Exhibit B _ Certificate of Minority Form.docx

This is a Certificate of Insurance and Minority Status form for the Design Professional Services solicitation (Project No. J-469-DP) for the Cochran Campus Domestic Water System Replacement at Middle Georgia State University in Cochran, Georgia. The form requires applying firms to provide their name, address, and professional liability insurance carrier information, including the amount of coverage and deductible per claim. The document establishes the documentation requirements for firms responding to this design services opportunity.

The form includes a certification section for minority status designation, requiring applicants to indicate whether the applying firm and any associated firm qualify as a Minority Business Enterprise (MBE), Women Business Enterprise (WBE), or other designated category. The form must be notarized with the notary public's signature, seal, and commission expiration date. This exhibit serves as a standardized compliance document to verify both insurance coverage adequacy and minority business status for evaluation purposes in the selection of design professionals for the domestic water system replacement project.