SBE_Compliance_Form.pdf
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- Solicitation number
- 26-0361-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 Fiscal Year 2027 Pavement Preservation Package 1 contract opportunity. The form serves as a mandatory compliance document requiring prime contractors to disclose Small Business Enterprise (SBE) subcontracting information and demonstrate achievement of project-specific SBE goals established by the County. The form requires contractors to provide detailed information about each subcontractor, including company name, address, contact information, email, telephone number, and the dollar amount of subcontracted work. Multiple subcontractor entries are accommodated on the form to capture the full scope of SBE participation.
The form requires prime contractors to certify that all submitted information is true and complete and acknowledges that the compliance form becomes part of the executed contract with Pinellas County. Pinellas County purchasing staff must review and verify bidder compliance with established SBE goals, with space provided for the reviewing staff member to initial, date, and confirm whether the bidder meets or fails to meet the mandatory SBE participation requirements. This compliance verification is a critical component of the bid evaluation process and must be completed prior to contract award for the pavement preservation project, which encompasses approximately 38.55 lane miles of roadway improvements across four paving locations in the 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: |
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