SBE_Compliance_Form.pdf
PDF 104 KB Posted
- Attached to
- Infrastructure Repair Work Order Contract
- Solicitation number
- 26-0208-ITB-C
- Issued by
- Pinellas County, Florida
About this file
This is an SBE Compliance Form for Pinellas County, Florida, used to verify contractor and subcontractor compliance with Small Business Enterprise (SBE) goals established for the Infrastructure Repair Work Order Contract. The form functions as a mandatory compliance documentation requirement for prime contractors bidding on work orders involving infrastructure repairs, including concrete repairs, site cleanup, milling and resurfacing, landscape work, fencing, sidewalk repairs, ADA ramps, and sheet pile installation throughout Pinellas County. The form requires bidders to identify themselves as prime contractors and list all subcontractors involved in the project, along with specific details regarding each subcontractor's involvement and the dollar amount of work subcontracted.
The compliance form requires prime contractors to disclose all subcontractor information, including company names, addresses, contact details, and subcontracted work amounts for each tier of subcontracting. The form mandates a specific percentage goal for SBE participation, though the exact percentage is not filled in on the template provided. Pinellas County purchasing staff must review and verify bidder compliance by initialing and dating the form, with a determination of whether the bidder meets or fails to meet the established SBE goals. Contractors certify under penalty of misrepresentation that all information provided is true and complete, and the completed form becomes part of the executed contract with Pinellas County.
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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: |
File details come from the government source that posted it. Updated .