SBE_Compliance_Form.pdf
PDF 104 KB Posted
- Attached to
- Ridgemoor Blvd and Brooker Creek at Brooker Creek Bridge #154153 Bridge Replacement Project (PID 005749A)
- Solicitation number
- 26-0506-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This is an SBE Compliance Form for Pinellas County related to the Ridgemoor Boulevard and Brooker Creek Bridge Replacement Project (PID 005749A) in Florida. The form requires prime contractors to document their Small Business Enterprise (SBE) subcontracting commitments and goals as part of their bid submission. Contractors must list all subcontractors participating on the project, including company names, addresses, contact information, and the dollar amounts of subcontracted work. The form includes certification language wherein the bidder attests that all information provided is true and complete to the best of their knowledge and belief, and acknowledges that the form becomes part of the resulting contract with Pinellas County.
The compliance form is evaluated by Pinellas County purchasing staff, who review the submission to determine whether the bidder meets the mandatory SBE project goals established for the invitation to bid. The form includes a section for county use only, where purchasing staff initials and date their review and indicate whether the bidder is or is not in compliance with the stated SBE goals. An authorized representative must sign the form to certify the accuracy of the submission. The specific SBE percentage goal and other contract details are not populated in this template document.
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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 .