SBE_Compliance_Form.pdf
PDF 102 KB Posted
- Attached to
- Countywide Mast Arms - Group 3 (Rebid)
- Solicitation number
- 24-0633-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
The document is an SBE (Small Business Enterprise) Compliance Form for Pinellas County, Florida, specifically related to the Countywide Mast Arms - Group 3 (Rebid) project. The form is designed to document subcontractor information and ensure compliance with mandatory Small Business Enterprise project goals for a transportation infrastructure project involving the replacement of existing signalization with mast arms at five intersections: Lake St George Dr at Tampa Rd, West Lake Rd at Tampa Rd, 113th St at 54th Ave N, Park Blvd at Ridge Rd, and Park Blvd at Seminole Blvd.
The compliance form requires the prime contractor to list subcontractor information, including company names, addresses, contact details, and the amount of subcontracted work. The form includes a certification by the authorized representative that the information is true and complete, and it will become part of the contract with Pinellas County. The document provides a section for Pinellas County purchasing staff to review and confirm whether the bidder meets the Invitation to Bid SBE goals, with checkboxes to indicate compliance status.
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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:
File details come from the government source that posted it. Updated .