SBE_Compliance_Form.pdf
PDF 160 KB Posted
- Attached to
- Dunn Exploratory Well (PID 004365A)
- Solicitation number
- 23-1141-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, designed to track subcontractor information and ensure compliance with Small Business Enterprise goals for a specific contract opportunity. The form provides space for listing 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 and includes a section for Pinellas County purchasing staff to verify compliance with the Invitation to Bid SBE goals.
The form is part of the procurement process for the Dunn Exploratory Well project (PID 004365A), which aims to develop a reclaimed water disposal injection well at the W.E. Dunn Water Reclamation Facility in Florida. The mandatory SBE project goal percentage is to be specified in the Special Conditions section, indicating the county's commitment to supporting small businesses in the contract. The form serves as a mechanism to document and verify the prime contractor's efforts to involve small businesses as subcontractors, with the completed form becoming part of the final contract with Pinellas County.
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Text version
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 .