Form 3- Local Business Entity or Local Impact Certification~14.pdf
PDF 62 KB Posted
- Attached to
- ADA MENTOR PROTEGE PILOT PROGRAM
- Solicitation number
- B2727161
- Issued by
- Pennsylvania
About this file
This is a Local Business Entity or Local Impact Certification form issued by the City of Philadelphia for use by applicants responding to a state and local contract opportunity in Pennsylvania. The form allows applicants to claim positive consideration as a Local Business Entity or to demonstrate Local Impact commitment in accordance with Mayoral Executive Order No. 04-12 and Section 17-109(3)(b) of The Philadelphia Code. Applicants completing this certification must submit it with their application and include a separate statement in their submission acknowledging that they meet the applicable criteria. The form permits applicants to select from three certification options: Local Business Entity Certification, Local Impact Certification (commitment to employ City residents), or Local Impact Certification (commitment to perform work in the City).
The Local Business Entity Certification requires applicants to demonstrate that during the preceding 12 months they filed a Commercial Activity or Business Privilege tax return with the City establishing business operations within the City. Additionally, applicants must show that during the preceding 18 months they maintained a valid Commercial Activity or Business Privilege License, continuously occupied an office within the City where business is conducted, and satisfied at least one employment requirement: more than half of full-time employees working in the City at least 60% of the time, more than 50 full-time employees working in the City at least 60% of the time, or principal place of business located in the City. This certification is associated with the ADA Mentor Protege Pilot Program in Pennsylvania, which has an engineer's estimate between $1,000,000 and $2,000,000 with a bid processing fee of $200.
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Text version
FORM 3
LOCAL BUSINESS ENTITY OR LOCAL IMPACT CERTIFICATION
Instructions: Applicants who seek as a positive factor in the City's consideration of their application that they meet the Local Business Entity or Local Impact criteria as provided in Mayoral Executive Order No.
04-12 should complete this Certification and return it with their application. Applicants providing this Certification should also include in a separate section of their application labeled "Local Business Entity or Local Impact Certification," a statement that the Applicant believes it has met the Local Business
Entity of Local Impact criteria "as set forth in the attached Local Business Entity or Local Impact Certification." Check all appropriate certification options that are applicable to Applicant and sign below:
Applicant Name: _________________ _
Local Business Entity Certification
_ I certify that the Applicant named above is a Local Business Entity because Applicant complies with the following criteria set forth in Section 17-109 (3) (b) of The Philadelphia Code:
I. During the preceding 12 months, Applicant has filed a Commercial Activity or Business Privilege tax return with the City establishing that Applicant conducted business within the City within the calendar year preceding the filing of the return; and
II. During the preceding 18 months, Applicant:
A. Has continuously maintained a valid Commercial Activity or Business Privilege License and all other licenses and permits necessary to conduct business with the City;
B. Has continuously occupied an office within the City, where business is conducted; and C. Satisfies at least one of the following requirements (Check those applicable to
Applicant):
_ (1) More than half of Applicant's full-time employees work in the City at least 60% of the time;
_ (2) More than 50 of Applicant's full-time employees work in the City at least 60% of the time; or
_ (3) Applicant's principal place of business is located in the City.
Local Impact Certification
_ I certify that in the performance of a contract resulting from this RFP, the Applicant named above will employ City residents
_ I certify that in the performance of a contract resulting from this RFP, the Applicant will perform the work in the City.
Authorized Signature Date
Print Name and Title
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