Attachment_E_SMC_Local_Preference_Self-Attestation_Form.pdf
PDF 92 KB Posted
- Attached to
- RFP Installation and Replacement of Generators
- Solicitation number
- ISD-20261908
- Issued by
- San Mateo County, California
About this file
The document is a San Mateo County Local Preference Self-Attestation Form that outlines a local business preference program for goods and services solicitations. The form allows for a 5% preference for businesses and non-profit organizations headquartered in San Mateo County, with specific definitions for qualifying as a "Local Business" or "Local Non-Profit" organization.
The form requires businesses or non-profits to self-attest to their local status by answering whether their principal office is located in San Mateo County. The county retains sole discretion in determining preference eligibility, with potential penalties for false claims including ineligibility for county contracts for at least one year. Vendors must complete and submit the form with their bid/proposal response and agree to provide additional substantiating information if requested. The self-attestation must be certified as true and accurate under penalty of perjury, with space provided for organization details, contact information, and an authorized representative's signature.
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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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