SBE_Compliance_Form.pdf
PDF 104 KB Posted
- Solicitation number
- 26-0364-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This is an SBE Compliance Form for Pinellas County, Florida, used to document Small Business Enterprise (SBE) participation requirements for the Fiscal Year 2027 Pavement Preservation - Package 4 project. The form requires prime contractors to disclose all subcontractors engaged for the work, including company names, addresses, contact information, and dollar amounts of subcontracted work. The document includes certification language whereby the bidder attests that all information provided is true and complete and acknowledges that the compliance form becomes part of the executed contract with Pinellas County. The form also includes a section for Pinellas County purchasing staff to verify bidder compliance with established SBE goals outlined in the invitation to bid, with designated spaces for staff initials, date, and authorized representative signature.
The form does not specify dollar amounts, pricing terms, or explicit SBE goal percentages in the provided document excerpt, though it references "Mandatory SBE PROJECT GOALS" with a blank percentage field. The compliance determination section requires the purchasing staff member to indicate whether the bidder IS or IS NOT in compliance with the SBE goals established for the invitation to bid. This form serves as the contractual mechanism through which Pinellas County monitors and enforces small business participation requirements for the pavement preservation project.
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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 .