8-OESBD Affiliated Entities of the Principals Certification.docx
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- Solicitation number
- BLD2131742P1
- Issued by
- Broward County, Fort Lauderdale City, Florida
About this file
This is an Affiliated Entities of the Principal(s) Certification form required by the Broward County Office of Economic and Small Business Development for a solicitation related to an Artificial Intelligence-Enabled System for Employee Screening X-Ray Machines at Fort Lauderdale-Hollywood International Airport in Florida. All vendors must complete and submit this certification form with their solicitation response, or if not submitted initially, within three business days of the County's request, with failure to timely submit resulting in the vendor being deemed non-responsive. The form requires vendors to disclose the names and addresses of all affiliated entities of the vendor's principal(s) over the preceding five years that have acted as prime vendors with the County.
The County will review disclosed affiliated entities for contract performance evaluations and 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. The vendor must certify either that no principal has prior affiliations meeting the definition of affiliated entities, or provide detailed information on any principals with such affiliations. Contract performance evaluations and compliance history of affiliated entities will be considered in the County's determination of vendor responsibility. The form requires vendor name, authorized signature, printed name, title, and date of certification, with the form version dated September 9, 2024.
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Text version
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
File details come from the government source that posted it. Updated .