Company_Affidavit.pdf

LP-1

Company Affidavit Notarized Affidavit

This Form must be completed and returned by the Prime Firm

Respondent affirms that information provided as it relates to location and facilities of working office is true and meets the definition and criteria as defined below:

Local office means the company has a valid Business Tax License issued by Lee County at least six (6) months prior to the proposal submission. This affirms the company has a physical business address from which to operate or perform business that is located within the limits of Lee County thus authorizing the company to conduct business with the City of Fort Myers. Post Office Boxes are not verifiable and shall not be used for the purpose of establishing said physical address.

Companies must demonstrate and document the in-County/in-office capability and availability of the personnel and the type of services performed at this location that is pertinent to the type of project. Companies shall affirm in writing their compliance with the foregoing at the time of proposal submission to be eligible for consideration as having a “Local Office”. A company who misrepresents the local preference status of its company in a proposal to the City will lose the privilege to claim local preference for a one-year period.

Please place a checkmark next to the appropriate criteria and related points. Provide supporting documentation with this affidavit as the City of Fort Myers reserves the right to request supporting documentation as evidence to substantiate the information given in this affidavit. Failure to do so will result in the respondent’s submission being deemed non-responsive.

Section 1: Office Location

Prime Firm must check appropriate spaces. Note: Points in this section will be applied to the Prime only during selection scoring process.

Criteria Points Bidder Check Off

Headquarters located within the Limits of the City of Fort Myers or 5 Headquarters not located within the City Limits, but is, located in boundaries of Lee County or 3 No office located within the Limits of the City of Fort Myers or the boundaries of Lee County 0

Legal Registration Name of Firm: ______________________________________________________________________

State of Registration: _______________________________________________________________________________

Headquarters Address

Street: ______________________________________________City/State/Zip: ________________________________

Local Office Address if different than Headquarters

Street: ______________________________________________City/State/Zip: ________________________________

Federal Tax I.D. Number: _______________________________Lee County Business Tax Number _________________

Printed Name and Title: _____________________________________________Signature________________________

State of Florida

County of _______________________________

Sworn to and subscribed before me, a Notary Public, for the above State and County on this _____________day of __________________________, 20_______.

Notary Public Commission Expiration

(Affix Official Seal)

The signee of this Affidavit guarantees, as evidenced by the sworn affidavit required herein, the truth and accuracy of this affidavit to interrogatories hereinafter made.