4-OESBD Affiliated Entities of the Principals Certification

OFFICE OF ECONOMIC AND SMALL BUSINESS DEVELOPMENT REQUIREMENTS

AFFILIATED ENTITIES OF THE PRINCIPAL(S) CERTIFICATION

The completed form should be submitted with the solicitation response. If not submitted with the solicitation response, it must be submitted within three business days after of County’s request. Failure to timely submit may result in Vendor being deemed non-responsive.

a. All Vendors are required to disclose the names and addresses of Affiliated Entities (defined below) of the Vendor’s principal(s) over the last five years (from the solicitation opening deadline) that have acted as a prime vendor with the County.

b. The County will review all Affiliated Entities of the Vendor’s principal(s) for contract performance evaluations and the compliance history with the County’s Small Business Development Program, including County Business Enterprise (CBE), Disadvantaged Business Enterprise (DBE) and Small Business Enterprise (SBE) goal attainment requirements. “Affiliated Entities” of the principal(s) are those entities related to the Vendor by the sharing of stock or other means of control, including but not limited to a subsidiary, parent, or sibling entity.

c. The County will consider the contract performance evaluations and the compliance history of the Affiliated Entities of the Vendor's principals in its review and determination of responsibility.

The Vendor hereby certifies that: (select one)

☐ No principal of the proposing Vendor has prior affiliations that meet the criteria defined as Affiliated Entities.

☐ Principal(s) listed below have prior affiliations that meet the criteria defined as Affiliated Entities.

Principal’s Name: Click or tap here to enter text.

Names and addresses of Affiliated Entities: Click or tap here to enter text.

Principal’s Name: Click or tap here to enter text.

Names and addresses of Affiliated Entities: Click or tap here to enter text.

Principal’s Name: Click or tap here to enter text.

Names and addresses of Affiliated Entities: Click or tap here to enter text.

Vendor Name: Click or tap here to enter text.

Signature: ______________________________ Printed Name: Click or tap here to enter text.

Title: Click or tap here to enter text.

Date: Click or tap to enter a date.

Form Date 9/9/24