2-B. SMBE Certification Form.pdf
PDF 408 KB Posted
- Solicitation number
- 26-0309
- Issued by
- Sarasota County, Florida
About this file
This document is a Small/Minority Business Enterprise Certification Form issued by The School Board of Sarasota County, Florida for a TV Studio and Broadcasting Equipment and Services procurement, identified as Bid #26-0309. The form provides an opportunity for businesses to certify their status as a Small Business Enterprise or Minority Business Enterprise, with specific categories including African American, Asian American, Woman Owned, Hispanic American, and Native American-owned businesses.
The certification form allows bidders to self-identify their business classification and provides space to indicate if they intend to subcontract portions of the work to small or minority business enterprises. Bidders can list subcontractors, their designation, and estimated dollar value of services. The form requires the bidder's name, bid number, authorized representative's information, and signature, with the option to indicate if they are not a small or minority business enterprise and do not plan to subcontract with such businesses.
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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
TV STUDIO AND BROADCASTING – EQUIPMENT AND SERVICES - BID #26-0309
| 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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