B._SMBE_Certification_Form.pdf

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Attached to
HVAC Filter Replacement Service Bid
Solicitation number
26-0130
Issued by
Sarasota County, Florida

About this file

This is a Small/Minority Business Enterprise Certification Form submitted by bidders to the School Board of Sarasota County, Florida, for Bid #26-0130, an HVAC Filter Replacement Service contract. The School Board of Sarasota County intends to enter into a one-year agreement for the ongoing replacement of HVAC filters and frames, including all required service and materials, across all facilities owned and operated by the school board. The project supports the school board's green initiative to move toward a cleaner, healthier environment, with filter specifications indicating minimum requirements for disposable or recycled filter material.

Bidders are required to certify their status as either a Small Business Enterprise or Minority Business Enterprise, or to indicate their intent to subcontract a portion of services to such enterprises. Certification categories include African American, Asian American, Woman Owned, Hispanic American, and Native American designations, with certification expected from the State of Florida Department of Management Services Office of Supplier Diversity or through self-report. Bidders must provide subcontractor information including name, small/minority business designation, and estimated dollar value of services for any portions of work subcontracted to S/MBE firms. The form requires the bidder's name, bid number and title, authorized representative signature and date, and allows bidders who are not small or minority business enterprises and do not intend to subcontract with such firms to indicate this status on the form.

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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

HVAC FILTER REPLACEMENT SERVICE – BID #26-0130

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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