SBE_Compliance_Form.pdf

160 KB Posted

Attached to
Sanitary Sewer CIPP Rehabilitation – Various Locations (PID 001933DEF)
Solicitation number
24-0206-ITB-C
Issued by
Pinellas County, Clewiston City, Florida

About this file

Written by GovTribe AI ·

This document is an SBE (Small Business Enterprise) Compliance Form for Pinellas County, Florida, specifically associated with the Sanitary Sewer CIPP Rehabilitation project (PID 001933DEF). The form is designed to document subcontractor information and ensure compliance with the county's small business enterprise goals for the project. It provides space for the prime contractor to list multiple subcontractors, including their company names, addresses, contact information, and the amount of subcontracted work.

The form requires the prime contractor to certify the accuracy of the information provided and acknowledges that the compliance form will become part of the contract with Pinellas County. A section is reserved for Pinellas County purchasing staff to review and verify compliance with the Invitation to Bid SBE goals. The form includes space for the authorized representative's name, title, and signature, as well as a checkbox for the county to indicate whether the bidder meets the mandatory SBE project goal percentage specified in the special conditions section.

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APPENDIX 7 - SBE COMPLIANCE FORM

APPENDIX 7 – SBE COMPLIANCE FORM

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:

MANDATORY SBE PROJECT GOAL PERCENTAGE LISTED IN SPECIAL CONDITIONS SECTION

File details come from the government source that posted it. Updated .