Affidavit of Eligibility Form - Buy Local or Veteran Small Business Program 12.25.pdf
PDF 2 MB Posted
- Attached to
- S-40 Erosion Repairs
- Solicitation number
- 146228
- Issued by
- Polk County, Florida
About this file
This is an Affidavit of Eligibility Form for the Buy Local or Veteran Small Business Program established by the State of Florida, applicable to solicitations within Orange, Osceola, Lake, Polk, and Seminole Counties. The form serves as a certification document that businesses must submit with their bid responses for solicitations that include Buy Local or Veteran preference designations if the business is not already certified. Bidders must select their applicable business type and provide their business name and signature to certify compliance with the program requirements.
The form establishes two distinct eligibility pathways. The Buy Local designation requires that a business maintain its headquarters, manufacturing facility, or principal office within the specified county jurisdictions for at least six months prior to solicitation issuance, or that the owner or principal maintain their primary residence in these counties. The Veteran Small Business designation requires the business to be owned and controlled by veterans as defined under 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. Applicants must submit required documentation including proof of small business status for veteran-owned businesses, a valid local business license tax receipt from the applicable county, a physical business address, and any additional verification materials requested by the contracting district.
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Text version
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: |
| Button11: |
| Business Type: [Select the Business Type (Preference)] |
File details come from the government source that posted it. Updated .