24-0791_SBE_Compliance_Form.pdf
PDF 116 KB Posted
- Solicitation number
- 24-0791-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
The document is an SBE (Small Business Enterprise) Compliance Form for Pinellas County, Florida, specifically related to the 53rd Avenue N. Force Main Replacement project (PID 005582A). The form requires prime contractors to detail subcontractor information and demonstrate compliance with a mandatory 10% SBE project goal. The form provides space for listing multiple subcontractors, including their company names, addresses, contact information, and the dollar amount of subcontracted work.
The compliance form serves as a certification mechanism for contractors to verify their commitment to utilizing small businesses in the project. The form must be completed and signed by an authorized representative, who certifies the information's accuracy and understands that the form will become part of the contract with Pinellas County. The county's purchasing staff will review the form to determine whether the bidder meets the SBE goals outlined in the Invitation to Bid, with a checkbox provided to indicate compliance status.
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Text version
APPENDIX 7 - SBE COMPLIANCE FORM
APPENDIX 7 – SBE COMPLIANCE FORM
Mandatory SBE PROJECT GOALS: 10%
PRIME CONTRACTOR NAME:
SUBCONTRACTOR(S) INFORMATION:
COMPANY: COMPANY:
ADDRESS: ADDRESS:
AMOUNT OF
SUBCONTRACTED
WORK: $
AMOUNT OF
SUBCONTRACTED
WORK: $
CONTACT: CONTACT:
EMAIL: EMAIL:
TELEPHONE: TELEPHONE:
COMPANY: COMPANY:
ADDRESS: ADDRESS:
AMOUNT OF
SUBCONTRACTED
WORK: $
AMOUNT OF
SUBCONTRACTED
WORK: $
CONTACT: CONTACT:
EMAIL: EMAIL:
TELEPHONE: TELEPHONE:
I certify that the information included in this Compliance Form is true and complete to the best of my knowledge and belief. I further understand and agree that this Compliance Form shall become a part of my contract with Pinellas County.
FOR PINELLAS COUNTY USE ONLY:
I have reviewed this Compliance Form and found the Bidder IS IS NOT in compliance with the Invitation to Bid SBE goals.
Purchasing Staff Member:
Initials: Date:
Name and Title of Authorized Representative:
Signature:
File details come from the government source that posted it. Updated .