DBE Reporting Contact” is the DBE
Coordinator for the EPA Region from which your
financial assistance agreement was originated.
For a list of DBE Coordinators please refer to the
EPA OSBP website at www.epa.gov/osbp. Click
on “Regional Contacts” for the name of your
coordinator.

*NOTE: To prevent double counting on line 5C, if
any amount on 5E is for a subcontract and the
prime contract has already been included on Line
5C in a prior reporting period, then report the
amount going to MBE or WBE subcontractor on
line 5E, but exclude the amount from Line 5C. To
include the amount on 5C again would result in
double counting because the prime contract,
which includes the subcontract, would have
already been reported.

3a-c.

Identify the agency, state authority, university or
other organization which is the recipient of the
Federal financial assistance and the person to
contact concerning this report.

4a.

Provide the Assistance Agreement number
assigned by EPA. A separate report must be
submitted for each Assistance Agreement.

5d.

State whether or not sub-awards and/or
subcontracts have been issued under the
assistance agreement by indicating “yes” or “no”.

*For SRF recipients: In box 4a list numbers for
ALL OPEN Assistance Agreements being
reported on this form. Please note that although
the New DBE Rule (which took effect May 27,
2008) revised the reporting frequency
requirements from quarterly to semiannually, that
change only applies to agreements awarded
AFTER the New DBE Rule took effect.
Therefore, SRF recipients may either continue to
report activity for all Agreements on one form on
a quarterly basis until the last award that was
made prior to the New DBE Rule has been closed
out; OR, the recipient may split the submission of
SRF reports into quarterly reports for Agreements
awarded prior the New DBE Rule, and
semiannually for the awards made after the New
DBE Rule.

5e.

Where requested, also provide the total dollar
amount of all MBE/WBE procurement awarded
during this reporting period by the recipient, subrecipients, SRF loan recipients, and prime
contractors in the categories of construction,
equipment, services and supplies. These
amounts include Federal funds plus recipient
matching funds and funds from other sources.
*For SRF recipients only: In 5c please enter the
total procurement amount for the quarter, or
semiannual period, under all of your SRF
Assistance Agreements. The figure reported in
this section is not directly tied to an individual
Assistance Agreement identification number.
(SRF state recipients report state
procurements in this section)

6.

If there were no MBE/WBE accomplishments this
reporting period, please briefly explain what

7.
8.

specific steps you are taking to achieve the
MBE/WBE requirements specified in the terms
and conditions of the Assistance Agreement.
Name and title of official administrator or
designated reporting official.
Signature, month, day, and year report submitted.

D. Instructions for Part II:
For each MBE/WBE procurement made under this
assistance agreement during the reporting period, provide
the following information:
1.

Check whether this procurement was made by
the recipient, sub-recipient/SRF loan recipient, or
the prime contractor.

2.

Check either the MBE or WBE column. If a firm
is both an MBE and WBE, the recipient may
choose to count the entire procurement towards
EITHER its MBE or WBE accomplishments. The
recipient may also divide the total amount of the
procurement (using any ratio it so chooses) and
count those divided amounts toward its MBE and
WBE accomplishments. If the recipient chooses
to divide the procurement amount and count
portions toward its MBE and WBE
accomplishments, please state the appropriate
amounts under the MBE and WBE columns on
the form. The combined MBE and WBE
amounts for that MBE/WBE contractor must
not exceed the “Value of the Procurement”
reported in column #3

3.

Dollar value of procurement.

4.

Date of procurement, shown as month, day, year.
Date of procurement is defined as the date the
contract or procurement was awarded, not the
date the contractor received payment under the
awarded contract or procurement, unless
payment occurred on the date of award. (Where
direct purchasing is the procurement method,
the date of procurement is the date the
purchase was made)

5.

Using codes at the bottom of the form, identify
type of product or service acquired through this
procurement (e.g., enter 1 if construction, 2 if
supplies, etc).

6.

Name, address, and telephone number of
MBE/WBE firm.

**This

data is requested to comply with provisions
mandated by: statute or regulations (40 CFR Part 30, 31,

and 33); OMB Circulars; or added by EPA to ensure
sound and effective assistance management. Accurate,
complete data are required to obtain funding, while no
pledge of confidentiality is provided.
The public reporting and recording burden for this
collection of information is estimated to average l hour per
response annually. Burden means the total time, effort,
or financial resources expended by persons to generate,
maintain, retain, or disclosure 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 through the use of
automated collection techniques to the Director, OPPE
Regulatory Information Division, U.S. Environmental
Protection Agency (2136), 1200 Pennsylvania Avenue,
NW, Washington, D.C. 20460. Include the OMB Control
number in any correspondence. Do not send the
completed form to this address.