Exhibit B _ Certificate of Minority Form.docx

This is an Exhibit B form for Certificate of Insurance and Minority Status, associated with a Program Management Services contract for Project No. J-460-PM, School of Optometry at Georgia Southern University in Statesboro, Georgia. The form requires applying firms and any associated firms to provide professional liability insurance information, including the name and address of the insurance carrier, coverage amounts, and deductible amounts per claim. The document establishes a standardized template for collecting this insurance documentation as part of the bidding process.

The form includes a section requiring firms to declare their minority status, with options to indicate whether the applying firm and any associated firm are Minority Business Enterprises (MBE), Women Business Enterprises (WBE), or other classifications. Completion requires notarization, with the applying firm's authorized representative signing before a notary public. This certification serves as documentation of both the firm's insurance capacity and its eligibility status regarding minority business enterprise participation in the Georgia Southern University project.