SBE_FORM.pdf
PDF 114 KB Posted
- Attached to
- U. S. 19 Fuel Site Renovation
- Solicitation number
- 23-1167-ITB-C
- Issued by
- Pinellas County, Florida
About this file
The document is an SBE (Small Business Enterprise) Compliance Form for Pinellas County, specifically related to the U.S. 19 Fuel Site Renovation project. The form is designed to document subcontractor information and compliance with mandatory Small Business Enterprise project goals, which are set at 5% for this procurement. The form provides space for listing multiple subcontractors, including their company names, addresses, contact information, and the amount of subcontracted work.
The compliance form requires the prime contractor to certify the accuracy of the submitted information and acknowledges that the 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 signature lines for the authorized representative and space for the purchasing staff member to initial and date their compliance review.
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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:
File details come from the government source that posted it. Updated .