Form_7.11_-_Local_Business_Affidacit_of_Eligibility.pdf
PDF 180 KB Posted
- Attached to
- City Center Sport Complex Ballfields Restoration
- Solicitation number
- ITB-26-22-CW
- Issued by
- Volusia County, Florida
About this file
This is a Local Business Affidavit of Eligibility form issued by the City of Port Orange, Florida, for use in connection with the City Center Sport Complex Ballfields Restoration project. The form requires respondents to certify their eligibility for local business preference consideration by demonstrating physical presence and operational authorization within Port Orange's jurisdictional boundaries at the time of solicitation opening.
To qualify for local preference, a business must possess a valid Business Tax Receipt (BTR) issued by the City of Port Orange authorizing provision of the goods, services, or construction being solicited, and maintain a physical business address within Port Orange's legal limits from which operations are conducted. Post Office Boxes do not satisfy the physical address requirement. The City verifies business eligibility through Sunbiz, the Florida Department of State's Division of Corporations database. Local preference applies only as a tiebreaker in formal solicitations and is prohibited when purchases are funded in whole or in part by entities that restrict such preferences through grant agreements, contracts, or applicable federal, state, or local law, or during emergency purchasing. The form requires the business name, contact information, Federal Employer Identification Number, business structure classification, and physical presence documentation. An authorized representative must sign the affidavit before a notary public and submit it with the bid response, attaching valid business tax receipt documentation or equivalent proof of eligibility.
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Text version
FORM 7.11 – LOCAL BUSINESS AFFIDAVIT OF ELIGIBILITY
City of Port Orange
This declaration is executed under penalty of perjury of the laws to the United States and the State of Florida
THIS AFFIDAVIT IS SUBMITTED IN REFERENCE TO THE FOLLOWING SOLICITATION:
Project# (as applicable): _________________________________
Business Name: __________________________________________________ Contact Person/Title: _______________________________________________
Mailing Address: _________________________________________________ City,State,Zip: ________________________________________________________
Phone Number: __________________________________________________ Email address: _______________________________________________________
Physical Presence of Business: ☐Headquarters ☐Principal Place of Business
Within Legal Boundaries: ☐City of Port Orange ☐Volusia County ☐State of Florida
FEIN (Federal Employer Identification Number): ______________________________________________________________
Business Structure: ☐Corporation ☐LLC ☐Partnership ☐Sole Proprietorship ☐Other (Specify): ________________________
**PLEASE ATTACH A VALID BUSINESS TAX RECEIPT OR OTHER SUCH DOCUMENTATION**
ATTESTATION – I understand that:
A local supplier or contractor is interpreted as a respondent to a solicitation, which as of the date of the solicitation opening, has a valid Business Tax Receipt (BTR) issued by the City of Port Orange to do business in the City of Port Orange which authorizes the supplier or contractor to provide the goods, services, or construction to be purchased and has a physical address located within the limits of Port Orange from which the supplier or contractor operates or performs business. A Post Office Box cannot be used to establish physical address. This local preference is only used as part of a tie breaker during a formal solicitation. The City uses Sunbiz to verify a supplier or contractor’s business address. Sunbiz is a database on the Florida Department of State, Division of Corporations website and can be accessed using this link:
https://dos.myflorida.com/sunbiz/.
Exemptions from Local Preference Local preference is not permitted when (1) the purchase is funded, in whole or in part, by an entity prohibiting application of the preferences by grant agreement, contract or applicable federal, state or local law; or (2) emergency purchasing.
As an authorized representative of the Firm, I certify that this Firm complies fully with the above requirements.
Name of Business
STATE OF:_________________________ Authorized Signature
COUNTY OF: _______________________ ______________________________________________________ Printed Name and Title
The foregoing instrument was acknowledged before me by means of ☐physical presence or ☐online notarization, this _________ day of _______________________, 2026, by____________________________________________________________ and who:
☐Is personally known to me; or ☐ has produced __________________ as identification.
__________________________________________ Notary Public, State of ______________________________________ Printed, typed or stamped name, commission and expiration:
This document must be completed and returned with your Submittal https://dos.myflorida.com/sunbiz/
File details come from the government source that posted it. Updated .