Attachment_B._SMBE_Certification_Form.pdf

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Attached to
Tank Pumping and Hydro-Jetting Service - Bid# 26-0119
Solicitation number
26-0119
Issued by
Sarasota County, Florida

About this file

This is a Small/Minority Business Enterprise Certification Form submitted to the School Board of Sarasota County, Florida for Bid #26-0119, Tank Pumping and Hydro-Jetting Service. The School Board seeks a contractor to provide comprehensive pumping and hydro-jetting services for all facilities owned or operated by the district, including grease traps, septic tanks, and transfer stations. The scope of work encompasses all labor, supervision, fuel, travel, disposal fees, equipment, materials, and transportation necessary to complete the services. Hydro-jetting services shall include treatment of grease trap inlet and outlet lines and other feed and miscellaneous lines as directed by the School Board representative. Regular maintenance service visits for grease traps are scheduled for two times per year on a predetermined basis as mutually agreed upon between the School Board's authorized representative and the selected contractor.

The certification form requires bidders to declare their small business enterprise (SBE) or minority business enterprise (MBE) status as defined by Florida Statutes 288.703, including designations for African American, Asian American, Woman-Owned, Hispanic American, or Native American ownership. Bidders must indicate certification by the State of Florida Department of Management Services Office of Supplier Diversity or provide self-reporting documentation if not certified through that agency. Bidders who are neither SBE nor MBE but intend to subcontract portions of the work to such enterprises must provide subcontractor information including name, designation, and estimated dollar value. Bidders who do not qualify as small or minority business enterprises and do not plan to utilize subcontractors must indicate this on the form.

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Text version

Small Business Enterprise, as defined by FS 288.703 (1)

Or a:

Minority Business Enterprise, Please select one or more as applicable:

African American Asian American Woman Owned Hispanic American Native American

As defined in FS 288.703 (2) and (3), and that it has been certified by one of the following agencies as an MBE:

State of Florida, Department of Management Services, Office of Supplier Diversity

If not by DMS, who/self-report: _

If you are not a small or minority business enterprise, but intend to subcontract a portion of services or work described in this ITB to a small or minority business enterprise, please provide the following information:

Subcontractor Name Small/MBE Designation Estimated Dollar Value of Services

1. __ _ _ _

2. __ _ _

3. __ _ _

NAME OF BIDDER BID # AND TITLE

PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE

SIGNATURE DATE

If Bidder is NOT a small or minority business enterprise and/or does not intend to subcontract a portion of the services or work described in this ITB to a S/MBE, then Bidder shall indicate here:

THE SCHOOL BOARD OF SARASOTA COUNTY, FLORIDA

TANK PUMPING & HYDRO-JETTING SERVICE - BID #26-0119

ATTACHMENT B

SMALL/MINORITY BUSINESS ENTERPRISE CERTIFICATION FORM

Please complete if you are either a:

Small Business Enterprise as defined by FS 288703 1: Off
Minority Business Enterprise: Off
African American: Off
Asian American: Off
Woman Owned: Off
Hispanic American: Off
Native American: Off
State of Florida Department of Management Services Office of Supplier Diversity: Off
If not by DMS whoselfreport: Off
undefined:
undefined_2:
SmallMBE Designation:
Estimated Dollar Value of Services:
1:
2:
1_2:
2_2:
NAME OF BIDDER BID AND TITLE:
PRINTED NAME AND TITLE OF AUTHORIZED REPRESENTATIVE:
SIGNATURE DATE:
Text5:
Text6:
Text7:
Check Box3: Off

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