Exhibit 1 "Small Business Enterprise Set-Aside Eligibility" - Connecticut

What Is Exhibit 1?

This is a legal form that was released by the Connecticut Department of Transportation - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2012;
  • The latest edition provided by the Connecticut Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Exhibit 1 by clicking the link below or browse more documents and templates provided by the Connecticut Department of Transportation.

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Download Exhibit 1 "Small Business Enterprise Set-Aside Eligibility" - Connecticut

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Exhibit 1
Revision May 2012
Small Business Enterprise Set-Aside Eligibility
I
, acting on behalf
(Official’s name)
of
, do hereby
(Company name)
certify and affirm that the information set forth below is true and accurate to the
best of my knowledge.
I attest that as of the date of this instrument, the Gross Revenue of this business
including any anticipated proceeds from this project (
), will
Project number
not exceed $15,000,000 in the company’s current fiscal year.
Signature:
Date:
Title:
,
.
.
Exhibit 1
Revision May 2012
Small Business Enterprise Set-Aside Eligibility
I
, acting on behalf
(Official’s name)
of
, do hereby
(Company name)
certify and affirm that the information set forth below is true and accurate to the
best of my knowledge.
I attest that as of the date of this instrument, the Gross Revenue of this business
including any anticipated proceeds from this project (
), will
Project number
not exceed $15,000,000 in the company’s current fiscal year.
Signature:
Date:
Title:
Exhibit 2
CONNECTICUT DEPARTMENT OF TRANSPORTATION (CTDOT)
Rev 7/2015
PRE-AWARD SBE COMMITMENT APPROVAL REQUEST
TO BE SUBMITTED WITHIN THE TIME FRAME INDICATED IN THE BID DOCUMENTS
Only certified SBE firms will be approved. The SBE directory is available on the Department of Administrative Service's web site:
http://www.biznet.ct.gov/SupplierDiversity/SDSearch.aspx
Sheet
of
CDOT Project Number (s):
SBE Subcontractor:
Town(s) of:
Address:
Submitted By:
Original Bid ($):
Dollar amount subcontracted to this SBE firm ($):
Is This
Quantity
item
Contract Unit
Quantity
Subcontract Unit
Total Item price
*
Item Number & Description
Firm Type Code
bid by the
Units
Partial
Price
Subcontracted
Price
**
subcontracted
Prime
Yes No
N
0.00
N
0.00
N
0.00
N
0.00
N
0.00
N
0.00
N
0.00
If any of the items above are checked Yes as to Partial, please provided or use an attachment to offer an explanation of the work involved. Also please identify who is responsible for the remainder of the partial items.
*
Firm Type Code: S (subcontractor), M (manufacturer), P (supplier), T (trucking), V (services)
**
In instances where the Prime is paying the Subcontractor a higher unit price than the bid, by submitting this form the Prime agrees to the higher subcontracted price without qadditional costs to the Department.
Signature of Prime Contractor, Title
Date
Signature of Subcontractor, Title
Date
After this submittal is approved by the Department, any proposed changes to it must be submitted to the Department for approval.
SBE Exhibit 3
Revised May 2012
Sample of Past Construction Experience
Only include the work within the last 5 years that are relevant to the work performed on this project
CTDOT Project Number:
SBE Firm:
Project Description and
Your Contract Value
The Name of the Owner or the Prime
Actual or Estimated
overview of items Performed
Location
Contractor on the Project/Contact Name
Completion Date
and Phone Number
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