6-Payment Assistance (SBE Set-Aside).pdf.pdf

PDF 61 KB Posted

Attached to
Countywide Fire Hydrant Replacement - WORCS-5
Solicitation number
IFB-26-00348
Issued by
Hillsborough County, Florida

About this file

This is a Payment Assistance Request Form for the Hillsborough County, Florida Small Disadvantaged Business Enterprise (SDBE) Program, related to the Countywide Fire Hydrant Replacement project (WORCS-5). The project involves replacement of fire hydrants, hydrant assemblies, and valves on existing water mains throughout Hillsborough County, with an estimated project value of $1,900,000. The Hillsborough County Water Resources Department intends to award one or more contracts to the responsive and responsible bidder(s) submitting the lowest total bid price, with the specific dollar amount for each award to be determined during bid evaluation. No required SBE goal has been established for this solicitation.

The Payment Assistance Request Form allows SDBE prime contractors to request joint checks made payable to both the contractor and a supply or material house to facilitate project financing. Contractors must specify the primary supplies to be purchased and certify that payment assistance will be utilized solely for the stated County project and identified supply house. The form must be submitted with the bid if payment assistance is being requested and requires authorization and signature from a contractor representative.

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Text version

PA – 1

1240 PMTASST.doc

(REV. 07/19/05)

THIS REQUEST MUST BE SUBMITTED WITH THE BID

(If Payment Assistance is Being Requested)

HILLSBOROUGH COUNTY, FLORIDA

SMALL DISADVANTAGED BUSINESS ENTERPRISE (SDBE) PROGRAM

REQUEST TO USE PAYMENT ASSISTANCE

This form shall be used by a Hillsborough County certified Small Disadvantaged Business Enterprise (SDBE) bidding as a prime contractor on a project. Pursuant to the Payment Assistance provisions of the SDBE Program, joint checks may be requested for a supply or material house and the prime contractor.

The desires to utilize the (Name of Contractor) assistance provision on (Project Name) if awarded the contract. The joint check(s)shall be issued in the name of and (Name of Contractor)

(Supply House/Address)

The primary supplies to be purchased are/is (Specify)

. The certifies that if this (Contractor) request is granted, it will be utilized only for the County project and supply house stated above.

Signature of Authorized Contractor Representative

Title

Date

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