SBE_Compliance_Form.pdf
PDF 160 KB Posted
- Solicitation number
- 25-0073-ITB-C STEP 2
- Issued by
- Pinellas County, Florida
About this file
This document is an Appendix 7 SBE (Small Business Enterprise) Compliance Form for Pinellas County, designed to track subcontractor information and ensure compliance with small business participation goals for a county procurement process. 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.
The form requires the prime contractor to certify the accuracy of the information and acknowledge that the completed compliance form will become part of the contract with Pinellas County. A section is reserved for Pinellas County purchasing staff to review and determine whether the bidder meets the SBE goals outlined in the Invitation to Bid. The form includes checkboxes for the purchasing staff to indicate compliance status and spaces for initials, date, and the authorized representative's signature.
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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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