24-8280S_Form_4_Local_Vendor_Preference_Certification_NOT_APPLICABLE.pdf

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Attached to
Services for Seniors - Supplemental - Grant Funded State and local contract opportunity
Solicitation number
24-8280S
Issued by
Collier County, Florida

About this file

This document is a Local Vendor Preference Certification form from the Collier County Procurement Services Division in the State of Florida. The form is designed for vendors seeking to qualify as a local business under Section Sixteen of the Collier County Procurement Ordinance. To be considered a local business, a vendor must have a physical business address within Collier County, listed with the Florida Department of State's Division of Corporations, and operate in an area zoned for their business type.

The form outlines specific requirements for local business status, including maintaining a legitimate business location (not a post office box or temporary structure) and demonstrating economic contribution to Collier County through employment opportunities, tax base support, and employee residency. Vendors must also possess a current local Business Tax Receipt issued by the Collier County Tax Collector prior to bid submission. The document warns that misrepresenting local business status can result in losing local preference privileges for up to one year, and vendors may be required to provide documentation substantiating their claims. The form includes a certification statement under penalties of perjury, with space for company name, date, signature, and title.

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Text version

Version 2 9.2.25

Procurement Services Division

Form 4: Local Vendor Preference Certification

(Check Appropriate Boxes Below)

State of Florida (Select County if Vendor is described as a Local Business) Collier County Lee County

Vendor affirms that it is a local business as defined by Section Sixteen of the Collier County Procurement Ordinance:

• A physical business address in Collier County with a County business address as listed with the Florida Department of State, Division of Corporations located within the limits of Collier County from which the vendor's staff operates and performs business in an area zoned for the conduct of such business. A post office box or a facility that receives mail, or a non-permanent structure such as a construction trailer, storage shed, or other non-permanent structure shall not be used to establish the physical address. In addition to the foregoing, a vendor shall not be considered a "local business" unless it contributes to the economic development and well-being of Collier County in a verifiable and measurable way. This may include, but not be limited to, the retention and expansion of employment opportunities, support and increase to the County's tax base, and residency of employees and principals of the business within Collier County. Vendors shall affirm in writing their compliance with the foregoing at the time of submitting their bid or proposal to be eligible for consideration as a "local business" under this section. A vendor who misrepresents the Local Preference status of its firm in a proposal or bid submitted to the County will lose the privilege to claim Local Preference status for a period of up to one year; and

• A current local Business Tax Receipt (also known as an Occupational License) issued by the Collier County Tax Collector prior to bid or proposal submission.

If requested by the County, Vendor will be required to provide documentation substantiating the information given in this certification. Failure to do so will result in the vendor’s submission being deemed non-responsive.

Under penalties of perjury, I certify that the information shown on this form is correct to my knowledge and a duly corporate authorized representative with signature authority.

Company Name: _________________________________________

Date: _____________________________

Signature: ____________________________________________ Title: _____________________________

Collier County: Off
Lee County: Off
Company Name_4:
Date22_af_date:
Title_4:

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