Exhibit C - Small Business Self-Cert form.docx
DOCX document 25 KB Posted
- Attached to
- Two-Way Radio System at Maple Lane
- Solicitation number
- PR2423619
- Issued by
- Thurston County, Washington
About this file
The document is a Small Business Self-Certification Statement form from Washington State, specifically related to the state's definitions of microbusinesses, minibusinesses, and small businesses under Chapter 39.26.010 RCW. The form provides detailed criteria for business classification based on independent ownership and annual gross revenue, allowing businesses to self-certify their status for state contracting opportunities.
The self-certification form enables businesses to verify their eligibility as a microbusiness (gross revenue under $1 million), minibusiness (gross revenue between $1-3 million), or small business (50 or fewer employees or gross revenue under $7 million). For the specific contract opportunity involving a two-way radio system at Maple Lane, businesses must certify that their principal office is located within Washington State, with the headquarters serving as the location for business decisions, books, records, and senior management personnel. The form requires an authorized signature, printed name, and date to validate the self-certification under penalty of perjury.
View the file
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Text version
SMALL, MINI, OR MICRO BUSINESS SELF-CERTIFICATION STATEMENT
Chapter 39.26.010 RCW, Definitions states:
(16) "Microbusiness" means any business entity, including a sole proprietorship, corporation, partnership, or other legal entity, that:
(a) Is owned and operated independently from all other businesses; and
(b) has a gross revenue of less than one million dollars annually as reported on its federal tax return or on its return filed with the department of revenue.
(17) "Minibusiness" means any business entity, including a sole proprietorship, corporation, partnership, or other legal entity, that:
(a) Is owned and operated independently from all other businesses; and
(b) has a gross revenue of less than three million dollars, but one million dollars or more annually as reported on its federal tax return or on its return filed with the department of revenue.
(22) "Small business" means an in-state business, including a sole proprietorship, corporation, partnership, or other legal entity, that:
(a) Certifies, under penalty of perjury, that it is owned and operated independently from all other businesses and has either:
(i) Fifty or fewer employees; or
(ii) A gross revenue of less than seven million dollars annually as reported on its federal income tax return or its return filed with the department of revenue over the previous three consecutive years; or
(b) Is certified with the office of women and minority business enterprises under chapter 39.19 RCW.
I hereby certify, under penalty of perjury, that [legal name of entity] meets the definition for the following type of business entity:
Verify that your principal office/place of business is located within Washington State.
(A principal office or principal place of business is the bidder’s headquarters where business decisions are made and the location for the bidder’s books and records as well as the bidder’s senior management personnel.)
Microbusiness Minibusiness Small Business
Signature of person authorized to sign on behalf of legal entity
Print name Date
File details come from the government source that posted it. Updated .