Appendix_B_Exhibit_5_CBE_form.xlsx

This is a Certification of Business Enterprise (CBE) form exhibit prepared by the County of Los Angeles, Department of Public Health for the Request for Applications (RFA) for Residential Care Services for Eligible Ryan White Program Clients in Los Angeles County. The form serves as the standardized documentation template that applicant organizations must complete to demonstrate their business enterprise certification status and eligibility to participate in the procurement process. The CBE form requires applicants to provide detailed organizational information, including business structure, ownership composition, annual revenue figures, number of employees, and certification documentation from relevant certifying agencies. Applicants must attest to their business enterprise classification and provide supporting evidence of any minority-owned, women-owned, disabled veteran-owned, or other disadvantaged business enterprise designations. The form establishes verification requirements and documentation standards that all bidding organizations must meet as part of their application submission.

The CBE form functions as a compliance and verification instrument within the RFA process, enabling the County to assess applicant organizations' qualifications and certifications prior to awarding contracts. Completion and submission of this exhibit is mandatory for all applicants seeking to provide residential care services under the Ryan White Program funding. The form includes sections for applicants to identify their certifying bodies, provide certification numbers, and demonstrate ongoing compliance with business enterprise requirements. Organizations must provide accurate and complete information as part of their overall application package, with false or misleading statements subject to disqualification and potential legal consequences.