Exhibit B

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Attached to
25-27 Auburn Avenue Renovation for Student Success
Solicitation number
BR-50-2201CxA
Issued by
Fulton County, Georgia

About this file

Exhibit B is a certificate of insurance and minority status form for applicants bidding on the Building Commissioning Services project for the 25-27 Auburn Avenue Renovation for Student Success Center at Georgia State University in Atlanta, Georgia. The form requires applying firms to provide professional liability insurance information, including the name and address of their insurance carrier, coverage amount, and deductible per claim. The document also requires applicants to declare their minority business status, with fields for both the applying firm and any associated firm to indicate whether they are a Minority Business Enterprise (MBE), Women Business Enterprise (WBE), or other classification.

The form must be notarized, with signature lines for both the applicant and notary public, including the date of notarization and the notary's commission expiration date. This documentation serves as a prerequisite for bid submission and ensures that firms meet insurance and compliance requirements established by Georgia State University for the project. The form does not specify coverage minimums or other substantive insurance requirements within the document itself, indicating that such details would be contained in the broader bid solicitation materials.

Text of this file

Exhibit B

CERTIFICATE OF INSURANCE AND MINORITY STATUS

INSURANCE:

Name of Applying Firm: _____________________________________________________

State the name and address of Applying Firm’s professional liability insurance carrier ____________________________________________________________________

Amount of coverage - $ ______________________________________________________

Amount of deductible per claim: $ ______________________________________________

MINORITY STATUS:

Indicate the status of the Applying Firm and Associated Firm, if applicable:

APPLYING FIRM: MBE_____ WBE_____ OTHER __________

ASSOCIATED FIRM: MBE_____ WBE_____ OTHER___________

______________________________________
Signature

Sworn and subscribed before me This ____day of ________, 20_____

NOTARY PUBLIC

NOTARY SEAL

My Commission expires: _________________

Other files

File Type Posted
GSU BR-50-2201-CxA RFQ-RFP —
Exhibit E —
Exhibit F —
Egnyte Upload Instructions —
Exhibit A —
Award Information —
GSU BR-50-2201-CxA Addn. No. 1 —

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