Affidavit of Eligibility Form - Buy Local or Veteran Small Business Program 12.25.pdf
PDF 2 MB Posted
- Attached to
- Traffic Signals Replacement
- Solicitation number
- 147530
- Issued by
- Polk County, Florida
About this file
This is an Affidavit of Eligibility Form for the Buy Local or Veteran Small Business Program related to a Traffic Signals Replacement contract opportunity in Florida. The form establishes eligibility criteria for two distinct preference categories: the Buy Local program and the Veteran Small Business program. For the Buy Local program, businesses must be veteran-owned and controlled as defined in Section 502 of the Veterans Benefits, Health Care, and Information Technology Act of 2006, be domiciled in Florida, and be listed in the federal Database of Veteran-owned Businesses. For the Veteran Small Business program, businesses must have their headquarters, manufacturing facility, or principal office located within Orange, Osceola, Lake, Polk, or Seminole County for at least six months prior to solicitation issuance, or the owner/principal must maintain their primary residence within those same jurisdictional boundaries. Bidders must submit this form with their bid response if they are claiming eligibility and are not already certified.
Required documentation varies by program category. Buy Local applicants must provide proof that the business is a small business concern owned and controlled by veterans as defined by the applicable federal statute. Veteran Small Business applicants must submit a physical business address, a copy of a valid and current Local Business License Tax Receipt from the applicable county, and any other information requested by the district to verify local business status. The District intends to award the contract to the lowest responsive and responsible bidder and reserves the right to award to the next lowest responsive bidder or reject any or all bids in accordance with applicable laws.
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Buy Local (or) Veteran Small Business Program
• The business owned and controlled by veterans as defined in Section 502 of the Veterans Benefits, Health Care, and Information Technology Act of 2006, as such may be amended from time to time, which business is also:
(i) domiciled in the State of Florida; and
(ii) listed in the federal Database of Veteran-owned Businesses.
• REQUIRED ATTACHMENTS:
o Proof the business is a small business concern that is owned and controlled by veterans as defined in Section 502 of the Veterans Benefits, Health Care, and Information Technology Act of 2006.
LOCAL BUSINESS (BUY LOCAL)
Business Information and Signature:
Affidavit of Eligibility Form
Submit this form with bid response for solicitations that have Buy Local or Veteran Preference if not already certified.
By signing below, I certify the Business meets the requirements for the type selected.
Business Type: ____________________________________________________________________________________
Business Name: __________________________________________________________________________________
Signature: _________________________________________________________________________________________
VETERAN SMALL BUSINESS
• The business has its headquarters, manufacturing facility, or principal office located or having a street address within the jurisdictional boundaries of Orange, Osceola, Lake, Polk, or Seminole County for at least six (6) months immediately prior to the issuance of the solicitation to which the business is responding; OR
• The Owner/Principal of the business maintains their primary residence within the jurisdictional boundaries of Orange, Osceola, Lake, Polk, or Seminole County.
• REQUIRED ATTACHMENTS:
o A physical business address (no post office boxes will be considered);
o A copy of a valid and current Local Business License Tax Receipt duly issued by a local government located within the jurisdictional boundaries of Osceola, Orange, Lake, Polk or Seminole County; and, o Any other information requested by the district that would verify local business status.
v 12.25
| Business Name: |
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| Business Type: [Select the Business Type (Preference)] |
File details come from the government source that posted it. Updated .