4-B. SMBE Certification Form.pdf
PDF 181 KB Posted
- Attached to
- FUMIGATION SERVICES - 26-0061 State and local contract opportunity
- Solicitation number
- 26-0061
- 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 Fumigation Services, specifically Bid #26-0061. The form is designed to collect information about bidders' small business or minority business enterprise status, allowing vendors to self-identify and certify their classification according to Florida Statutes 288.703.
The certification form provides options for businesses to indicate if they are a Small Business Enterprise or a Minority Business Enterprise, with specific categories including African American, Asian American, Woman Owned, Hispanic American, and Native American owned businesses. Bidders can also indicate if they intend to subcontract a portion of services to a small or minority business enterprise by listing subcontractor names, their designation, and estimated dollar value of services. The form requires the bidder's name, bid number, authorized representative's information, and signature, with a provision for businesses that do not qualify as a small or minority business enterprise to acknowledge their status.
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Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 5-Fumigation26-0061ITB.pdf | ||
| 7-C. Emergency Hurricane or Disaster EHD.pdf | ||
| 2-F. Use of Companies owned or Controlled by a Foreign Country of Concern Affidavit for Nongovernmental Entities.pdf | ||
| 6-D. Commercial Reference Form 3yr.pdf | ||
| 1-Fumigation26-0061BF - LOCKED.xlsx | XLSX spreadsheet | |
| 3-A. Certification Page.pdf | ||
| 8-E. Use of Coercion for Labor and Services Affidavit for Nongovernmental Entities.pdf |
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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
FUMIGATION SERVICES - BID #26-0061
| 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 |
File details come from the government source that posted it. Updated .