Laserfiche WebLink
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: CA �xPKer \ �,. -beu6yoleitt.LLC_ <br />- 2. Address:1T\ `1� 1 1 e.1a,>JA,1� , �� �e� C� e Itip (cl 3 LI q S a <br />3. If applicable, Contractor License or Competency Card #: \\sa3 \ <br />- 4. PLEASE ATTACH COPY OF CONTRACTOR LICENSE OR COMPETENCY CARD PTC dock <br />5. If applicable, Business Tax Receipt #: Ate= r7 c aou loo v a s�.u. �E e�y <br />- 6. PLEASE ATTACH COPY OF BUSINESS TAX RECEIPT f <br />7.Phone Number: 'y\a.. )D 4O5 8.Fax Number: II . ytpck.00l q <br />- 9. I 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, <br />terialman, or supplier. <br />�'. <br />Signature: C <br />e/, fIC A /34 44 R <br />- Name and Title: t C _ <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 - 1 <br />F:\Public Woiks\ENGINEERING DIVISION PROJECTS\0946-47TH Street (USI to Terminus Point)Wdrnim\bid documents\0946 Contract Documents\00460 - Local Business Certification <br />Form revised.doc <br />00460 - Local Business Certification Form revised.doc <br />