2010-139 - Laserfiche WebLink

Home Browse Search

Section 00460 Local Business Certification Form (1) "Local business" shall mean a business that meets all of the following criteria: (a) Has had a staffed and fixed office or distribution point, with a verifiable street address, located within Brevard; Indian River; Martin; Okeechobee; Osceola; or St. Lucie County for at least one (1) full calendar year immediately prior to the issuance of the request for competitive bids or request for proposals by the County. Post office boxes shall not be used or considered for the purpose of establishing a physical address; and (b) Has had, for at least 12 months prior to the date of the advertisement for the particular good or service being solicited, a current "Local Business Tax Receipt" issued by Brevard; Indian River Martin; Okeechobee; Osceola; or St. Lucie County, if applicable; and (c) Holds any license or competency card required by Indian River County; if applicable; and (d) If the contract is awarded, will be the person or entity in direct privity of contract with Indian River County and not as subcontractor, or any lower -tier subcontractor, materialman, or supplier. 1. Company Name: S, P S. 06 nf(-Ccc b AG , Inc. 2. Address: CIO 15 Aryl -e r -i (0'-A a k o c(,A. S,L�6. -fie I a 1�er� & & C k . F 1.-- 3) 3. If applicable, Contractor License or Competency Card #: 1C G C 0 0 75'j-1 4. PLEASE ATTACH COPY OF CONTRACTOR LICENSE OR COMPETENCY CARD 5. If applicable, Business Tax Receipt #: 51113L,153 6. PLEASE ATTACH COPY OF BUSINESS TAX RECEIPT 7.Phone Number: -7-7a-7-77-49-78 8.Fax Number: '7-7a - 7 7 � - a g & Z 9. 1 hereby certify that, If the contract is awarded, the entity set forth in item 1 above will be the person or entity in direct privity of contract with Indian River County and not as subcontractor, or any lower -tier subcontractor, mate man, or supplier. Signature: W Name and Title: him Vel lctmann, N nir c+ E dm%nisfro-hr- VENDOR PLEASE DO NOT COMPLETE BELOW To be completed by an authorized representative from Indian River County Purchasing Division: Meets definition of Local Business _ YES _ NO If NO, provide reason: Date: (Authorized Signature) To receive Local Bid preference, this certification and copies of all required documents must be submitted with your Bid package. 00480 - Local Business Certification Form revisedAoe 00460 -1 FiPubtic Works%ENGINEERING DIVISION PROJECTSW455-8th Street Sidewalk Inprove nems I Mh Ct to Old Dbda\AdrMmAWd doeuments\00480 - Local Business Certification Form revised.doc