B._SMBE_Certification_Form.pdf
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- Attached to
- APPLICANT TRACKING SYSTEM ITN#26-0059
- Solicitation number
- ITN #26-0059
- 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, issued in connection with Invitation to Negotiate (ITN) #26-0059 for an Applicant Tracking System. The form requires bidders to certify their status as either a Small Business Enterprise as defined by Florida Statute 288.703(1) or a Minority Business Enterprise as defined by FS 288.703(2) and (3), with minority designations including African American, Asian American, Woman Owned, Hispanic American, and Native American. Bidders must indicate certification by the State of Florida Department of Management Services Office of Supplier Diversity or provide self-reporting information if not certified by that agency. The form includes fields for bidder name, bid number and title, and authorized representative information with signature and date.
For bidders that are not small or minority business enterprises but intend to subcontract a portion of services to S/MBE firms, the form requires documentation of subcontractor name, S/MBE designation, and estimated dollar value of services for up to three subcontractors. Bidders that do not qualify as small or minority business enterprises and do not intend to subcontract to S/MBE firms must indicate this on the form. The certification form serves as an attachment to the ITN process and supports compliance tracking within The School Board of Sarasota County's Applicant Tracking System.
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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
APPLICANT TRACKING SYSTEM - ITN #26-0059
| 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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