SBE_Compliance_Form.pdf
PDF 104 KB Posted
- Solicitation number
- 25-0791-ITB-C
- Issued by
- Pinellas County, Florida
About this file
This document is an SBE (Small Business Enterprise) Compliance Form for Pinellas County, designed to track subcontractor information and verify compliance with mandatory Small Business Enterprise project goals. The form provides space for the prime contractor to list multiple subcontractors, including their company names, addresses, contact information, and the dollar amount of subcontracted work. The prime contractor must certify the information's accuracy and acknowledge that the form will become part of their contract with Pinellas County.
The form includes a section for Pinellas County's Purchasing Staff to review and determine whether the bidder meets the Invitation to Bid SBE goals. Specific details such as the mandatory SBE project goal percentage and the prime contractor's name are left blank, indicating this is a template form to be filled out during a specific procurement process. The document requires an authorized representative's signature, confirming the submitted information's completeness and truthfulness, with a designated area for county staff to initial and date their compliance review.
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Text version
APPENDIX 7 - SBE COMPLIANCE FORM
APPENDIX 7 – SBE COMPLIANCE FORM
Mandatory SBE PROJECT GOALS: %
PRIME CONTRACTOR NAME:
SUBCONTRACTOR(S) INFORMATION:
COMPANY: COMPANY:
ADDRESS: ADDRESS:
AMOUNT OF
SUBCONTRACTED
WORK: $
AMOUNT OF
SUBCONTRACTED
WORK: $
CONTACT: CONTACT:
EMAIL: EMAIL:
TELEPHONE: TELEPHONE:
COMPANY: COMPANY:
ADDRESS: ADDRESS:
AMOUNT OF
SUBCONTRACTED
WORK: $
AMOUNT OF
SUBCONTRACTED
WORK: $
CONTACT: CONTACT:
EMAIL: EMAIL:
TELEPHONE: TELEPHONE:
I certify that the information included in this Compliance Form is true and complete to the best of my knowledge and belief. I further understand and agree that this Compliance Form shall become a part of my contract with Pinellas County.
FOR PINELLAS COUNTY USE ONLY:
I have reviewed this Compliance Form and found the Bidder IS IS NOT in compliance with the Invitation to Bid SBE goals.
Purchasing Staff Member:
Initials: Date:
Name and Title of Authorized Representative:
Signature:
| COMPANY: |
| COMPANY_2: |
| ADDRESS 1: |
| ADDRESS 2: |
| ADDRESS 1_2: |
| ADDRESS 2_2: |
| undefined_2: |
| undefined_3: |
| CONTACT 1: |
| CONTACT 2: |
| CONTACT 1_2: |
| CONTACT 2_2: |
| TELEPHONE: |
| COMPANY 1: |
| COMPANY 2: |
| COMPANY 1_2: |
| COMPANY 2_2: |
| ADDRESS: |
| ADDRESS_2: |
| undefined_4: |
| undefined_5: |
| CONTACT 1_3: |
| CONTACT 2_3: |
| CONTACT 1_4: |
| CONTACT 2_4: |
| TELEPHONE_2: |
| TELEPHONE_3: |
| undefined_6: |
| I have reviewed this Compliance Form and found the Bidder: Off |
| IS: Off |
| Initials: |
| Date: |
| Name: |
| Project Goals: |
| Contractor Name: |
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