HomeMy WebLinkAboutMinority Affidavit 6?,4, MINORITY/WOMEN BUSINESS AFFAIRS REGISTRATION AFFIDAVIT
Check One Box Only : ispanic [ j Fernale [ j Black [ j Not Applicable
.t:giness is not 51%minority/i'emale owned , affidavit does not apply. If not applicable, motarizadort is not required.
c 'r, the undersigned agree to the following conditions:
that we have read Section 2.25 of the General Terms and meet the fifty-one percent (51%) ownership and
management requitement for minority/women registration status and will abide by all of the policies and
regulations governing the City of Miami Minority and Women Business Enterprise Procedures;
that if at any time information submitted by the undersigned applicant in his/her Bidder Application should
prove to be false, inaccurate, or misleading, applicant's name will be struck from the City of Miami's
Master Bidder list with no Further consideration given to this applicant;
that the City of Marti maintains the right. through award of bid/contract, to revoke the award, should it be
.found that false, inaccurate or misleading information or a change in the original information have
occurred;
to notify the City of Miami within thirty (30) days of any change in the firm's ownership, control,
management or status as an ongoing minorityfwomen business concern as indicated on the Bidder
Application, and that the City of Miami, upon a finding to the contrary, may render a firm's registration
with the City null and void and cease to include that firm in its registered list of minority and women -
owned businesses;
that the City of Miurmi has a tight to diligently verify all information submitted by applicant in his/her
Bidder Application to monitor the status of the Minority/Women Business Enterprise, once registered;
that the City of Miami may share a firm's z gistration information concerning its minority/women status
and its capability with other municipal or state agencies for the sole purpose of accessing the fires to their
procurement opportunities, unless otherwise specified by the firm in writing.
•e) certify under the penalties of penury that the information contained in any and all application documents
::lied to the City of Miami is correct as per Ordinance No. 10062 as amended.
(Name, Title & Date)
(Name, Title & Date)
.tpplication must be signed by at least one .epartner of a partnership or the proprietor of a sole
i+orship or all partners of a joint venture.
F i NTY, S5
!Nil, OF DADE
►owledged the forego iil a comment as his/her act and deed.
rb5S e tej> �!' !Z2 ,,,�. Z•' I- S6 C) as identification.
,► Commission�t DD420062 NOTARY PUBLIC; 6
�xpExpiresAprApril 27, 2tkle
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ARIZATION
Date:. . r\e 10 1-223 ( L
penally appeared before rue and
My Commission Expires: 4409
City or Mang
Bid No. 05.00-034
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