Attach B1 Small Business Self Cert.docx

This document is a Small Business Self-Certification Statement attachment for the Washington State Department of Children, Youth & Families (DCYF) Public Health Nurse Pilot competitive solicitation (RFP #27-DCYF-PPS-109). The certification form establishes the definition and requirements for small business eligibility under state guidelines, defining a small business as an in-state entity that is independently owned and operated and meets at least one of two criteria: fifty or fewer employees, or gross revenue of less than seven million dollars annually based on federal income tax returns or state Department of Revenue filings over the previous three consecutive years. Bidders must sign the certification statement under penalty of perjury to confirm their business meets the small business definition.

The form requires the legal name of the entity and the signature of an authorized representative along with the date of certification. This attachment is part of the solicitation package for Public Health Nursing Services to be provided to the Washington State DCYF to strengthen families' skills and capacity, promote child safety, support healthy child development, and enhance family stability through nursing assessment, care coordination, evidence-informed home visiting, and connections to appropriate resources and supports. The document does not contain pricing information, contract term details, or specific response deadlines.