AttachB1 SB Self Cert - ATLP.docx

DOCX document 26 KB Posted

Attached to
Adolescent Transitional Living Program-ATLP Region 6
Solicitation number
26-DCYF-CW-104
Issued by
Adams County, Asotin County, Benton County, Chelan County, Clallam County, Clark County, Columbia County, Cowlitz County, Douglas County, Ferry County, Franklin County, Garfield County, Grant County, Grays Harbor County, Island County, Jefferson County, King County, Kitsap County, Kittitas County, Klickitat County, Lewis County, Lincoln County, Mason County, Okanogan County, Pacific County, Pend Oreille County, Pierce County, San Juan County, Skagit County, Skamania County, Snohomish County, Spokane County, Stevens County, Thurston County, Wahkiakum County, Walla Walla County, Whatcom County, Whitman County, Yakima County, Asotin City, Clarkston City, Clarkston Heights-Vineland CDP, West Clarkston-Highland CDP, Benton City, Chelan City, Chelan Falls CDP, Clallam Bay CDP, Lewisville CDP, Rock Island City, Pacific Beach CDP, Whidbey Island Station CDP, Mercer Island City, Pacific City, Bainbridge Island City, Kingston CDP, Kitsap Lake CDP, Kittitas City, Klickitat CDP, Okanogan City, Anderson Island CDP, Fort Lewis CDP, Fox Island CDP, Herron Island CDP, Ketron Island CDP, North Fort Lewis CDP, Raft Island CDP, Stevenson City, Hat Island CDP, Lake Stevens City, Snohomish City, Spokane City, Spokane Valley City, Puget Island CDP, Garfield Town, Yakima City, Washington

About this file

This is a Small Business Self-Certification Statement attachment for the Washington State Department of Children, Youth & Families (DCYF) Adolescent Transitional Living Program (ATLP) Region 6 competitive solicitation (RFQ 26-DCYF-CW-104). DCYF seeks to award up to one contract to provide ATLP services to five male-identifying youth ages 16 to 21 who are under DCYF care and custody in Region 6. The contract is structured as a rate-based agreement for the provision of transitional living services to the specified youth population.

The self-certification statement establishes eligibility criteria for small business bidders, defining "small business" as an in-state business entity that is independently owned and operated and meets at least one of two threshold requirements: either fifty or fewer employees, or gross revenue of less than seven million dollars annually as reported on federal income tax returns or state department of revenue filings over the previous three consecutive years. Bidders must certify under penalty of perjury that their entity meets this definition of small business by submitting a signed statement with their proposal.

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Text version

ATTACHMENT B.1

BIDDER SMALL BUSINESS

SELF-CERTIFICATION STATEMENT

(21) "Small business" means an in-state business, including a sole proprietorship, corporation, partnership, or other legal entity, that:

(a) Certifies, under penalty of perjury, that it is owned and operated independently from all other businesses and has either:

(i) Fifty or fewer employees; or

(ii) A gross revenue of less than seven million dollars annually as reported on its federal income tax return or its return filed with the department of revenue over the previous three consecutive years;

I hereby certify, under penalty of perjury, that [legal name of entity] meets the above definition of “small business”.

Signature of person authorized to sign on behalf of legal entity

Written name

Date

DCYF-RFQ 26-DCYF-CW-104 Adolescent Transitional Living Program (ATLP) Page 3 of 3

File details come from the government source that posted it. Updated .