Attachment_B._SMBE_Certification_Form.pdf
PDF 211 KB Posted
- Solicitation number
- 26-0158
- Issued by
- Sarasota County, Florida
About this file
This is a Small/Minority Business Enterprise Certification Form for the School Board of Sarasota County, Florida's Safety & Security Systems bid (Bid #26-0158). The form requests certification documentation for bidders who qualify as small business enterprises under Florida Statute 288.703(1) or minority business enterprises under FS 288.703(2) and (3). Bidders may self-certify or provide certification from the State of Florida Department of Management Services Office of Supplier Diversity. The form also requires bidders to disclose any subcontracting arrangements with small or minority business enterprises, including the subcontractor name, designation, and estimated dollar value of services. Bidders who do not qualify as small or minority business enterprises and do not intend to subcontract with such firms must indicate this status on the form.
The certification form serves as documentation of small and minority business participation in the bid process for security systems, services, and parts procurement. Bidders must identify their business classification by category, including African American, Asian American, Woman Owned, Hispanic American, or Native American designations, as applicable. The form includes signature and authorization requirements with fields for the bidder name, authorized representative information, and submission date. This documentation supports the School Board's procurement objectives while establishing baseline information regarding small and minority business enterprise involvement in the contract opportunity.
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Text version
ATTACHMENT B
SMALL/MINORITY BUSINESS ENTERPRISE CERTIFICATION FORM
Please complete if you are either a:
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
SAFETY & SECURITY SYSTEMS - SERVICES, PARTS, & CONSUMABLES – BID #26-0158
| 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 |
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