SBE_Compliance_Form.pdf
PDF 104 KB Posted
- Attached to
- STAR Center AHU -104, -161, -162 Replacement
- Solicitation number
- 26-0306-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This is an SBE Compliance Form for Pinellas County, Florida, related to the STAR Center AHU -104, -161, -162 Replacement project. The form serves as a mandatory submission requirement for bidders to document their compliance with Small Business Enterprise (SBE) project goals established by Pinellas County. Bidders must identify themselves as the prime contractor and list all subcontractors involved in the project, including their company names, addresses, contact information, telephone numbers, email addresses, and the dollar amounts of subcontracted work. The form requires certification by an authorized representative that all information provided is true and complete to the best of their knowledge and belief.
Upon receipt, Pinellas County purchasing staff review the completed compliance form to determine whether the bidder meets the mandatory SBE goals for the project. The form includes a verification section for county use, where staff indicate whether the bidder is or is not in compliance with the ITB SBE requirements and document their review through initials, date, and authorized signatures. This compliance form becomes part of the executed contract with Pinellas County and represents a contractual obligation for the bidder to maintain the subcontracting and SBE participation commitments outlined in their submission.
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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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