Attachment_D_SMC_Local_Preference_Self-Attestation_Form.pdf
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- Solicitation number
- TSD-20261921
- Issued by
- San Mateo County, California
About this file
This is a Local Preference Self-Attestation Form issued by the County of San Mateo for use in state and local contract solicitations. The form implements Chapter 2.89 of Title 2 of the San Mateo County Ordinance Code, which permits a 5% preference on goods and services solicitations submitted by eligible local businesses and non-profits. The County defines "Local Business" as any for-profit business with its principal place of business or headquarters in San Mateo County, and "Local Non-Profit" as a tax-exempt 501(c)(3) public charity organization similarly located in San Mateo County. Vendors seeking the 5% local preference must complete and submit this form with their bid or proposal response and certify that their principal office or headquarters is located in San Mateo County.
The form requires vendors to provide their business or non-profit organization name, principal office address, city, state, zip code, website if available, telephone number, email, and authorized representative information. Vendors must attest under penalty of perjury that the information provided is true and accurate, and the County retains sole discretion to determine eligibility and request additional documentation to substantiate the self-attestation. Any business that falsely claims the local preference will be ineligible for County contracts for a minimum of one year from the date of discovery of the false certification. Completion and submission of this certification form is mandatory for vendors applying for the 5% local business preference in response to County solicitations.
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Text version
San Mateo County Local Preference Self-Attestation Form
Chapter 2.89 of Title 2 of the San Mateo County Ordinance Code allows a 5% preference on goods and services solicitations submitted by local businesses.
The County of San Mateo defines:
• “Local Business” as any for-profit business which has its principal place of business, or is headquartered, in San Mateo County.
• “Local Non-Profit" as a tax-exempt public charity organization (within the meaning of section 501(c)(3) of the Internal Revenue Code) that is formed for purposes other than making a profit, is exempt from paying federal income taxes on the income generated for their exempt purposes, and has its principal place of business, or is headquartered, in San Mateo County.
If you are applying for the 5% local business preference, please answer the following question:
1. Is your business or non-profit organization principal office located, or headquartered, in San Mateo County?
Yes No Other: _______________________________
The County shall have the sole discretion to determine whether satisfactory proof of eligibility for a preference has been provided. In addition to any other penalties provided by law, any business that falsely claims a preference pursuant to Chapter 2.89 shall be ineligible for consideration for County contracts for a period of not less than one year from the date of discovery of the false certification.
The Local Business Preference Certification form must be completed and submitted with your bid/proposal response if you are applying for the 5% local business preference. Upon request, vendor agrees to provide additional information to substantiate this self-attestation. Vendor certifies information provided is true and accurate under penalty of perjury.
Business or Non-Profit Organization Name
Business or Non-Profit Organization Address (Principal Office/Headquarters) City, State, Zip Code (No P.O. Box)
Website (if available)
Telephone Number
Title of Authorized Representative
Signature of Authorized Representative
Date
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