Exhibit B _ Certificate of Minority Form.docx

This document is a Certificate of Insurance and Minority Status form for Gordon State College's Project PPV-89-1201, related to a Student Activity and Recreation Center procurement. The form provides a template for potential vendors to document their professional liability insurance coverage and minority business status, with designated spaces for firms to indicate their Minority Business Enterprise (MBE) or Women's Business Enterprise (WBE) classification. The document requires the applying firm to specify their insurance carrier, coverage amount, deductible per claim, and minority status, and mandates notarization to validate the submitted information.

The form appears to be part of a broader Request for Qualifications/Proposal (RFQ/RFP) process, with spaces for completing key vendor identification and certification details. While specific insurance amounts and minority status designations are left blank, the document suggests Gordon State College is seeking to ensure vendor diversity and appropriate insurance protections as part of their procurement process for the Student Activity and Recreation Center project. The form includes a notary section for official verification, indicating the importance of accurate and authenticated vendor information in the solicitation process.