SBE_Compliance_Form.pdf
PDF 104 KB Posted
- Solicitation number
- 26-0362-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This is an SBE Compliance Form used by Pinellas County, Florida, for evaluating Small Business Enterprise (SBE) participation in contract opportunities. The form is designed to be completed by prime contractors bidding on Pinellas County projects and requires disclosure of all subcontractors involved in the work. The document serves as a mandatory compliance instrument for the Fiscal Year 2027 Pavement Preservation Package 2 project, which encompasses approximately 33.27 lane miles of roadway improvements across four paving locations in Pinellas County, including one arterial project and three local neighborhood projects.
The SBE Compliance Form requires prime contractors to identify the mandatory SBE project goals percentage and provide detailed information for all subcontractors, including company names, addresses, contact information, telephone numbers, email addresses, and the dollar amounts of subcontracted work. The form includes certification language wherein the contractor attests to the truthfulness and completeness of the information provided and acknowledges that the form becomes part of the contract with Pinellas County. County purchasing staff are responsible for reviewing each submission to determine compliance with the stated SBE goals, and the form includes space for staff signature, initials, date, and authorization by a designated county representative. This compliance documentation is essential for contract award and serves as verification that bidders meet the county's small business enterprise participation requirements.
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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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