Exhibit B _ Certificate of Minority Form.docx

This is a Certificate of Insurance and Minority Status form for Exhibit B of Project J-474, Campuswide HVAC Renewal at Georgia Southern University's Swainsboro Campus in Georgia. The form requires applying firms to provide professional liability insurance information, including the name and address of their insurance carrier, coverage amounts, and deductible per claim details. The document also mandates disclosure of minority business status for both the applying firm and any associated firms, with options to identify as Minority Business Enterprise (MBE), Women Business Enterprise (WBE), or other classifications. The form requires notarization with the notary public's signature, seal, commission expiration date, and execution date.

The form serves as a compliance document for firms submitting proposals for the design professional services contract associated with the campuswide HVAC renewal project. Completion and submission of this certificate is a requirement for bid consideration, establishing that applicants maintain appropriate professional liability insurance coverage and providing transparency regarding minority business participation. The form does not specify minimum insurance amounts or thresholds but requires applicants to state their actual coverage levels and deductible structures.