MBDA Internal/External Client Engagement Form

Minority Business Development Agency Business Center Program Services

Business Center Internal/External Client Engagement Form

The U.S. Department of Commerce Minority Business Development Agency’s (MBDA) mission is to foster the growth and global competitiveness of minority business enterprises (MBEs). MBDA accomplishes its mission by funding and working cooperatively with Business Centers that assist clients with facilitating transactions through referrals, business consulting, contract bid/proposal preparation, loan packaging, and/or matching contract opportunities and capital sources (i.e., loans, equity, bonding, etc.). In addition, Business Centers help clients to achieve their growth objectives by connecting them with prospective strategic partners through business-to-business matching, teaming arrangements, joint ventures, or other strategic advisory services.

Acknowledgement of Client Relationship

(“client”) has engaged with the Business Center (“Business Center”) for business consulting or other services. The services provided by Business Center to the client are subsidized through Federal appropriations. MBDA-funded Business Center agrees to provide one or more of the following services:

business consulting business match-making

contract opportunity sourcing capital sourcing

other services (describe) .

MBDA does not guarantee any particular outcome or business result on behalf of the client or associated third parties and is not liable for any outcomes or business decisions made by the client or associated third parties.

Acceptance of Client Relationship

The client agrees to: (a) acknowledge the relationship with Business Center (as demonstrated in this agreement); (b) provide firm contact and profile information; (c) disclose to MBDA and/or Business Center outcome(s) based on the services provided to the client by Business Center to MBDA; and (d) provide documentary verification to MBDA and/or Business Center for transactions resulting from services provided pursuant to this engagement.

Certification

Under this agreement, the client certifies under penalty of perjury that it is a minority business enterprise (MBE), as defined by the MBDA Act. 15 U.S.C. §§ 9501(9), (15). A minority business enterprise (MBE) under the MBDA Act is a business enterprise owned and controlled by at least one socially or economically disadvantaged individual. 15 U.S.C. § 9501(9).  A socially disadvantaged individual is an individual who has been subjected to racial or ethnic prejudice or cultural bias because of the identity of the individual as a member of a group, without regard to any individual quality of the individual that is unrelated to that identity. 15 U.S.C. § 9501(15).  An economically disadvantaged individual is an individual whose ability to compete in the free enterprise system been impaired due to diminished capital and credit opportunities, as compared to others in the same line of business and competitive market areas, because of the identity of the individual as a member of a group, without regard to any individual quality of the individual that is unrelated to that identity. 15 U.S.C. § 9501(15). An individual that identifies as a member of one or more of the following groups is presumed to be socially or economically disadvantaged:  Black or African American; Hispanic or Latino; American Indian or Alaska Native; Asian (including South Asian); Native Hawaiian or other Pacific Islander; and Hasidic Jews. 15 U.S.C. § 9501(15). An individual does not need to identify as a member of one of these groups to be a socially or economically disadvantaged individual eligible to receive Business Center services under the MBDA Act.

Privacy Disclosure and Information Use

By submitting this form, your company agrees to allow the Business Center and/or MBDA to share this document, information contained therein, and any supplementary material provided by your company (collectively “Client Engagement Form”) on an as needed basis, with United States Government agencies to carry out appropriate due diligence and more effectively advocate for your interests. The Client Engagement Form also may be used by MBDA and Business Centers for the purposes of conducting research, studies, and analysis consistent with the MBDA mission as stated in the MBDA Act. The Client Engagement Form is considered business confidential and will not be shared with any other person or organization outside the U.S. Government unless MBDA is given permission to do so by your company. All business confidential information will be protected from disclosure to the extent permitted by law.

Signature of Authorized Client Representative (Date)

Print Name of Authorized Client Representative

Name of Business

Address

City, State, Zip

Telephone

E-Mail

Signature of MBDA Business Center Representative (Date)

Print Name of MBDA Business Center Representative

OMB Control No. ___________

Expiration Date: ____________

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