4-FORM 1 - LOCAL VENDOR AFFIDAVIT.pdf

FORM 1

Local Vendor Affidavit

Effective November 10, 2012, the City of Tallahassee’s Local Business Incentive Program (pilot program where local businesses received 10% preference) was replaced with the original Local Preference Program under Code of Ordinances, Part II, Chapter 2, Article X, Section 2-201 through 2-203. Therefore, under the original ordinance local vendors/businesses may qualify for up to a 5% preference, dependent on the aggregate amount of the quote. To qualify, a vendor must maintain a permanent place of business with full-time employees within Leon, Wakulla, Gadsden or Jefferson County, Florida, for a minimum of six (6) months prior to the date quotes are received. Local vendor must submit this Local Vendor Affidavit with their bid/quote for the preference.

The undersigned, as a duly authorized representative of the vendor listed herein, certifies to the best of his/her knowledge and belief, that the vendor meets the definition of a “Local Business.” For purposes of this section, "local business" shall mean a business which meets ALL below requirements:

a) Has had a fixed office or distribution point located in and having a street address within the four county area of Leon, Wakulla, Gadsden and Jefferson for at least six (6) months immediately prior to the submission of bids/quotes, to the City of Tallahassee, and

b) Holds any business license required by the four county area of Leon, Wakulla, Gadsden, and Jefferson (please attach copies); and

c) Employs at least one (1) full time employee, or two (2) part time employees whose primary residence is in the four county area of Leon, Wakulla, Gadsden, and Jefferson, or, if the business has no employees, the business shall be at least fifty percent (50%) owned by one or more persons whose primary residence is in the four county area of Leon, Wakulla, Gadsden, and Jefferson.

Please complete the following in support of the self-certification and submit copies of your County and/or City business licenses. Failure to provide the information requested will result in denial of certification as a local business.

NOTE: The purchasing agent shall not be required to verify the accuracy of any such certifications and shall have the sole discretion to determine if a bidder meets the definition of a "local business."

Signature of Authorized Representative Print Name of Authorized Representative

Date Signed

Business/Company Name:

Current Local Address: Phone: ( )

Fax: ( )

If the above address has been for less than six months, please provide the prior local address:

Length of time at this address:

Home Office Address: Phone: ( )

Fax: ( )