Exhibit B _ Certificate of Minority Form.docx

This is a Certificate of Insurance and Minority Status form (Exhibit B) for Project No. J-460-DP, School of Optometry at Georgia Southern University in Statesboro, Georgia. The form is required from applying firms and associated firms as part of the design professional services procurement process. Applicants must provide documentation of their professional liability insurance coverage, including the name and address of their insurance carrier, the amount of coverage, and the deductible per claim. The form also requires firms to declare their minority status classification.

The form requires applicants to indicate whether their firm qualifies as a Minority Business Enterprise (MBE), Women Business Enterprise (WBE), or other minority status designation for both the applying firm and any associated firm involved in the project. All information must be sworn and subscribed before a notary public, with the notary seal and commission expiration date required on the form. This documentation serves as verification of both insurance compliance and minority business participation eligibility for the School of Optometry design professional services contract opportunity.