SBE_FORM.pdf
PDF 332 KB Posted
- Attached to
- Countywide Mast Arms - Group 3 (PID 004183A)
- Solicitation number
- 23-1147-ITB-C
- Issued by
- Pinellas County, Florida
About this file
This document is an SBE (Small Business Enterprise) Compliance Form for Pinellas County, specifically related to the Countywide Mast Arms - Group 3 project (PID 004183A). The form is designed to document subcontractor information and compliance with mandatory Small Business Enterprise project goals for a federally-funded infrastructure project involving signalization and intersection improvements at seven different locations in Pinellas County, Florida.
The form provides a template for prime contractors to list subcontractor details, including company names, addresses, contact information, and the amount of subcontracted work. The document includes a certification statement where the authorized representative affirms the accuracy of the submitted information and acknowledges that the form will become part of the contract with Pinellas County. The form also includes a section for Pinellas County purchasing staff to review and determine 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:
N/A
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