6-B. SMBE Certification Form.pdf

PDF 405 KB Posted

Attached to
Yearbook Services - RFQ #26-0004
Solicitation number
26-0004
Issued by
Sarasota County, Florida

About this file

This is a Small/Minority Business Enterprise Certification Form for The School Board of Sarasota County, Florida's Yearbook Services solicitation #26-0004. The form serves as Attachment B to the solicitation and requires bidders to identify whether they qualify as a Small Business Enterprise under Florida Statute 288.703(1) or as a Minority Business Enterprise with designations including African American, Asian American, Woman Owned, Hispanic American, or Native American as defined in Florida Statute 288.703(2) and (3). Bidders must indicate if they have been certified by the State of Florida Department of Management Services Office of Supplier Diversity or provide self-reporting information if certified by another agency. The form also requires bidders who are not small or minority businesses but plan to subcontract to S/MBEs to provide details including subcontractor names, designations, and estimated dollar values of services.

The form includes spaces for bidders to list up to three subcontractors and their corresponding S/MBE designations and estimated service values. Bidders must complete signature fields including the name of bidder, bid number and title, printed name and title of authorized representative, signature, and date. If a bidder does not qualify as a small or minority business enterprise and does not intend to subcontract any portion of work to S/MBEs, they must indicate this by checking a designated box at the bottom of the form. The document emphasizes compliance with Florida statutes regarding small and minority business enterprise participation in public contracting.

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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

YEARBOOK SERVICES - #26-0004

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

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