SBE Certification Application*

Transcription

1 City of Charlotte SBE Certification Application* Mail or deliver original application to: City of Charlotte Small Business Development Program c/o Certification Services 600 East Fourth Street, 8 th floor Charlotte, NC To speak with a Certification Specialist, please call: Phone: PLEASE READ THIS APPLICATION AND CERTIFICATION CRITERIA COMPLETELY BEFORE SUBMITTING YOU MUST SUBMIT ALL REQUIRED DOCUMENTS - SEE CHECKLIST ON PAGE 2 NO FAXED APPLICATIONS ACCEPTED APPLICATION MUST BE NOTARIZED ON PAGE 10 ALL INCOMPLETE APPLICATIONS WILL BE RETURNED PLEASE ALLOW DAYS FOR PROCESSING *This application can also used for MWBE certification. The City of Charlotte, SBDP makes no representations as to the qualifications of any Business Enterprise. 1

2 CHECKLIST Revised April 2004 COMPLETE THIS CHECKLIST TO ENSURE YOU INCLUDE ALL REQUIRED DOCUMENTS Thank you for your interest in becoming a certified SBE and/or MWBE with the City of Charlotte. Please review the checklist below and compare it with your application and submission documents. Please make sure to include all supplemental documentation (as applicable) with your application. Failure to submit a complete and accurate application could result in your application being returned to you with no action taken. Please mail or deliver a complete application with required documents to the address on the front of this packet. Faxed applications will not be accepted. SBE & MWBE APPLICANTS MUST SUBMIT: Work experience resume(s) that include places of ownership/employment and corresponding dates List of equipment (leased or owned) along with signed lease agreements, titles/proof of ownership of equipment needed to operate your business Signed lease for office/storage space End of Year Balance Sheets and Income Statements for the past 3 years (or life of firm if less than 3 years old). A new business must provide a current Balance Sheet Copies of relevant licenses Other DBE/MBE/WBE, SBA 8(a) or SDB certifications or denials and de-certification letters Schedule of salaries paid to all officers, managers, owners, or directors of the firm (W-2's) Proof of Citizenship or Permanent Residence (Birth Certificate, Passport, Voter s Registration Card, Green Card, or Military ID) Architectural, Engineering, Surveyors, Attorneys, and CPAs must provide a copy of professional license Personal Net Worth Statement or notarized statement from CPA or attorney stating that you do not exceed the $750,000 Personal Net Worth limitation (to be reviewed during site visit SBE Applicants only) List of construction equipment and vehicles owned and titles/proof of ownership (MWBE Applicants Only) Proof of Ethnicity (Passport, green card, birth certificate) (MWBE Applicants Only) SUBMIT ADDITIONAL INFORMATION ACCORDING TO YOUR BUSINESS STRUCTURE SOLE PROPRIETORSHIP: Business License (or professional license when business license is not required) Mecklenburg County Business License Office PARTNERSHIP OR JOINT VENTURE: Original and any amended Partnership or Joint Venture Agreements Business License (or professional license when business license is not required) CORPORATION OR LLC: Official Articles of Incorporation (signed by state official) Both sides of all Corporate Stock Certificates and Stock Transfer Ledger Shareholders Agreement Minutes of all stockholder and Board of Directors meetings Corporate by-laws and any amendments Business License (or professional license when business license is not required) 2

3 SBE Certification Criteria (for City of Charlotte Small Business Development Program) To qualify for SBE Certification, a firm must meet the City of Charlotte definition of an SBE and complete all sections of the certification application: 1. Geographic Restriction. The Business Enterprise must have its principle place of business within the Charlotte Metropolitan Statistical Area*. The business headquarters must be in one of the following counties: Mecklenburg Cabarrus Lincoln Rowan Gaston Union York Anson 2. Ownership Requirements. At least fifty-one percent (51%) of the interest in the Business Enterprise must be owned by one or more Eligible Owner(s). A person shall be deemed an Eligible Owner of all or a portion of a Business Enterprise if such person: a) Owns in his or her own name the legal and equitable interest in the Business Enterprise; b) Acquired the interest in a real and substantial arms-length transaction utilizing real and substantial consideration; c) Together with his or her spouse have a combined personal net worth under $750,000, excluding: (i) up to $500,000 of their combined equity in their primary residence; and (ii) their combined ownership interest in the applicant Business Enterprise; and (iii) owner s and spouses total retirement investments as defined by the US Tax Code and the IRS; and d) Is not currently an official, officer or employee of the City 3. Management and control. The daily business operations of the Business Enterprise shall be managed and controlled by one or more Eligible Owners (the Managing Eligible Owners ). The Managing Eligible Owner(s) shall be deemed to manage and control the daily business operations only if: a) Their management and control is specifically demonstrated to be real, substantial and continuing and goes beyond the pro-forma ownership of the Business Enterprise as reflected in its ownership documents; b) They possess the power to and actually direct the management and policies of the Business Enterprise; c) They make both routine and major decisions on matters of management, policy and operations; and d) They are not subject to formal or informal restrictions that are inconsistent with the customary discretion of majority owners. In addition, one or more Managing Eligible Owners must: a) Hold the professional license or contractor license necessary for operation of each type of business for which the Business Enterprise seeks certification; b) Have substantial experience in the trade or industry which would be necessary to make routine and major decisions for the Business Enterprise; and c) Regularly hold themselves out to the public and sign important documents and financial instruments in a manner that is indicative of primary management and control of daily business operations and responsibility for routine and major decisions. 4. Citizenship Requirements: Owner(s) must be U.S. citizen(s) or Permanent Resident. 5. Actively in business for three (3) months. The Business Enterprise may not be certified as an SBE until three (3) months after satisfaction of all of the following requirements: a) Formation of the Business Enterprise; b) Commencement of sustained business activity in the trade or profession described on the certification application; and c) Commencement of ownership, management and control of daily business operations by the identified Eligible Owner(s). 6. Perform a commercially useful function. The Business Enterprise must be a for-profit business that performs a commercially useful function. A Business Enterprise does not perform a commercially useful function if it merely acts as a conduit by passing the scope of work for which it is scheduled to perform or supply on the contract to a non-sbe firm. 7. Threshold size. The annual sales volume of the Business Enterprise and the number of employees of the Business Enterprise cannot exceed the size standards set forth in the table below: *NOTE: The Charlotte MSA has changed. However, the City of Charlotte will offer SBE certification to all counties listed until further notice. 3

4 Industry NAICS Section Annual Receipts over a 3-yr period No. of Employees 1 Agriculture, Forestry, Fishing 11 $187,500 N/A Mining 21 $1,500,000 N/A Utilities 22 $3,937,500 N/A General Construction 23 $7,125,000 N/A Specialty Construction Trades 238 $3,000,000 N/A Manufacturing $N/A 99 or less Wholesale Trade 42 $N/A 49 or less Retail Trade $N/A 49 or less Transportation $8,062,500 N/A Information 51 $1,500,000 N/A Finance, Insurance 52 $1,500,000 N/A Real Estate 53 $4,500,000 N/A Professional and Technical Services 54 $1,500,000 N/A Administrative and Support Services 56 $3,937,500 N/A Food Service 72 $1,500,000 N/A Other 81 $1,500,000 N/A For details on SBA size standards, please visit the SBA website at For purposes of the above standards, The annual receipts and number of employees of an applicant shall be determined in accordance with the definitions and methodology established by the Small Business Administration at 13 C.F. R et. seq., as amended, or successor regulation or classification system (the SBA Size Regulations ). The size limitation for any firm not included in the categories listed above shall be one fourth of the applicable size standard established by the SBA Size Regulations. MWBE Certification Criteria To qualify for MWBE Certification, a firm must meet the definition of an MWBE as follows and complete all sections of the certification application: 1. Geographic Restriction. There is no geographic restriction for MWBE certification. 2. MWBE Classifications: African American Asian American Native American Hispanic American Non-Minority Woman 3. Ownership Requirements. The necessary ownership criteria is established at a minimum of 51% of all corporate assets and liabilities vested in the minority or woman owner(s). a) Their management and control is specifically demonstrated to be real, substantial and continuing and goes beyond the pro-forma ownership of the Business Enterprise as reflected in its ownership documents; b) They possess the power to and actually direct the management and policies of the Business Enterprise; 4. Citizenship Requirements: Owner(s) must be U.S. citizen(s) or Permanent Resident. 5. Management and control. The daily business operations of the Business Enterprise shall be managed and controlled by the minority or woman owner. All licenses must be in the minority and/or woman owner s name. a) Their management and control is specifically demonstrated to be real, substantial and continuing and goes beyond the pro-forma ownership of the Business Enterprise as reflected in its ownership documents; b) They possess the power to and actually direct the management and policies of the Business Enterprise; c) They make both routine and major decisions on matters of management, policy and operations; and d) They are not subject to formal or informal restrictions that are inconsistent with the customary discretion of majority owners. e) Regularly hold themselves out to the public and sign important documents and financial instruments in a manner which is indicative of primary management and control of daily business operations and responsibility for routine and major decisions. 6. Waiting period for transfer in ownership. Firms that were previously majority owned may apply for MWBE Certification 1 year after the change in ownership. 1 Based on County Business Patterns (Mecklenburg) 4

5 City of Charlotte Small Business Development Program Certification Application for: Revised April 2004 Small Business Enterprise (SBE) Minority or Women Business Enterprise (MBE/WBE) Application Date Please print or type all responses. Do not leave any items blank: write None or Not Applicable as necessary. Attach additional pages as necessary and identify the item being completed on the attachment. The City of Charlotte reserves the right to request additional information, if warranted, to verify eligibility. Make a copy of this signed application and keep for your records. Section I: General Information 1. Authorized Name of Business Enterprise Doing business as name, if any 2. Street Address (No P.O. Box) City State Zip Mailing Address, if different 4. Business Telephone Fax Number 5. Website 6. Name of Owner/President/CEO 7. Name of contact Section II: Business Profile 8. Legal form of Business Enterprise Sole proprietorship Partnership Corporation Limited Liability Corp Joint Venture 9. Date business was established Date incorporated Dun & Bradstreet # 10. Federal Employer ID Number or Applicant s Social Security Number 11. N.C. Professional License Number or Charlotte-Mecklenburg Privilege License Other License(s) & Number: 12. List any business or trade name(s) previously used by this Business Enterprise 5

6 13. Check appropriate status 2 African American (B) Asian American (A) Caucasian American (C) Hispanic American (H) Native American (N) Other (O) Specify Male (M) Female (F) 14. Are all owners U.S. Citizens Yes No or Permanent Residents Yes No 15. A. Is the business located in a residence? Yes No If yes, please provide name of home owner(s): B. If the business is located in a commercial space, is there a rental/lease agreement? Yes No If yes, please submit a copy of the signed lease for office or storage space. 1) State name of renter or lessee 16. Does any other Business Enterprise(s) share the same residential space, office space or warehouse space? Yes No If yes, provide the following: Name of other Business Enterprise (s): Owner(s) of other Business Enterprise (s): Type of business for other business: 17. Check applicable categories: Has this Business Enterprise, any of its Owners, Board Members, Officers, or Management Personnel, or any Business Enterprise with which they serve in any of these capacities or are otherwise associated, applied for certification with any certifying entity before? If yes, complete the following table. If no, skip question 17. Name of Certification Office Pending Certified Certification Dates Denial Date Section III: Ownership 18. List all individuals or holding companies with any ownership interest and provide the following information for each: Name and Address (Use ethnicity codes in parenthesis on #13) % of ownership Ethnicity Code # of shares (Corporation) Class Current Employer (Name & Address) 2 This information is collected for statistical purposes for SBE s but is required for MBE/WBE certification 6

7 19. List all contributions/investments of cash, equipment, real estate, expertise, or other consideration used by each owner to acquire ownership. Name of Owner Name of Owner Name of Owner Cash $ Cash $ Cash $ Real Estate $ Real Estate $ Real Estate $ Equipment $ Equipment $ Equipment $ Other $ Other $ Other $ TOTAL $ TOTAL $ TOTAL $ 20. CORPORATIONS ONLY (Questions 20-22) List Total Shares AUTHORIZED: Amount Class Amount Class List Total Shares ISSUED: Amount Class 21. Identify Company Officers and Board of Directors (Use ethnicity codes in parenthesis from question #13) Name Title Ethnicity 3 Gender 4 Company Officers Board of Directors 22. Has the ownership of the stock changed in the last year? If YES, please explain Yes No Section IV. Work Specialty 23. List your company s primary product or service: 24. List additional goods and/or service the applicant business can provide: (Please print clearly) List Additional Services Below: NIGP Code (Optional) List Additional Services Below: NIGP Code (Optional) The City s list of NIGP Codes is available at Check the box(s) indicating materials or service the applicant business can provide: Construction A & E (Architecture, Engineering, Surveying) Goods & Supplies 3 Required only for MWBE certification 4 Required only for MWBE certification 7

8 Section V: Personnel and Management Other Services (Staffing, Marketing) Professional Services (Legal, Acct.) 26. Current number of employees: Full time Part-time 27. List management personnel who are primarily responsible for the following activities. (Use ethnicity codes from question #13) Financial decisions Name Title Ethnicity 5 Gender 6 Estimating and bidding Hiring and firing of management personnel Hiring and firing of filed personnel Marketing and Sales Supervision of Operations Signing of Payroll Negotiating Bonds/Loans Office Management Negotiating Contracts Signing Contracts 5 Required only for MWBE certification 6 Required only for MWBE certification 8

9 Section VI: Financial Information Revised April List all financial institutions where the applicant business has business accounts: Name Address Contact person Phone # Name Address Contact person Phone # 29. Does the applicant Business Enterprise normally carry any of the following insurance Errors & Omissions insurance $ General Liability $ List amount below: 30. Is the equity in your primary residence over $500,000? (circle one) YES NO 31. Please list firm s gross receipts for each of the last three (3) years. If the firm has not been in business for three years, provide gross receipts for each year in business. $ $ $ Year Receipts Year Receipts Year Receipts 32. Does the applicant business normally provide a payment or performance bond for its contracts? Yes No 33. Please provide the following information regarding your last three contracts: A) B) Firm/Agency Name Address Firm/Agency Name Telephone Number Date of Contract Telephone Number C) Address Firm/Agency Name Address Date of Contract Telephone Number Date of Contract I certify under penalty of perjury that my personal net worth does not exceed $750,000 and that my business headquarters resides in County. The City of Charlotte is authorized to verify the accuracy of this statement to determine whether I meet the size standards of its Small Business Development Program. 9

10 AFFIDAVIT OF CERTIFICATION A material or false statement or omission made in connection with this application is sufficient cause for denial of certification, revocation of a prior approval, initiation of suspension or debarment proceedings, and may subject the person and/or entity making the false statement to any and all civil and criminal penalties available pursuant to applicable federal and state law. I (full name), swear or affirm under penalty of law that I am (title) of applicant firm (firm name) and that I have read and understood all of the questions in this application and that all of the foregoing information and statements submitted in this application and its attachments and supporting documents are true and correct to the best of my knowledge, and that all responses to the questions in are full and complete, omitting no material information. The responses include all material information necessary to fully and accurately identify and explain the operations, capabilities, and pertinent history of the named firm as well as the ownership, control, affiliations thereof. I recognize that the information submitted in the application is for the purpose of inducing certification approval by a government agency. I understand that a government agency may, by mean it deems appropriate, determine the accuracy and truth of the statements in the application, and I authorize such agency to contact any entity named in the application, and the named firm s bonding companies, banking institutions, credit agencies, contractors, clients, and other certifying agencies for the purpose of verifying the information supplied and determining the named firm s eligibility. I agree to submit to government audit, examination and review of books records, documents and files, in whatever form they exist, of the names firm and is affiliates, inspection of its place(s) of business and equipment, and to permit interviews of principals, agents, and employees. I understand that refusal to permit such inquiries shall be grounds for denial of certification. If awarded a contract or subcontract, I agree to promptly and directly provide the prime contractor, if any, and the City of Charlotte on an ongoing basis, current, complete, and accurate information regarding (1) work performed on the project; (2) payments; and (3) proposed changes, if any, to the foregoing arrangements. I agree to provide written notice to the City of Charlotte of any material change in the information contained in the original application within 30 days of such change (e.g., ownership, address, telephone number, etc.). I acknowledge and agree that any misrepresentations in this application or in records pertaining to a contract or subcontract will be grounds for terminating any contract or subcontract which may be awarded; denial or revocation of certification; suspension and debarment; and for initiating action under federal and/or state law concerning false statement, fraud or other applicable offenses. I declare under penalty of perjury that the foregoing is true and correct. Signature of Eligible Owner Date (mm/dd/yy) Signature of Eligible Owner Date (mm/dd/yy) I declare under penalty of perjury that the information provided in this application and supporting documents relating to my disadvantaged status and me is true and correct. Print Name: Signature: Date: Print Name: Signature: Date: Print Name: Signature: Date: NOTARY CERTIFICATE STATE OF COUNTY OF Subscribed and sworn to before me this day of, 20. Signature of Notary Public Printer/typed name of Notary Public County of residence Date commission expires This page must be notarized. 10