Exhibit B _ Certificate of Minority Form.docx
DOCX document 32 KB Posted
- 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 | ||
| Exhibit D _ DP Fee Proposal.doc | DOC document | |
| Egnyte Upload Instructions.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 | ||
| 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 .