SBE_FORM_NA.pdf
PDF 115 KB Posted
- Attached to
- WELL SERVICES FOR PINELLAS COUNTY UTILITIES
- Solicitation number
- 23-0884-ITB-C
- Issued by
- Pinellas County, Florida
About this file
This document is an SBE (Small Business Enterprise) Compliance Form for Pinellas County, specifically designed for a well services contract. The form is a template for prime contractors to document their subcontractor information and demonstrate compliance with the county's SBE requirements. It 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 acknowledges that the completed document will become part of the contract with Pinellas County. A section is reserved for Pinellas County Purchasing Staff to review and confirm whether the bidder meets the SBE goals outlined in the Invitation to Bid. While the specific SBE project goals are marked as "N/A" on this form, it is part of the procurement process for the well services contract, which seeks a five-year drilling services contractor to perform evaluation, maintenance, repair, rehabilitation, and construction of wells for the Pinellas County Utilities Department.
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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
File details come from the government source that posted it. Updated .