Attachment B.1 Small Business Self Cert.pdf

PDF 104 KB Posted

Attached to
SFW Community Based Perinatal Mental Health Promotion
Solicitation number
27-DCYF-EL-003
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 form for the Strengthening Families Washington (SFWA) Perinatal Mental Health initiative managed by the State of Washington. The form serves as a declaration document for small businesses seeking to participate in or qualify for this contract opportunity, which focuses on providing ongoing training and technical assistance to increase community capacity in recognizing, supporting, and referring families to appropriate resources for perinatal mood and anxiety disorders across non-clinical community settings.

The self-certification form establishes the documentation requirements for small business entities to confirm their eligibility status for set-aside or preference consideration in this procurement. By completing and submitting this attachment, prospective vendors affirm their small business classification and commitment to meeting the standards and qualifications necessary to deliver the training, technical assistance, and related services outlined in the broader perinatal mental health promotion initiative.

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Other files

File Type Posted
Attachment A Sample Contract.pdf PDF
Workplan Template.xlsx XLSX spreadsheet
Attachment B Bidder Cert and Assurances.pdf PDF
BidderResponseAttachC1 with References.docx DOCX document
BidderResponseAttachC2.docx DOCX document
BidderResponseAttachC3-Cost Reimbursement.xlsx XLSX spreadsheet
27-DCYF-EL-003 RFQQ.pdf PDF

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Text version

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

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