CERTIFICATION FOR BUSINESS CONCERNS SEEKING SECTION 3 PREFERENCE IN CONTRACTING AND DEMONSTRATION OF CAPABILITY

Name of Business__________________________________

Address of Business_________________________________

_________________________________________________

Type of Business: Corporation Partnership

 Sole Proprietorship Joint Venture 

Attached is the following documentation as evidence of status:

For Business claiming status as a Section 3 resident-owned enterprise:

Copy of resident lease Copy of receipt of public assistance

Copy of evidence of participation Other evidence in a public assistance program

For business entity as applicable:

Copy of Articles of Incorporation Certificate of Good Standing

Assumed Business Name Certificate Partnership Agreement

List of owners/stockholders and % ownership of each

  Corporation Annual Report

  Latest Board minutes appointing officers

Organization chart with names and titles

  Additional documentation and brief function statement

For business claiming Section 3 status by subcontracting 25 percent of the dollar awarded to qualified Section 3 business:

List of subcontracted Section 3 business(es) and subcontract amount

For business claiming Section 3 status, claiming at least 30 percent of their workforce are currently Section 3 residents or were Section 3 eligible residents within 3 years of date of first employment with the business:

List of all current full-time employees List of employees claiming Section 3 status

PHA/IHA Residential lease less than 3 Other evidence of Section 3 status less than 3 years from day of employmentyears from date of employment

Evidence of ability to perform successfully under the terms and conditions of the proposed contract:

Current financial statement

Statement of ability to comply with public policy

List of owned equipment

List of all contracts for the past two years

____________________________________(Corporate Seal)

Authorizing Name and Signature

Attested by:  _____________________________