5700-52A MBE/WBE Utilization Under Federal Grants and Cooperative

OMB CONTROL NO. 2030-0020
APPROVED:

06/30/2014

APPROVAL EXPIRES: 06/30/2017

U.S. ENVIRONMENTAL PROTECTION AGENCY
MBE/WBE UTILIZATION UNDER FEDERAL GRANTS
AND COOPERATIVE AGREEMENTS
FOR COOPERATIVE AGREEMENTS OR OTHER FEDERAL FINANCIAL ASSISTANCE WHERE THE COMBINED TOTAL OF FUNDS BUDGETED FOR PROCURING SUPPLIES,
EQUIPMENT, CONSTRUCTION OR SERVICES EXCEED $150,000.
PART 1: PLEASE REVIEW INSTRUCTIONS BEFORE COMPLETING
1A. FEDERAL FISCAL YEAR (Oct 1- Sep 30)

1B. REPORT TYPE
☐Annual

20_____

☐ Last Report (Project completed)

1C: REVISION OF A PRIOR YEAR REPORT? ☐ No ☐ Yes, Year________________
IF YES, 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

Name:

Name:

Email:

Address:

Phone:

Phone:

Fax:

Email:

4A. FINANCIAL ASSISTANCE AGREEMENT ID NUMBER
(SRF State Recipients, refer to Instructions for Completion of blocks 4A, 5A and 5C)

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

5A. TOTAL ASSISTANCE AGREEMENT AMOUNT
EPA Share:
$ _____________

5B. If NO procurements 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: $ _____________
☐ N/A (SRF Recipient)
5C.

Total Procurements This Reporting Period (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?

5E.

Yes____ No____

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

Equipment

$MBE:

____________

_____________

$WBE:

____________

______________

Services

Supplies

Total

_____________

_____________

0.00
________________

______________

_____________

0.00
________________

6. COMMENTS: (If no MBE/WBE procurements, please summarize how certified MBEs/WBEs were notified of the opportunities to compete for the procurement dollars
entered in Block 5C and why certified MBEs /WBEs were not awarded any procurements during this reporting period.)

7. NAME OF RECIPIENT’S AUTHORIZED REPRESENTATIVE

TITLE

8. SIGNATURE OF RECIPIENT’S AUTHORIZED REPRESENTATIVE

DATE

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

OMB CONTROL NO. 2030-0020
APPROVED:

PART II.
MBE/WBE PROCUREMENTS MADE DURING REPORTING PERIOD
EPA Financial Assistance Agreement Number: __________________
1. Procurement Made By
2. Business Enterprise 3. $ Value of
Recipient Sub-Recipient and/or Prime Minority Women Procurement
SRF Loan Recipient

Type of Product or Service Codes:

1 = Construction

2 = Supplies

4. Date of
5. Type of Product 6. Name/Address/Phone Number of MBE/WBE Contractor or Vendor
Procurement or Service
MM/DD/YY (Enter Code)

3 = Services

4 = Equipment

Note: Recipients are required to submit MBE/WBE reports to EPA beginning with the Federal fiscal year the recipients receive the award, continuing until the project is completed.

06/30/2014

APPROVAL EXPIRES: 06/30/2017

Instructions:
A. General Instructions:
MBE/WBE utilization is based on 40 CFR Part 33.
The reporting requirement reflects the class
deviation issued on November 8, 2013, clarified on
January 9, 2014 and modified on December 2,
2014. EPA Form 5700-52A must be completed
annually by recipients of financial assistance
agreements where the combined total of funds
budgeted for procuring supplies, equipment,
construction or services exceeds $150,000.This
reporting requirement applies to all new and
existing awards and voids all previous reporting
requirements.
In determining whether the $150,000 threshold
is exceeded for a particular assistance
agreement, the analysis must focus on funds
budgeted for procurement under the supplies,
equipment, construction, services or “other”
categories, and include funds budgeted for
procurement under sub-awards or loans
Reporting will also be required in cases where the
details of the budgets of sub-awards/loans are not
clear at the time of the grant awards and the
combined total of the procurement and subawards and/or loans exceeds the $150,000
threshold.
When reporting is required, all procurement
actions are reportable, not just the portion which
exceeds $150,000.
If at the time of award the budgeted funds exceed
$150,000 but actual expenditures fall below, a
report is still required.

If at the time of award, the combined total of funds
budgeted for procurements in any category is less
than or equal to $150,000 and is maintained below
the threshold, no DBE report is required to be
submitted.
Recipients are required to report 30 days after the
end of each federal year, per the terms and
conditions of the financial assistance agreement.
Last reports are due October 30th or 90 days after
the end of the project period, whichever comes
first.
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.
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.
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 recipients under EPA’s DBE Program, an
entity must be properly certified as required by 40
CFR Part 33, Subpart B.
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 not managed
and operated by minorities or females do not
qualify for meeting MBE/WBE procurement goals.
U.S. Citizenship is required.

efforts for utilizing MBEs and WBEs must be
documented. Such documentation is subject to
EPA review upon request:
1. Ensure DBEs are made aware of contracting
opportunities to the fullest extent practicable
through outreach and recruitment activities.
For Indian Tribal, State and Local and
Government recipients, this will include placing
DBEs on solicitation lists and soliciting them
whenever they are potential sources.
2. Make information on forthcoming
opportunities available to DBEs and arrange
time frames for contracts and establish delivery
schedules, where the requirements permit, in a
way that encourages and facilitates
participation by DBEs in the competitive
process. This includes, whenever possible,
posting solicitations for bids or proposals for a
minimum of 30 calendar days before the bid or
proposal closing date.
3. Consider in the contracting process whether
firms competing for large contracts could
subcontract with DBEs. For Indian Tribal, State
and local Government recipients, this will
include dividing total requirements when
economically feasible into smaller tasks or
quantities to permit maximum participation by
DBEs in the competitive process.
4. Encourage contracting with a consortium of
DBEs when a contract is too large for one of
these firms to handle individually.

Good Faith Efforts

5. Use the services and assistance of the SBA and
the Minority Business Development Agency of
the Department of Commerce.

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

6. If the prime contractor awards subcontracts,
require the prime contractor to take the steps
in paragraphs (a) through (e) of this section.

C. Instructions for Part I:
1A. Specify Federal fiscal year this report covers.
The Federal fiscal year runs from October 1st
through September 30th (e.g. November 29, 2014
falls within Federal fiscal year 2015)
1B. Specify report type. Check the annual
reporting box. Also indicate if the project is
completed.
1C. Indicate if this is a revision to a previous year
and provide a brief description of the revision you
are making.
2A-B. 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 http://epa.gov/osbp/dbe_cord.
3A-B. 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.
*For SRF recipients: In box 4a list numbers for ALL
OPEN Assistance Agreements being reported on
this form.
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.
*For SRF recipients only: SRF recipients will not
enter an amount in 5a. SRF recipients should check
the “N/A” box.
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, not just the
portion which exceeds $150,000. 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).
*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.
*For SRF recipients only: In 5c please enter the
total annual procurement amount 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)

5D. State whether or not sub-awards and/or
subcontracts have been issued under the financial
assistance agreements by indicating “yes” or “no”.
5E. Where requested, also provide the total
dollar amount of all MBE/WBE procurement
awarded during this reporting period by the
recipient, sub-recipients, 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.
6.
If there were no MBE/WBE accomplishments
this reporting period, please briefly how certified
MBEs/WBEs were notified of the opportunities to
compete for the procurement dollars entered in
Block 5C and why certified MBEs /WBEs were not
awarded any procurements during this reporting
period.
7.
Name and title of official administrator or
designated reporting official.
8.
Signature, month, day, and year report
submitted.
D. Instructions for Part II:
For each MBE/WBE procurement made under this
financial assistance agreements 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 Parts 30, 31, and
33 and/or 2 CFR Parts 200 and 1500); 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.