SBE_Compliance_Form.pdf
PDF 160 KB Posted
- Solicitation number
- 25-0669-ITB-C STEP 2
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This document is an SBE (Small Business Enterprise) Compliance Form for Pinellas County, designed to track subcontractor information and compliance with bid goals. The form provides space for the prime contractor to list multiple subcontractors, including their company names, addresses, contact information, and the amount of subcontracted work for each.
The form requires the prime contractor to certify the accuracy of the submitted information and acknowledges that this compliance form will become part of the contract with Pinellas County. A section is reserved for Pinellas County purchasing staff to review and indicate whether the bidder meets the mandatory SBE project goal percentage specified in the special conditions section. The form includes signature lines for the authorized representative and space for the county's purchasing staff to initial and date their review.
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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
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