Form_4_Local_Vendor_Preference_Certification.pdf
PDF 155 KB Posted
- Attached to
- Wellness Engagement Platform
- Solicitation number
- 26-8653
- Issued by
- Collier County, Florida
About this file
This is a Local Vendor Preference Certification Form for Collier County, Florida, used in conjunction with a Request for Proposals issued by the Collier County Board of County Commissioners Procurement Services Division for a Wellness Engagement Platform. The certification form allows vendors to affirm their status as local businesses eligible for preference consideration in the procurement process. Vendors must demonstrate compliance with specific criteria to qualify, including maintaining a physical business address within Collier County from which operations are conducted in an appropriately zoned area, and contributing to the county's economic development through measurable means such as employment retention and expansion, tax base support, and employee residency within the county.
To claim local vendor preference status, vendors must possess a current local Business Tax Receipt (Occupational License) issued by the Collier County Tax Collector prior to bid submission and must certify their compliance in writing at the time of proposal submission. Vendors who misrepresent their local preference status face penalties, including loss of local preference privileges for up to one year. The county reserves the right to request documentation substantiating the information provided in the certification, and failure to provide such documentation will render the vendor's submission non-responsive. All certifying officers must sign the form under penalty of perjury, confirming the accuracy of the information provided.
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Text version
Version 2 9.2.25
Procurement Services Division
Form 4: Local Vendor Preference Certification
(Check Appropriate Boxes Below)
State of Florida (Select County if Vendor is described as a Local Business) Collier County Lee County
Vendor affirms that it is a local business as defined by Section Sixteen of the Collier County Procurement Ordinance:
• A physical business address in Collier County with a County business address as listed with the Florida Department of State, Division of Corporations located within the limits of Collier County from which the vendor's staff operates and performs business in an area zoned for the conduct of such business. A post office box or a facility that receives mail, or a non-permanent structure such as a construction trailer, storage shed, or other non-permanent structure shall not be used to establish the physical address. In addition to the foregoing, a vendor shall not be considered a "local business" unless it contributes to the economic development and well-being of Collier County in a verifiable and measurable way. This may include, but not be limited to, the retention and expansion of employment opportunities, support and increase to the County's tax base, and residency of employees and principals of the business within Collier County. Vendors shall affirm in writing their compliance with the foregoing at the time of submitting their bid or proposal to be eligible for consideration as a "local business" under this section. A vendor who misrepresents the Local Preference status of its firm in a proposal or bid submitted to the County will lose the privilege to claim Local Preference status for a period of up to one year; and
• A current local Business Tax Receipt (also known as an Occupational License) issued by the Collier County Tax Collector prior to bid or proposal submission.
If requested by the County, Vendor will be required to provide documentation substantiating the information given in this certification. Failure to do so will result in the vendor’s submission being deemed non-responsive.
Under penalties of perjury, I certify that the information shown on this form is correct to my knowledge and a duly corporate authorized representative with signature authority.
Company Name: _________________________________________
Date: _____________________________
Signature: ____________________________________________ Title: _____________________________
| Collier County: Off |
| Lee County: Off |
| Company Name_4: |
| Date22_af_date: |
| Title_4: |
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