2-B. SMBE Certification Form.pdf

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Attached to
GYMNASIUM, BLEACHERS, AND ATHLETIC EQUIPMENT, MAINTENANCE AND REPAIRS - BID #26-0103
Solicitation number
26-0103
Issued by
Sarasota County, Florida

About this file

This is a Small/Minority Business Enterprise Certification Form (Attachment B) for The School Board of Sarasota County, Florida's Bid #26-0103 for Gymnasium, Bleachers, and Athletic Equipment, Maintenance and Repairs. The form serves as a certification document for bidders to declare their status as either a Small Business Enterprise (as defined by Florida Statute 288.703(1)) or a Minority Business Enterprise with categories including African American, Asian American, Woman Owned, Hispanic American, or Native American businesses. The form requires certification by the State of Florida Department of Management Services Office of Supplier Diversity or self-reporting if certified by another agency. For non-small or minority businesses that plan to subcontract portions of the work to qualified S/MBE firms, the form provides space to list up to three subcontractors with their designations and estimated dollar values of services.

The form includes standard bid submission requirements with spaces for the bidder's name, bid number and title, printed name and title of authorized representative, signature, and date. Bidders who do not qualify as small or minority business enterprises and do not intend to use S/MBE subcontractors must indicate this status by checking a designated box at the bottom of the form. This certification form appears to be part of the school district's procurement process to track and potentially provide preferences for small and minority-owned businesses in accordance with Florida state statutes.

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Text version

ATTACHMENT B

SMALL/MINORITY BUSINESS ENTERPRISE CERTIFICATION FORM

Please complete if you are either a:

Small Business Enterprise, as defined by FS 288.703 (1)

Or a:

Minority Business Enterprise, Please select one or more as applicable:

African American Asian American Woman Owned Hispanic American Native American

As defined in FS 288.703 (2) and (3), and that it has been certified by one of the following agencies as an MBE:

State of Florida, Department of Management Services, Office of Supplier Diversity

If not by DMS, who/self-report: _

If you are not a small or minority business enterprise, but intend to subcontract a portion of services or work described in this ITB to a small or minority business enterprise, please provide the following information:

Subcontractor Name Small/MBE Designation Estimated Dollar Value of Services

1. __ _ _ _

2. __ _ _

3. __ _ _

NAME OF BIDDER BID # AND TITLE

PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE

SIGNATURE DATE

If Bidder is NOT a small or minority business enterprise and/or does not intend to subcontract a portion of the services or work described in this ITB to a S/MBE, then Bidder shall indicate here:

THE SCHOOL BOARD OF SARASOTA COUNTY, FLORIDA

GYMNASIUM, BLEACHERS, AND ATHLETIC EQUIPMENT, MAINTENANCE AND REPAIRS - BID #26-0103

Small Business Enterprise as defined by FS 288703 1: Off
Minority Business Enterprise: Off
African American: Off
Asian American: Off
Woman Owned: Off
Hispanic American: Off
Native American: Off
State of Florida Department of Management Services Office of Supplier Diversity: Off
If not by DMS whoselfreport: Off
undefined:
undefined_2:
SmallMBE Designation:
Estimated Dollar Value of Services:
1:
2:
1_2:
2_2:
NAME OF BIDDER BID AND TITLE:
PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE:
SIGNATURE DATE:
Text5:
Text6:
Text7:
Check Box3: Off

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