Exhibit B _ Certificate of Minority Form.docx

DOCX document 32 KB Posted

Attached to
GSC J-432 DP Campuswide HVAC and Electrical Systems Renewal
Solicitation number
PE-47200-RFQ-2025-000000050
Issued by
Lamar County, Georgia

About this file

This document is an Exhibit B Certificate of Insurance and Minority Status form related to a state and local contract opportunity for Design Professional Services for Project No. J-432 DP Campuswide HVAC and Electrical Systems Renewal at Gordon State College in Barnesville, Georgia. The form requires applicants to provide information about their professional liability insurance coverage, including the name and address of the insurance carrier, the amount of coverage, and the deductible per claim. The form also requires applicants to indicate their minority business enterprise (MBE) or women-owned business enterprise (WBE) status, if applicable.

The contract opportunity is being solicited by the State of Georgia and Lamar County. Applicants are instructed to submit written questions about the RFQ or the project to Mr. R. Todd Griffin at Gordon State College. No additional details are provided about the pricing terms, set asides, incumbents, funding requirements, or other salient information.

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Other files

File Type Posted
J_432 GSC DP RFQ _ ADDENDUM_1.pdf PDF
Exhibit D _ DP Fee Proposal.doc DOC document
Egnyte Upload Instructions.pdf PDF
Exhibit E _ Contractor Affidavit.docx DOCX document
Exhibit C _ Project Team Composition Form.docx DOCX document
_J_432 GSC Campuswide HVAC _ Elec Sys Renewal.pdf PDF
Exhibit F _ Proposers Disclosure Statement.doc DOC document
Exhibit A _ Certification Form.docx DOCX document
Exhibit G _ 179D Allocation Agreement.doc DOC document

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Text version

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: _________________

Gordon State College PPV-89-1201, Student Activity & Rec Ctr., PM RFQ/RFP

File details come from the government source that posted it. Updated .