B._SMBE_Certification_Form.pdf
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- Attached to
- Air Conveyance System Cleaning - Bid #26-0146
- Solicitation number
- 26-0146
- Issued by
- Sarasota County, Florida
About this file
This is a Small/Minority Business Enterprise Certification Form for Bid #26-0146, Air Conveyance System Cleaning, issued by The School Board of Sarasota County, Florida. The contract establishes firm, fixed prices for a period of one year from the date of award for cleaning and decontamination services of air handling and conveyance equipment. The form is designed for bidders to declare their small or minority business enterprise (S/MBE) status or to identify subcontractors with such designations who will perform a portion of the work.
Bidders may certify as a Small Business Enterprise as defined by Florida Statutes 288.703(1), or as a Minority Business Enterprise as defined by FS 288.703(2) and (3), with categories including African American, Asian American, Woman Owned, Hispanic American, and Native American designations. Certification must be provided by the State of Florida Department of Management Services Office of Supplier Diversity, or bidders may self-report if not certified by that agency. Bidders who are not S/MBE entities themselves must identify any S/MBE subcontractors and provide the subcontractor name, designation, and estimated dollar value of services for each subcontractor participating in the bid.
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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
AIR CONVEYANCE SYSTEM CLEANING - BID #26-0146
| 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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