SBE_Compliance_Form.pdf
PDF 104 KB Posted
- Attached to
- Chesnut Park Managed Aquifer Recharge Well Drilling And Completion Of Subsurface Testing
- Solicitation number
- 26-0046-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This is an SBE Compliance Form prepared by Pinellas County for the Chesnut Park Managed Aquifer Recharge Well Drilling and Completion of Subsurface Testing project. The form requires the prime contractor to identify and document all subcontractors involved in the project, including their company information, addresses, contact details, and the dollar amounts of subcontracted work. The project involves drilling a 24-inch diameter injection well to a depth of 1,250 feet below land surface in John Chesnut Sr. Park to recharge the upper Floridan aquifer and mitigate saltwater intrusion. A mandatory site visit was scheduled for November 5, 2025, at 10:00 am, with questions due by November 7, 2025, and proposal submissions due November 13, 2025, at 3:00 pm. The contract will be awarded to the lowest responsive, responsible bidder and includes a contract duration of 540 consecutive calendar days with a 12-month guarantee period.
The project includes a mandatory Small Business Enterprise (SBE) participation goal of 5% of the contract value, which is documented through this compliance form. Contractors must certify the accuracy and completeness of the subcontractor information provided and acknowledge that the form becomes part of the contract with Pinellas County. Pinellas County Purchasing Staff reviews the form to determine bidder compliance with SBE goals outlined in the Invitation to Bid. The project is co-funded by the Southwest Florida Water Management District (SWFWMD) and requires comprehensive insurance coverage, E-Verify compliance, and adherence to Florida Department of Environmental Protection regulations. All workers hired after January 1, 2021, must provide proof of employment authorization.
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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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