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III <br />0 <br />C' <br />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 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: <br />2. Address: J 1l�0�1 N _ 9151f � S <br />E2G <br />3. If applicable, Contractor License or Competency Card #: k , UC.. 0[ 00 % i <br />4. PLEASE ATTACH COPY OF CONTRACTOR LICENSE OR COMPETENCY CARD <br />5. If applicable, Business Tax Receipt #: - <br />6. PLEASE ATTACH COPY OF BUSINESS TA <br />X RECEIPT <br />� <br />7.Phone Number: 12 a� 8.Fax Number: 17v� "1 oc ( qq4 6 <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: D " / <br />Name and Title: Zkkv �• 7iA . ��,c 51 LSC ry <br />VENDOR PLEASE DO NOT COMPLETE BELOW <br />® To be completed by an authorized representative from Indian River County Purchasing Division: <br />i� 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 />00480 - Local Business CeM noon Form reviseil.doc <br />00460-1 <br />F:lEngineerinqZapltal ProJects\0205 Old Dixie Highway Bridge over ft South Relief Cana110205 Contract Documents 6 Specs100460 • Local Business Cerefipfion Farm rovised.doe <br />