6-26-204JH - Statement of Intent to Perform as SBE Subcontractor-Supplier.pdf
PDF 72 KB Posted
- Attached to
- Legislative Representation Services
- Solicitation number
- RFP No.: 26-204/JH
- Issued by
- Palm Beach County, Florida
About this file
This document is a Statement of Intent to Perform as an SBE (Small Business Enterprise) Subcontractor/Supplier form from the Equal Business Opportunity Office of the Solid Waste Authority of Palm Beach County. The form is designed to be completed by bidders and SBE subcontractors/suppliers, documenting their intent to participate in a specific solicitation and contract. The form requires details about the type of work to be performed, including a breakdown of work items, agreed-upon prices, and percentage of work.
The form emphasizes the SBE vendor's certification status and requires signatures from both the SBE subcontractor and the prime contractor. It includes a certification that the signatory has full legal authority to execute the document, with potential consequences for incorrect information, including being deemed non-responsive or subject to penalties outlined in the Authority's Purchasing Manual. The document provides space for specifying the solicitation and contract numbers, the type of business entity (individual, partnership, corporation, or other), and a detailed description of the work to be performed.
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Text version
Equal Business Opportunity Office
Statement Of Intent To Perform As An SBE Subcontractor/Supplier
A signed Statement of Intent to Perform as a Small Business Enterprise (SBE) Subcontractor/Supplier form must be completed by the Bidder and owner or authorized principal of each SBE firm listed in the SBE Subcontractor/Supplier Participation Schedule.
SOLICITATION #:
CONTRACT #:
STATEMENT OF INTENT
The undersigned is certified as an SBE vendor in accordance with the Solid Waste Authority of Palm Beach County’s Equal Business Opportunity Program Policy: _____ Yes _____ No __________________________________________________ (Name of SBE Subcontractor/Supplier) agrees to perform work on the above contract as a (check one):
Individual Partnership Corporation Other
The SBE subcontractor will enter into a formal agreement with __________________________________________________ (Name of Bidder/Proposer) conditioned upon the Bidder/Proposer executing a contract with the Authority.
DESCRIPTION OF WORK TO BE PERFORMED & VALUE
Please provide the details and value of the work to be performed:
Item No. Type of Work Agreed Upon Price % of Work
1 $ %
2 $ %
3 $ %
4 $ %
TOTAL VALUE OF WORK $ %
SBE SUBCONTRACTOR/SUPPLIER SIGNATURE
By executing this form, I hereby certify to all that I have full legal authority to execute this document on behalf of the companies mentioned above, and that my signature is specifically being relied on as such for all purposes related to this solicitation, including any resulting contract award. I understand that if this certification is determined to be incorrect for any reason, that my response to this solicitation may be deemed non-responsive or I may be subject to any applicable penalties/sanctions set forth in Section (6) of the Authority's Purchasing Manual or applicable law.
SBE Subcontractor (Signature) Title
Name of SBE Subcontractor (Print) Date
Prime Contractor (Signature) Title
Prime Contractor (Print) Date
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