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Section 00460 <br /> Local Business Certification Form <br /> ( 1 ) " Local business" shall mean a business that meets all of the following criteria : <br /> (a ) Has had a staffed and fixed office or distribution point, with a verifiable street address , located <br /> within Brevard ; Indian River; Martin ; Okeechobee ; Osceola ; or St. Lucie County for at least one ( 1 ) full <br /> calendar year immediately prior to the issuance of the request for competitive bids or request for <br /> proposals by the County. Post office boxes shall not be used or considered for the purpose <br /> of <br /> establishing a physical address ; and <br /> ( b) Has had , for at least 12 months prior to the date of the advertisement for the particular good or <br /> service being solicited , a current " Local Business Tax Receipt' issued by Brevard ; Indian River; Martin ; <br /> Okeechobee ; Osceola ; or St. Lucie County, if applicable ; and <br /> (c) Holds any license or competency card required by. Indian River County; if applicable ; and <br /> (d ) If the contract is awarded , will be the person or entity in direct privity of contract with Indian <br /> River County and not as subcontractor, or any lower-tier subcontractor, materialman , or supplier. <br /> 1 . Company Name : S , i�. S . Cc n A- Cc C,h ac4 Tn C . <br /> 2 . Address :.(] 01SS j1 m,(7_ rI cco-i ct I? COaC1 ScL-i 4-e I Vc� ry ti- Ck Ft3 c1 C. (p <br /> 3 . If applicable , Contractor License or Competency Card # : G G G 0 0 75L-I- ) <br /> 4 . PLEASE ATTACH COPY OF CONTRACTOR LICENSE OR COMPETENCY CARD <br /> S. If applicable , Business Tax Receipt # : 113G53 <br /> 6 . PLEASE ATTACH COPY OF BUSINESS TAX RECEIPT <br /> 7 . Phone Number: .77a� - 77 F � 't8 �7 9 85ax Number: '7 "7 a - 779 - J � G oL <br /> 9 . 1 hereby certify that, If the contract is awarded , the entity set forth in item 1 above will be the person <br /> or entity in direct privity of contract with Indian River County and not as subcontractor, or any lower-tier <br /> subcontractor, materialman , or supplier. <br /> Signature : <br /> -- <br /> Name and Title : i rn (% 61, & V1f1 <br /> VENDOR PLEASE DO NOT COMPLETE BELOW <br /> To be completed by an authorized representative from Indian River County Purchasing Division : <br /> Meets definition of Local Business YES NO <br /> If NO , provide reason : <br /> Date : <br /> (Authorized Signature) <br /> To receive Local Bid preference , this certification and copies of all required documents must be <br /> submitted with your Bid package . <br /> 00460 - Local Business Cerfificallon Form revised.doc <br /> 00460 - 1 <br /> F.Tublic Works\ENGINEERING DIVISION PROJECTS\0550 SR60858th Ave Intersection Improvements (KHA)Vldmlm\Bld Documents\00460 - Local Business Certification Form <br /> revised.doc <br />