Pursuant to the mutually agreed upon terms of the Minority Business Development Agency (MBDA) Internal/External Client Engagement Form, your firm contracted with MBDA to provide one or more of the following services:

For transactions in which the services provided by MBDA, either directly or indirectly, by providing business consulting, referrals or other services, resulted in either a contract or capital award, please answer the following questions:

Contract Award

If yes, what was/were the Dollar Amount(s) of the award(s)?

Capital Award

If yes, what was/were the Dollar Amount(s) of the capital obtained?

Job Opportunities Created

Pursuant to the client responsibilities outlined in Section (d) of the MBDA Internal/External Client Engagement Form, please provide any and all documentary evidence (contract award documents, agreements, etc.) to your servicing MBDA Business Center Program or MBDA Business Development Specialist as evidence of the above transaction(s). All documentation will be kept on file and confidential within the MBDA Business Center. MBDA and MBDA Business Center Programs will take reasonable action to restrict access to such information by non-governmental entities. All information will remain confidential to the fullest extent of the law.

I hereby certify that the information and statements provided in this document are truthful and accurate representations of the transaction(s) that occurred as a result of MBDA’s services. I also certify that all verifying documents are authentic and accurately represent the transaction(s) referenced above.