Business and Contractors

Business Self Certification

These forms are for businesses who are seeking to identify themselves as a Section 3 business to uncover their Section 3 status. Businesses or contractors seeking to be considered a Section 3 business directly for PRDOH should use the PRDOH self certification form.

Certificación de Negocio EN

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Basic Business Information

Business Name

Point of Contact Name

Point of Contact Email

Point of Contact Phone

Address of Business

City

State

Zipcode

Business Federal ID#

Business Type

Corporation

Partnership

Sole Proprietorship

Joint Venture

*Supporting documentation must be provided as an attachment to this form, otherwise this form alone is not sufficient for evaluation of your Section 3 Business Concern status. A minimum of one documentation should be provided for Evidence of business ownership.

Industry Area (NAICS Code) *

Section 1: Business Ownership

If the primary owner(s) of the business is/are Section 3 Residents, complete sections 1A and 1B below. Attach documents as needed.

1A. Business Ownership

I am the sole owner of this business or one of a group of owners of this business that each qualifies as a Section 3 Resident and collectively holds at least fifty-one percent (51%) percent ownership

AND

I am a seeking to be qualified as a Section 3 Resident.

I am attaching my Section 3 Resident Self-certification Form.

I have been previously verified as Section 3 Resident by PRDOH.

1B. Evidence of Business Ownership ( I am attaching the following: )

A copy of my business Articles of Incorporation

A copy of my business By-laws

Proof of my fifty-one percent (51%) company ownership; or proof of the comibined Section 3 Resident owners that comprise fifty-one (51%) ownership.

Business Certificate

Partnership Agreement

Section 2: Employees of the Business

If the business qualifies as Section 3 Business Concern due to thirty percent (30%) of full-time employees being Section 3 Residents, complete Sections 2A and 2B below.

2A Employees for the Business

My business currently employs ______ as full-time, permanent workforce .

Employees

At least thirty percent (30%) of them are Section 3 resident employees; or are Section 3 Residents who have remained employed for no longer than three (3) years from the date CDBG-DR funds were first received.

My business does not currenlty employ at least thirty percent (30%)

2B Evidence of Employees of the Business

I am attaching the following roster of all of my full-tme, permanent workforce.

I am attaching the completed Section 3 Resident Self Certification Form for each of my employees who qualify as newly hired Section 3 Resident employees; or are Section 3 Residents who have remained employed for three (3) years from the date CDBG-DR funds were first received.

I certify that I have reviewed and confirm each of my employees listed as Section 3 Residents qualify as Section 3 Residents based on their supporting documentation provided and retained on file.

Section 3: Subcontracting

If the business concern meets Section 3 Business Concern requirements through subcontracting goals, complete Sections 3A and 3B below.

3A Subcontracting

I am currently subcontracting at least twenty-five percent (25%) of the dollar award of all of my existing CDBG-DR contracts with another Section 3 business and have listed work opportunites on the HUD Section 3 Business Registry.

If awarded a contract using CDBG-DR funding I am firmly committed to subcontracting at least twenty-five percent (25%) of the dollar award of all of my existing CDBG-DR contracts with another Section 3 business.

3B Evidence of Subcontracting

I am attaching a dully signed letter as evidence that I am currently subcontracting at least twenty-five percent (25%) of the dollar award of all of my existing CDBG-DR contracts with another Section 3 Business. I am including all data points listed below:

1. Business names, addresses, and points of contact information.
2. List of all awarded contracts and subcontracts with brief Scope of Work and total dollar amounts identified.
3. Subcontract amount for Section 3 Business (at least twent-five percent (25%)).
4. All subcontractor’s Section 3 certifications and evidence of being a Section 3 Business.
5. Signatures of both business representatives attesting to truthfulness of information provided.

3B Evidence of Subcontracting

I do not have an awarded contract yet with CDBG-DR funding but I am committed to subcontracting at least twenty-five percent (25%) of the dollar award of all of my CDBG-DR contracts with another Section 3 Business. I am providing this letter dully signed with the points listed below which serve as evidence presented:

1. Proposed Business names, addresses, and point of contact information
2. List of services you intend to subcontract and brief intended Scope of Work and dollar amounts identified
3. Affirm the subcontract amount for the Section 3 Business (at least twenty-five percent (25%))
4. All subcontractor’s Section 3 certification and evidence of being a Section 3 Business
5. Signatures of both business representatives attesting to truthfulness of information provided.

Section 4: Signature

Checkboxes

As the authorized representative of my business, I am certifying the information provided on this form is true and accurate under penalty of perjury.

Checkboxes

I would like to be placed on a list for contractors to receive my information for open job opportunities.

Checkboxes

I would like to receive notifications about upcoming networking events and open job opportunities.

Checkboxes

I understand that if this form is provided with incomplete supporting documentation, I will have no more than thirty (30) days from the date of submission to provide all requisite paperwork.

I will have no more than thirty (30) calendar days from the date of submission to provide all requisite paperwork.
Once the thirty (30) days period passed, PRDOH will dismiss all self-certifications forms deemed incomplete, if not completed by the contractor.

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Business and Contractors

Business Self Certification

Basic Business Information

Section 1: Business Ownership

Section 2: Employees of the Business

Section 3: Subcontracting

Section 4: Signature

Form

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